Experiences and knowledge of nurses, occupational therapists, pharmacists and physiotherapists about certifying fit notes: a UK-wide survey

Objective To identify facilitators and barriers to fit note certification among nurses, occupational therapists, pharmacists and physiotherapists (NOPPs), and identify ongoing training needs.Design An online survey informed by the Theoretical Domains Framework (TDF) was used to gather data from NOPP...

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Main Authors: Avril Drummond, Katie Powers, Denise Kendrick, Claire Anderson, Stephen Timmons, Diane Trusson, Gill Phillips, Shan Martin, Jain Holmes, Jade Kettlewell, Kate Radford, Nick Pahl
Format: Article
Language:English
Published: BMJ Publishing Group 2025-05-01
Series:BMJ Open
Online Access:https://bmjopen.bmj.com/content/15/5/e092211.full
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author Avril Drummond
Katie Powers
Denise Kendrick
Claire Anderson
Stephen Timmons
Diane Trusson
Gill Phillips
Shan Martin
Jain Holmes
Jade Kettlewell
Kate Radford
Nick Pahl
author_facet Avril Drummond
Katie Powers
Denise Kendrick
Claire Anderson
Stephen Timmons
Diane Trusson
Gill Phillips
Shan Martin
Jain Holmes
Jade Kettlewell
Kate Radford
Nick Pahl
author_sort Avril Drummond
collection DOAJ
description Objective To identify facilitators and barriers to fit note certification among nurses, occupational therapists, pharmacists and physiotherapists (NOPPs), and identify ongoing training needs.Design An online survey informed by the Theoretical Domains Framework (TDF) was used to gather data from NOPPs to identify implementation barriers and personal, social and environmental influences on fit note certification.Data were analysed using descriptive statistics. Mean TDF domain scores were calculated (mean scores ≤3.5 indicated barriers, ≥5 indicated facilitators). Free-text data were thematically analysed using the TDF.Setting United Kingdom.Participants The survey was completed by 198 respondents: physiotherapists (n=66, 33%), occupational therapists (n=49, 25%), nurses (n=44, 22%), pharmacists (n=39, 20%).Results Only 47 (24%) of survey respondents had certified fit notes; 66 (37%) had completed training, most pharmacists had done neither. TDF analysis indicated three barriers: 1) ‘skills’ (being able to certify, review and practice completing fit notes) (mean=3.32, SD=0.75, 95% CI 1.84, 4.80); 2) ‘goals’ (the level of priority given to fit note completion) (mean=3.22, SD=0.51, 95% CI 2.21, 4.22); 3) ‘memory, attention and decision processes’ (disagreeing with the statement: ‘certifying fit notes is something I do automatically’) (mean=2.73, SD=0). Free-text comments suggested that low ‘skills’ rates may be due to lack of opportunity to do training. The low priority afforded to completing fit notes, which was not done automatically as part of their role, may reflect the lack of organisational policies/guidelines or priorities.The only facilitator identified was ‘belief about consequences’ (mean=5.74, SD=0.12, 95% CI: 5.50, 5.98). Participants believed that certifying fit notes was useful and worthwhile.Conclusions Legislation allowing NOPPs to undertake fit note certification does not appear to have been successfully implemented. Further resources are required to provide NOPPs with the necessary skills/confidence (e.g., via training) to certify fit notes, supporting more patients to return to and remain in work.
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spelling doaj-art-bdf31c8ffca443d9b7401a4df061aa832025-08-20T03:10:27ZengBMJ Publishing GroupBMJ Open2044-60552025-05-0115510.1136/bmjopen-2024-092211Experiences and knowledge of nurses, occupational therapists, pharmacists and physiotherapists about certifying fit notes: a UK-wide surveyAvril Drummond0Katie Powers1Denise Kendrick2Claire Anderson3Stephen Timmons4Diane Trusson5Gill Phillips6Shan Martin7Jain Holmes8Jade Kettlewell9Kate Radford10Nick Pahl11University of Nottingham School of Health Sciences, Nottingham, UKUniversity of Nottingham School of Medicine, Nottingham, UKCentre for Academic Primary Care, University of Nottingham School of Medicine, Nottingham, UKDivision of Pharmacy Practice and Policy, University of Nottingham School of Pharmacy, Nottingham, UKNottingham University Business School, Nottingham, UKCentre for Academic Primary Care, University of Nottingham School of Medicine, Nottingham, UKPPI Representative, University of Nottingham School of Medicine, Nottingham, UKPPI Representative, University of Nottingham School of Medicine, Nottingham, UKCentre for Rehabilitation and Ageing Research, University of Nottingham School of Medicine, Nottingham, UKCentre for Academic Primary Care, University of Nottingham School of Medicine, Nottingham, UKNIHR Nottingham Biomedical Research Centre, Nottingham, UKSociety of Occupational Medicine, London, UKObjective To identify facilitators and barriers to fit note certification among nurses, occupational therapists, pharmacists and physiotherapists (NOPPs), and identify ongoing training needs.Design An online survey informed by the Theoretical Domains Framework (TDF) was used to gather data from NOPPs to identify implementation barriers and personal, social and environmental influences on fit note certification.Data were analysed using descriptive statistics. Mean TDF domain scores were calculated (mean scores ≤3.5 indicated barriers, ≥5 indicated facilitators). Free-text data were thematically analysed using the TDF.Setting United Kingdom.Participants The survey was completed by 198 respondents: physiotherapists (n=66, 33%), occupational therapists (n=49, 25%), nurses (n=44, 22%), pharmacists (n=39, 20%).Results Only 47 (24%) of survey respondents had certified fit notes; 66 (37%) had completed training, most pharmacists had done neither. TDF analysis indicated three barriers: 1) ‘skills’ (being able to certify, review and practice completing fit notes) (mean=3.32, SD=0.75, 95% CI 1.84, 4.80); 2) ‘goals’ (the level of priority given to fit note completion) (mean=3.22, SD=0.51, 95% CI 2.21, 4.22); 3) ‘memory, attention and decision processes’ (disagreeing with the statement: ‘certifying fit notes is something I do automatically’) (mean=2.73, SD=0). Free-text comments suggested that low ‘skills’ rates may be due to lack of opportunity to do training. The low priority afforded to completing fit notes, which was not done automatically as part of their role, may reflect the lack of organisational policies/guidelines or priorities.The only facilitator identified was ‘belief about consequences’ (mean=5.74, SD=0.12, 95% CI: 5.50, 5.98). Participants believed that certifying fit notes was useful and worthwhile.Conclusions Legislation allowing NOPPs to undertake fit note certification does not appear to have been successfully implemented. Further resources are required to provide NOPPs with the necessary skills/confidence (e.g., via training) to certify fit notes, supporting more patients to return to and remain in work.https://bmjopen.bmj.com/content/15/5/e092211.full
spellingShingle Avril Drummond
Katie Powers
Denise Kendrick
Claire Anderson
Stephen Timmons
Diane Trusson
Gill Phillips
Shan Martin
Jain Holmes
Jade Kettlewell
Kate Radford
Nick Pahl
Experiences and knowledge of nurses, occupational therapists, pharmacists and physiotherapists about certifying fit notes: a UK-wide survey
BMJ Open
title Experiences and knowledge of nurses, occupational therapists, pharmacists and physiotherapists about certifying fit notes: a UK-wide survey
title_full Experiences and knowledge of nurses, occupational therapists, pharmacists and physiotherapists about certifying fit notes: a UK-wide survey
title_fullStr Experiences and knowledge of nurses, occupational therapists, pharmacists and physiotherapists about certifying fit notes: a UK-wide survey
title_full_unstemmed Experiences and knowledge of nurses, occupational therapists, pharmacists and physiotherapists about certifying fit notes: a UK-wide survey
title_short Experiences and knowledge of nurses, occupational therapists, pharmacists and physiotherapists about certifying fit notes: a UK-wide survey
title_sort experiences and knowledge of nurses occupational therapists pharmacists and physiotherapists about certifying fit notes a uk wide survey
url https://bmjopen.bmj.com/content/15/5/e092211.full
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