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 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. 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. 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.