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Recent NHS data sheds light on the evolving landscape of fit note certification, indicating a gradual expansion of roles beyond traditional medical practitioners to pharmacists and nurses. This uptake in numbers coincides with the Department of Work and Pensions's (DWP) call for evidence in relation to fit note reform which will remain open till 8 July 2024. According to figures published by NHS Digital, during the nine-month period from April 2023 to December 2023, pharmacists certified a significant number of fit notes. Approximately 1.4 per cent of fit notes of the 8 million were issued by pharmacists while the rest were issued by the GP surgeries reflecting the impact following legislative amendments in July 2022, which extended certification authority to pharmacists, nurses, occupational therapists, and physiotherapists. In June 2022, the Pharmacists' Defence Association (PDA) advised pharmacists not to sign fit notes where the required therapeutic, diagnostic, or examination skills lie outside their scope of competence. The association remarked that healthcare professionals needed mandatory training under the Health Education England before they are fit to issue fitness notes to the public.

A new legislation has been introduced to allow authorised pharmacists along with other healthcare professionals in Northern Ireland to certify 'fit notes', health minister Robin Swann has announced. Pharmacists and some other healthcare professionals in England, Scotland and Wales are already allowed to sign 'fit notes'. Swann announced that 'fit notes' were also set to go fully digital in the future, meaning they would no longer need to be signed in ink. He said: "I am delighted to introduce this legislation in Northern Ireland. This change will make it easier for people and employers to get the advice they need so people can stay in work and will help free up doctors' time. "Too often we see people being faced with unnecessary challenges to get a fit note. More professionals being able to offer this vital service will speed up the process and support people to return to or remain in work."

The Pharmacists' Defence Association (PDA) has called for a mandatory training for those who wish to sign fit notes. The union said it will be seeking urgent clarification around the rollout of guidance and timescales of when this will be available to PDA members working in primary care and hospitals, who will be at the forefront of the implementation. "As with any activity, regulated health professionals will be expected to ensure they have received adequate training and guidance before taking on new elements of practice and to ensure they are acting within the limits of their professional competency," said the association. It also highlighted that completing a fit note may have an impact on the income received by the patient and therefore the consequences of supplying the document could mean a direct financial consequence for them, such as eligibility for sick pay or insurance claims, as well as a health outcome. The PDA expects the mandatory training to cover any factors which will need to be considered in this regard so that pharmacists understand any limitations on when, how, and for who they might complete the fit notes.