GP Resources

Writing Fitness to Work Certificates (Med3) ‘sick notes’ in the hospital.

You should not be asked to provide a fit note for patients who are discharged following admission nor those who are reviewed as outpatients unless there is a clinical need for a GP review.

It is the responsibility of the discharging team to provide the patient with a medical certificate for the period of time off work that is foreseen to be required. Please do not sign a certificate for two weeks if you know they would require a minimum of 6 weeks off, as this then requires a GP to issue a further a certificate. Thousands of GP appointments each year are taken up for issuing of certificates that could have been issued at discharge.

• The certificate is a legal document and should contain only factual information.
• If the patient has a review appointment booked, please document on the certificate.

• It is important that you discuss this with the patient as their occupation may impact the time off required.
• You must document the signing of a medical certificate in the patient’s notes and include the information in the patient’s discharge summary. This should include wording used for the diagnosis and the exact period of time signed for.
• These are the minimum amounts of time that a person would be required not to work in order to promote efficient healing and recovery.
• This is intended as a guide and clinical judgement needs to be used in individual cases. Please contact the lead Consultant if there is any doubt.

Specific Procedures

Primary total prosthetic replacement of knee joint using cement - 6 weeks (6-12 depending on occupation)

Removal of internal fixation from bone (3 weeks upper limb 6 weeks lower)

Primary open reduction of fracture of long bone and extramedullary fixation using plate         (6-12 weeks depending on site and occupation)

Primary total prosthetic replacement of hip joint using cement (6-12 weeks depending on occupation)

Primary simple repair of tendon (6-12 weeks depending on tendon number and site e.g. flexors longer)

Primary prosthetic replacement of head of femur using cement (6-12 weeks)

Primary total prosthetic replacement of hip joint not using cement (6-12 weeks)

Closed reduction of fracture of long bone and rigid internal fixation NEC (6-12 weeks)

Carpal tunnel release (3-6 weeks)

Total cholecystectomy (2 weeks)

Primary repair of inguinal hernia using insert of prosthetic material (2- 6 weeks depending on occupation)

Emergency excision of abnormal appendix laparoscopy (2 weeks)

Bilateral dissection tonsillectomy (2 weeks)

Extracorporeal shock wave lithotripsy of calculus of kidney (2 weeks)

Bowel surgery (4 weeks)

Bowel surgery with stoma (6 weeks)

Skin sparing mastectomy (6 weeks)

Lumpectomy – breast (2 weeks)

Total abdominal hysterectomy (6 weeks)

Vaginal Hysterectomy (6 weeks)

Caesarean Section (6 weeks)

Varicose vein scleropathy (2 weeks)

Peripheral limb angioplasty (2 weeks)

CABG (3 months).

For further information, visit https://www.gov.uk/government/publications/fit-note-guidance-for-hospital-doctors/statement-of-fitness-for-work-a-guide-for-hospital-doctors

Newly diagnosed babies with cleft lip and palate

1. Contact our Clinical Nurse Specialists immediately after birth on 01245 516029. Please leave a voicemail if no answer at any time of the day.

• Please complete the North Thames Referral Form [doc] 2MB

2. Complete the referral form and email it to mse.midessexcleftservice@nhs.net

Our standard is that the Clinical Nurse Specialists will aim to see new babies within 24 hours of referral.  A delay in referral will prevent babies being seen and assessed (please see cleft protocol).

Referral of mothers diagnosed antenatally

1. Contact our Clinical Nurse Specialists immediately on 01245 516029. Please leave a voicemail if no answer at any time of the day.

2. Email referral to mse.midessexcleftservice@nhs.net

We aim to contact mothers following antenatal diagnosis of a baby with a cleft within 24 hours.

Other referrals

• Other patients (children and adults) with cleft lip and palate
• Patients with velopharyngeal dysfunction
• Related craniofacial anomalies.

Send referral letters to mse.midessexcleftservice@nhs.net.