The consultation is seeking views on how to halve the disability employment gap; 4.6 million people who are disabled or suffering with long-term health conditions are currently out of work, it says. Less than half (48%) of disabled people are in employment, compared with 80% of the non-disabled population.
Secretary of state for health, Jeremy Hunt, said the National Health Service spends around £7bn a year treating long-term health conditions that keep people out of work, and suggested that employment could help them recover.
He said: "This green paper launches a wide-ranging debate about recognising the value of work as a health outcome. With all the evidence showing that work is a major driver of health, this is a big opportunity to make sure that people get the support they need, improve their health and benefit the NHS all at the same time."
The document, Improving Lives: the work, health and disability green paper, says the fit note is "not fully achieving what it set out to do" and GPs signing fit notes "rarely" use the option that allows them to specify that a patient "may be fit for work subject to the following advice".
It also highlights that a failure to recognise that many people can work with the appropriate support "increases the risk that the individual falls out of work altogether or moves further away from securing employment".
There is little detail in the consultation document on how the fit note would be changed. However, it proposes a system where healthcare professionals "feel confident to use their skills and knowledge to issue fit notes only when appropriate and make full use of the 'may be fit' option that is available to them", and "recognise the value of a referral to Fit for Work for occupational health advice and return to work support and make referrals routine for eligible patients when appropriate".
Consideration is also being given to extending fit notes from doctors to other healthcare professionals to help ensure people receive more tailored support.
A GP's fit note provides evidence of the advice they have given a patient about their fitness for work. If a patient has been unfit for work for four weeks or more, the GP or employer can refer them to the Fit for Work service --introduced by the government to provide patients and employers return-to-work advice to minimise the need for long-term sickness absence.
Damian Green, secretary of state for work and pensions, said: "At the moment, for many people, a period of ill health, or a condition that gets worse, can cause huge difficulties. For those in work, but who are just managing, it can lead to them losing their job and then struggling to get back into work. Unable to support themselves and their family, and without the positive psychological and social support that comes from being in work, their wellbeing can decline and their health can worsen.
"The impact of this downward spiral is felt not just by each person affected and their families, but also by employers who lose valuable skills and health services that bear additional costs. There is a lack of practical support to help people stay connected to work and get back to work. This has to change."
EEF employers association Sayeed Khan told IOSH Magazine in October that GPs' use of the options on the fit note to sign employees fit to work with adjusted duties is diminishing.
"It's because they are not being incentivised," he said. "In fact they face a disincentive. GPs have highlighted in our training how difficult it is not to give a note to someone if they want it -- it's bullying [by] patients."
