Authorised nurses, occupational therapists, pharmacists and physiotherapists can now certify and issue fit notes in addition to doctors.

New legislation has been introduced in Northern Ireland which will allow a wider range of healthcare professionals to certify fit notes. The change will enable patients to get advice and fit notes from their healthcare professional – without having to separately see a doctor. Fit notes are also set to go fully digital in the future, meaning they will no longer need to be signed in ink.

A fit note, also known as a statement for fitness to work, is a medical statement that issues to patients whose health condition affects their ability to work. Previously, only doctors could sign a fit note.

If an employee/potential benefit claimant has been off work with illness for more than seven days, a fit note provides evidence of their incapacity and relevant advice on how to support them to remain in or return to work.

Welcoming the change, Health Minister Robin Swann said: “I am delighted to introduce this legislation in Northern Ireland. This change will make it easier for people and employers to get the advice they need so people can stay in work and will help free up doctors’ time.

“Too often we see people being faced with unnecessary challenges to get a fit note. More professionals being able to offer this vital service will speed up the process and support people to return to or remain in work.”
This change will be delivered by authorised nurses, occupational therapists, pharmacists and physiotherapists in general practice and hospital settings where fit notes are currently provided and recognises the valuable role other professions have to play in providing health and work advice and supporting people to remain in work where possible. The changes also complement the healthcare system by allowing for, and supporting, the increased move towards a diverse and multi-disciplinary workforce and reducing the demand on doctors.

Chief Nursing Officer, Maria McIlgorm said: “We have introduced these powers to ensure certifying fit notes can be carried out by other healthcare professionals – improving the patient experience and access and helping to relieve pressures on GPs. Nurses possess the skills and experience to deliver this service. We are aiming to diversify and simplify systems in order to deliver services more efficiently and this is one more example of how this can be achieved.”
Suzanne Martin, Chief Allied Health Professions Officer said: “Allied Health Professionals (AHPs) are already at the forefront of patient care but these new powers to certify fit notes will ensure a more efficient process to support patients’ return to work.

“AHP expertise is often key in having health and work conversations and providing effective rehabilitation throughout the return to work journey. Getting treatment and support right can help patients remain in work and manage conditions effectively or return to work in a timely manner.

“These new measures remove the need for a separate appointment with a GP. This can only be good news for patients as well as help to take some pressure off primary care services.”
Cathy Harrison, Chief Pharmaceutical Officer said: “I welcome the change announced today which will further support multi-professional working in our general practices and hospital settings, for the benefit of patients. Many patients recovering from illness rely on medication and pharmacists can provide the advice and expertise needed to support recovery and return to work.”
The fit note change will support and empower better conversations about work and health between employers and staff by making it easier to get advice certified by the most relevant healthcare professional.

It will also improve a patient’s experience and reduce pressure on doctors as people will no longer have to be sent to a doctor to have the fit note signed when seeing and receiving treatment from an alternative professional for their health condition.

Fit notes provide evidence to employers about a person’s absence and any relevant advice on how to support their employees to remain in or return to work. They also provide evidence for claims to benefits for those who are out of work.

There is guidance and training available to support the new rules about who can certify fit notes. Employers and healthcare professionals should read the guidance(external link opens in a new window / tab) on that provides a summary of the knowledge, skills, and experience that healthcare professionals eligible to sign fit notes are expected to have before undertaking this task. Healthcare professionals eligible to certify fit notes should also complete the e-learning training programme which is freely accessible on the e-learning for healthcare website(external link opens in a new window / tab).