چکیده (انگلیسی):

Background:Although the UK fit note has been broadly welcomed as a tool to facilitate return to work, difficulties
and uncertainties have resulted in wide variation in its use. Agreement on what constitutes the‘ideal’ fit note from the
perspective of all stakeholders is needed to inform best practice. A recent Delphi study conducted by the authors
reached consensus on 67 recommendations for best practice in fit note use for employed patients. However, such
recommendations are not necessarily followed in practice. The purpose of this study was therefore to investigate the
perceived achievability of implementing these Delphi recommendations with a further reference panel of stakeholders.
Methods:Potential participants were identified by the research team and study steering group. These included
representatives of employers, government departments, trades unions, patient organisations, general and medical
practitioners and occupational health organisations who were believed to have the knowledge and experience to
comment on the recommendations. The consensus Delphi statements were presented to the participants on-line.
Participants were invited to comment on whether the recommendations were achievable, and what might hinder or
facilitate their use in practice. Free text comments were combined with comments made in the Delphi study that
referred to issues of feasibility or practicality. These were synthesised and analysed thematically.
Results:Twelve individuals representing a range of stakeholder groups participated. Many of the recommendations
were considered achievable, such as improved format and use of the electronic fit note, completion of all fields, better
application and revision of guidance and education in fit note use. However a number of obstacles to implementation
were identified. These included: legislation governing the fit note and GP contracts; the costs and complexity of IT
systems and software; the limitations of the GP consultation; unclear roles and responsibilities for the funding and delivery
of education, guidance and training for all stakeholders, and the evaluation of practice.
Conclusions:This study demonstrated that although many recommendations for the ideal fit note are considered
achievable, there are considerable financial, legal, organisational and professional obstacles to be overcome in order for
the recommendations to be implemented successfully.