Guidance

Annex C – Case studies

Updated 6 October 2023

Case study 1: An employer makes changes based on healthcare professional’s advice – working from home

A proof-reader in your company has been issued a fit note stating they have a cold and cystic fibrosis. The healthcare professional has advised that they ‘may be fit’ for work and has ticked the workplace adaptation box on the fit note. The fit note covers a period of 10 days, and the healthcare professional has indicated that they do not need to see the employee once the fit note expires.

The healthcare professional’s further advice in the comments box of the fit note reads: ‘Your employee cannot travel into the office because they are at high risk of developing a chest infection whilst they have a cold. The increased risk is due to their pre-existing chest condition: cystic fibrosis. They can work from home during this period.’

During the health and work discussion with your employee, you advise the employee they should work from home for the next 10 days to help with their recovery and their return to work. You e-mail them their work schedule during this sickness absence.

After 10 days, your employee has recovered from their cold, returns to work, and continues with their current job without going back to see the healthcare professional.

Case study 2: An employer makes changes – a delivery driver who can’t drive

One of your delivery drivers has just undergone laser eye surgery and has been advised by their healthcare professional to refrain from driving for the next 2 weeks.

The healthcare professional has issued them with a fit note stating they ‘may be fit’ for work. Taking into consideration, the employee’s general fitness, the healthcare professional ticks the amended duties box and the advice in the comment box of the fit note reads: ‘Dry eyes, may experience temporary blurring of vision. Should not drive for 2 weeks. They can still perform other reasonable physical tasks. Mental function unaffected. If they use the computer, they should take regular short breaks as per standard guidance.’

The healthcare professional also indicates on the fit note that they do not need to assess the employee once the fit note expires, so the employee can return to work after their sickness absence.

You arrange a health and work meeting with your employee to discuss the fit note with them and agree that they should not drive for the next 2 weeks. You assign them to general admin duties during their recovery period.

After 2 weeks the employee’s eyesight is back to normal, and they return to their driving job, without having to see the healthcare professional.

Case study 3: An employer makes changes - phased return to work

A sales assistant on your team has sent a fit note stating they have anxiety disorder. Their healthcare professional has indicated on the fit note that your employee ‘may be fit’ for work and states in the comments box that ‘They can perform physical tasks, but they get anxious when faced with confrontations and difficult customers and should not be left alone.’ The healthcare professional ticks ‘amended duties’. The fit note covers 2 weeks. You arrange a meeting with your employee to discuss the fit note advice and other possible duties, at this stage you are unable to accommodate the advice. Therefore, during this sickness period, you arrange for Statutory Sick Pay to be paid and set up ‘keep in touch’ meetings with your employee to check on their recovery and keep them updated.

A second fit note is sent 2 weeks later which states that your employee ‘may be fit’ for work and suggests a phased return to work starting with just a few hours a day as well as other workplace adjustments which include not having to speak to customers during busy periods.

You are pleased with these recommendations. You and your employee agree to do quieter shifts or work away from the shop floor during busier times. You arrange for the Statutory Sick Pay to end. You also arrange for them to attend a course to support managing health conditions in the workplace. This is intended to help them become more confident when dealing with customers.

After 4 weeks, your employee informs you that they feel more confident when dealing with the public and says they would like to return to normal duties.  You both jointly agree to this, and they return to work as normal.

Case study 4: Short term illness due to long covid – employer and occupational therapist supports employee to return to work.

Your employee who is suffering from long covid has sent in a fit note from their occupational therapist which indicates, ‘not fit for work.’

The occupational therapist and patient collaboratively agree on a plan, goals, and coping strategies. They then agree a fit note indicating as may be fit for work, including recommendations of a return-to-work plan and adjustments. The advice reads “Patient is experiencing fatigue, advise a phased return to work starting at reduced hours, three days per week, suggest regular reviews before increasing hours. Some supportive adjustments include a quiet space to work and relaxation, provide additional time for administration tasks, postpone additional projects until settled into compulsory tasks of role.”

The patient, their employer, and occupational therapist agree on reasonable adjustments. After six sessions of intervention the patient returns to their education-based role. At three months post discharge the patient reports they have achieved and sustained a phased return to work and continue to access supportive adjustments.

Case study 5: History of lower back pain and return to employment

A patient with history of lower back pain has been unemployed for a long period, last working in a construction job two years ago. They have been receiving repeat fit notes indicating as not fit for work for their benefit claim.

On the patient’s fit note, it indicates may be fit for work. The advice reads “Back pain is triggered by prolonged walking and standing, repeated bending, repeated use of stairs or ladders. Alternative roles to construction may be more suited. May require adjustments including seated breaks for standing tasks, reduce regular bending or use of stairs. Would require a workstation assessment if engaging in computer-based work.” The patient is referred to a local vocational service to support work seeking and training. They engage in a hospitality course and a part time job accessing supportive adjustments.

The patient is successful in obtaining employment, they discuss their fit note with their employer, and they agree to make those workplace modification to support their employee.

Case Study 6: An employer makes changes based on Physiotherapist advice

A Team Leader in a supply chain department visits their physiotherapy clinic complaining of knee and toe pain following a fall. They are diagnosed with a quadriceps soft tissue tear.

The injury affects their fitness for work, but they agree, they can still perform non-physical tasks. They currently struggle to walk for more than 10 minutes and are unable to drive due to the injury. The employee is keen to return to work and states that 50% of their duties are desk based.

The Physiotherapist states on the fit note that the employee may be fit for work and writes; ‘I recommend a return to work on desk-based duties, preferably from home to avoid driving until the patient feels able to do so. They should then make a gradual return to manual duties over the next six weeks. The fit note states ‘amended duties’. The employee manages to complete their return to work and attends physiotherapy weekly for rehabilitation. They discuss this with their employer the advice from their physiotherapy sessions to tailor their return to manual duties appropriately.