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Original research
Demographic variation in fit note receipt and long-term conditions in south London
  1. Sarah Dorrington1,2,
  2. Ewan Carr3,
  3. Sharon A M Stevelink1,4,
  4. Alexandru Dregan1,
  5. David Whitney5,
  6. Stevo Durbaba5,
  7. Mark Ashworth5,
  8. Arnstein Mykletun6,7,8,9,10,
  9. Matthew Broadbent2,
  10. Ira Madan11,
  11. Stephani Hatch1,
  12. Matthew Hotopf1,2
  1. 1Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
  2. 2Biomedical Research Nucleus, South London and Maudsley Mental Health NHS Trust, London, London, UK
  3. 3Biostatistics and Health Informatics, King's College London, London, UK
  4. 4King's Centre for Military Health Research, King's College London, London, UK
  5. 5School of Population Health and Environmental Sciences, King's College London, London, London, UK
  6. 6Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway
  7. 7Norway Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
  8. 8Norway Research Unit, Directorate of Labour and Welfare, Oslo, Norway
  9. 9Norway Centre for Research and Education in Forensic Psychiatry and Psychology, Haukeland University Hospital, Bergen, UK
  10. 10Department of Community Medicine, University of Tromsø, Tromsø, Norway
  11. 11Department of Occupational Health, Guys and St Thomas NHS Foundation Trust, London, UK
  1. Correspondence to Dr Sarah Dorrington, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, London, UK; sarah.dorrington{at}


Objectives Introduced in the UK in 2010, the fit note was designed to address the problem of long-term sickness absence. We explored (1) associations between demographic variables and fit note receipt, ‘maybe fit’ use and long-term conditions, (2) whether individuals with long-term conditions receive more fit notes and are more likely to have the ‘maybe fit’ option selected and (3) whether long-term conditions explained associations between demographic variables and fit note receipt.

Methods Data were extracted from Lambeth DataNet, a database containing electronic medical records of all 45 general practitioner (GP) practices within the borough of Lambeth. Individual-level anonymised data on GP consultations, prescriptions, Quality and Outcomes Framework diagnostic data and demographic information were analysed using survival analysis.

Results In a sample of 326 415 people, 41 502 (12.7%) received a fit note. We found substantial differences in fit note receipt by gender, age, ethnicity and area-level deprivation. Chronic pain (HR 3.7 (95% CI 3.3 to 4.0)) and depression (HR 3.4 (95% CI 3.3 to 3.6)) had the highest rates for first fit note receipt. ‘Maybe fit’ recommendations were used least often in patients with epilepsy and serious mental illness. The presence of long-term conditions did not explain associations between demographic variables and fit note use.

Conclusions For the first time, we show the relationships between fit note use and long-term conditions using individual-level primary care data from south London. Further research is required in order to evaluate this relatively new policy and to understand the needs of the population it was designed to support.

  • fit note
  • primary care
  • occupational health practice
  • epidemiology
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  • Contributors Sarah Dorrington designed the study, analysed the data and drafted the manuscript. Matthew Hotopf, Stephani Hatch and Ira Madan advised extensively throughout the process. Ewan Carr advised on the statistical analysis. Matthew Broadbent, David Whitney, Stevo Durbaba, Mark Ashworth, Sharon Stevelink and Alex Dregan provided expertise and guidance on extracting, analysing and interpreting the data. Arnstein Mykletun and all authors commented on the final manuscript.

  • Funding This paper represents independent research part funded by the Royal College of Psychiatrists’ Donald Dean Fellowship and the National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the Royal College of Psychiatrists, the NHS, the NIHR or the Department of Health and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK.

  • Competing interests Professor MH receives funding from Janssen as part of the RADAR-CNS consortium which includes a project on depression. He is a principal investigator of RADAR-CNS, a pre-competitive public–private partnership co-funded by Innovative Medicines Initiative (European Commission) and European Federation of Pharmaceutical Industries and Associations. He has also been an independent expert witness in group litigations instructed by claimants against pharmaceutical companies for alleged harmful effects of their products. The authors have no other conflict of interest to declare.

  • Patient consent for publication Not required.

  • Ethics approval CRIS was established in 2008 and approved by the Oxfordshire Research Ethics Committee in 2008 (reference 18/SC/0372). Approval for linkage with Lambeth DataNet was granted by Lambeth Clinical Commissioning Group and Information Governance Committee. This project was approved by the CRIS Oversight Committee in 2015.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Access to the deidentified data in this study can be applied for through Lambeth Datanet and South London and Maudsley Biomedical Research Centre (BRC), De Crespigny Park, London SE5 8AF ( Access is granted only if approval is given by both the BRC and the Lambeth Datanet Steering Group.

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