Guidance for GPs

  1. How will an assessment help?
  2. Eligibility
  3. When to make a referral
  4. Completing a referral
  1. After referring a patient
  2. Return to work plan
  3. Tax exemption and sick pay
  4. Feedback

1. How will an assessment help?

As a GP, in most cases, you're the first port of call for people whose health problems mean they may need to take time off work. You, therefore, play a leading role in helping people to stay in, or return to, work more quickly by providing early advice and information.

We provide GPs with a referral route through Scottish Care Information (SCI) Gateway to access a supportive work-focussed assessment for patients who could be absent from work for four weeks or more. 

About the assessment

Our assessments are:

  • Free — your patient, and their employer, pay nothing for the assessment.
  • Quick — a telephone assessment will be conducted within two working days, a face to face assessment will be conducted within five working days.
  • Supportive — our assessment is not mandatory for your patients. The advice given by our health professionals complement your advice and reduce the need for repeated fit notes.

If you refer a patient, a case manager will contact them within two working days of a referral and they will receive:

  • an assessment by a qualified health professional.
  • a tailored return to work plan that is specific to their needs.

If your patient has requested a face-to-face assessment, this will happen after five working days of the initial referral.

This return to work plan will reflect the assessment, advice and recommendations that your patient has agreed with their case manager. This can be sent to you or your patient's employer, but only if they give consent.

2. Eligibility

To be eligible for an assessment, your patient must:

  • be in paid employment
  • have been absent, or likely to be absent, from work for four weeks or more
  • agree to being referred for an assessment.

Your patient won't be eligible if they:

  • don't live in Scotland — patients who live and work in England or Wales should be referred to the English and Welsh Fit for Work service
  • have been absent from work for less than four weeks
  • are either self-employed or unemployed
  • have previously received an assessment and return to work plan from Fit for Work in the last 12 months.

3. When to make a referral

You should refer your patient if they:

  • have been absent from work for four weeks, or are likely to reach four weeks
  • are likely to be able to return to work within a 12 week period.

Can I refer someone earlier or later than 4 weeks?

You can refer earlier or later than four weeks if:

  • it's obvious they will be absent for four weeks — an earlier referral may help shorten sickness absence
  • a referral may not be appropriate at four weeks, but could be suitable at six weeks — for example, if they're recovering from hip replacement surgery.

You should always exercise professional judgement about the clinical appropriateness of making a referral.

When is a referral unnecessary?

You shouldn't refer your patient for an assessment if:

  • they're self-employed or unemployed
  • in your judgement, they don't have a realistic prospect of returning to work
  • they're a hospital inpatient
  • they're at an acute phase of a medical condition
  • they've been absent prior to the launch of Fit for Work Scotland.

4. Completing a referral

If your patient is eligible for the service, you can refer them through SCI Gateway. You don't need to tell your patient's employer if you've referred them for an assessment. Your patient might give their consent for us to contact their employer as part of the assessment process.

When referring your patient, you will be asked to provide the following:

  • agreement that your patient has given consent
  • your patient's details
  • your own details
  • a description of your patient's condition and requirements.


Your patient must give their consent before you can refer them for an assessment. Before continuing with your application, you must make sure that your patient knows, and understands, what is involved and gives permission for you to refer them.

Patient details

You will be asked to provide the following details about your patient:

  • Full name
  • Address
  • Sex
  • Date of birth
  • CHI Number
  • Contact details

GP details

You will be asked to provide the following details about yourself, and your practice:

  • Your name
  • Practice name
  • Practice code
  • Practice address
  • Practice contact

Conditions and requirements

You will be asked to provide the following details about your patients condition and requirements:

  • Their reason for being off work as noted on their fit note
  • When did their absence start?
  • When does your patients current fit note end?
  • Does your patient have any additional support requirements?

5. Consent

Your patient must give consent to be referred. If consent isn't given, you shouldn't refer them for an assessment.

Consent must be explicit, informed and freely given:

  • before they're referred for an assessment
  • when they're enrolled in the service
  • before and during the assessment.

Your patient can withdraw consent at any point during the process.

6. After referring a patient

After making a referral, a case manager will contact your patient to conduct a telephone assessment at a convenient time for them — usually within two working days of receipt of referral or five working days for a face-to-face referral, if this has been requested.

During the assessment

The assessment is carried out by health professionals who act as case managers through to the end of the process and are the single point of contact for your patient and their employer.

During the assessment, the case manager will:

  • try to identify the obstacles preventing your patient from returning to work
  • agree a plan designed to address each obstacle to enable a safe and sustained return to work.

We have access to specialist musculoskeletal and mental health advice and, where necessary, we will engage with these services before developing your patient's return to work plan.

If your patient's case is complex, we may need to complete further assessments before a plan can be developed.

After the assessment

After the assessment, the health professional will share the return to work plan with you, your patient and their employer subject to your patient’s consent.

This plan will detail steps appropriate for your patient in order to support them back to work. These are recommendations and don't change your clinical judgement.


Your patient will automatically complete using our service once they have:

  • returned to work
  • started a phased return to work
  • Fit for Work Scotland is no longer appropriate.
  • reached 12 weeks of engagment.

Change to circumstances

If there's a change to your patient's health condition, you should address this based on your clinical judgement.

If there's a change in relation to any other factor, their case manager will help to address this.

In these situations, you or your patient's case manager will decide whether they can continue with, or be withdrawn from, the service.

7. Return to work plan

Following an assessment, responsibility for applying recommendations lies with you, your patient and their employer. It's not mandatory to make the changes we recommend in your patient's return to work plan.

Fit note

Fit for Work Scotland is not mandatory and therefore a fit note can still be issued.

When making a referral, you should ensure there is a valid fit note to cover the referral and initial assessment period.

More about the fit note.

Evidence of sickness absence

Your patient's employer can accept the return to work plan as evidence of sickness absence in exactly the same way as a fit note, so you won't need to issue repeat fit notes during the time they're engaged with us (up to 12 weeks).

If your patient is still engaged with us after two weeks, they can use their return to work plan as evidence of sickness absence instead of a fit note.

8. Tax exemption and sick pay

If your patient requires medical treatment as part of their return to work plan, their employer may be entitled to a tax exemption of up to £500 per year.

This sum can help fund medical treatments recommended by the Fit for Work Scotland case manager or employer-arranged occupational health service.

Sick pay

Your patient's choice to use, or not use, our service doesn't affect their Statutory Sick Pay entitlement.

Find out what sick pay your patient might be entitled to.

Access to Work

If your patient meets the criteria for Access to Work, they can apply for financial support to help pay for items, such as:

  • adaptations to equipment, or specialist equipment to help them do their work
  • fares to work if they can't use public transport
  • a support worker or job coach to help in the workplace.

There is no set amount for an Access to Work grant. How much your patient will get depends on their circumstances.

Find out more about Access to Work through GOV.UK.

9. Feedback

Fit for Work is audited by independent, authorised auditors, who will review a proportion of the case records, so that they can monitor the service. They may also contact you as part of the customer satisfaction audit.

The service is being independently evaluated for quality and efficiency. You may be contacted in the future by a third party who is working on the Fit for Work evaluation.

Fit for Work Guidance

To support Fit for Work, the Department of Work and Pensions has produced guidance to help employees, employers and GPs to make the best use of the service.

Read the guidance on GOV.UK