• Elaine Wainwright, David Wainwright, Edmund Keogh, and Christopher Eccleston.
• Bath Centre for Pain Research, University of Bath, Bath. esh26@bath.ac.uk
• Br J Gen Pract. 2011 Dec 1; 61 (593): e794e800e794-800.

BackgroundStaying in work may benefit patients with chronic pain, but can be difficult for GPs to negotiate with patients and their employers. The new fit note is designed to help this process, but little is known of how it is operating.AimTo explore GPs' views on the fit note, with particular reference to sickness certification for patients with chronic pain.Design And SettingQualitative study using semi-structured interviews in eight primary care trusts in south-west England.MethodIn-depth interviews with 13 GPs.ResultsGPs reported that the rationale behind the fit note is sound and that it may help patients with chronic pain to return to work earlier. However, GPs also reported barriers to successful fit note use, including the need to preserve doctor-patient relationships, inconsistent engagement from employers, GPs' lack of specialist occupational health knowledge, issues with fit note training, and whether a new form can achieve cultural shift.ConclusionWhile doctors agree that good work improves health outcomes, they do not think that fit notes will greatly alter sickness-certification rates without more concerted initiatives to manage the tripartite negotiation between doctor, patient, and employer.

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