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  • Getting the most out of the fit note: guidance for healthcare professionals

    Getting the most out of the fit note: guidance for healthcare professionals

    This guidance is to help doctors, nurses, occupational therapists, pharmacists, and physiotherapists to make the best use of the fit note to support the health and wellbeing of patients.

    It gives you information on completing each section of the fit note, including the reassessment box, comments section and return to work tick boxes, and uses illustrative case studies to give real world examples.

    Changes to the fit note

    From 1 July 2022, legislative change has enabled a wider range of healthcare professionals to certify fit notes. The healthcare professionals who can now certify fit notes in addition to doctors are nurses, occupational therapists, pharmacists and physiotherapists. This change is targeted at those providing relevant NHS services.

    To support the new professions this guidance has been updated alongside the publication of non-statutory guidance and a training package on E-learning for healthcare. These resources are to be used together to support eligible healthcare professionals ensure that they have the required expertise and knowledge to be able to certify and issue fit notes.

    In April 2022, a new version of fit note was introduced to replace the 2017 version – this replaced the signature in ink with the name and profession of the issuer. IT systems in primary care will auto populate this information but in secondary care it will be necessary to continue to use the pre-printed forms supplied by DWP leaflets and how to order them and to add your name and profession in the appropriate space.

    There will be a transitional period during which both the 2017 and 2022 versions of the fit note forms will be legally valid whilst relevant IT systems are updated and stocks of paper fit notes in hospitals are replaced.
     

    Context and reason for the legislative change

    It is generally accepted and there is evidence [footnote 1] [footnote 2] [footnote 3] [footnote 4] [footnote 5] [footnote 6] [footnote 7] that good quality work is good for physical health, mental health and wellbeing. Evidence[footnote 8] indicates that the longer someone is off work due to ill health, the less likely they are to return to employment. There is also strong evidence that long periods out of work are associated with poor mental and physical health, increased use of health services and poverty. Even if people are not fully fit, engaging with work can deliver health benefits.
     
    Until now fit notes could only be certified and issued by registered medical practitioners. This change recognises that healthcare professionals from a range of disciplines now play a central role alongside doctors in leading the delivery of healthcare and support for patients to enable them to manage their health and wellbeing. Increasingly this applies to enabling people to safely remain in or return to work wherever possible, and to manage their own health and wellbeing.

    It is also recognised that as part of multidisciplinary teams there are a wider range of other healthcare professionals that can support patients return to work. In these situations, doctors, nurses, occupational therapists, pharmacists and physiotherapists can use a written report from another healthcare professional to assess a patient’s capability to work and issue a fit note.

    Key messages

    Your assessment about whether your patient is fit for work is about their fitness for work in general and is not job-specific.

    If you assess that your patient’s fitness for work is not impaired by a health condition, they are fit for work and do not need a fit note.

    Always consider if your patient could do work of some kind before advising that they are not fit for any work. Remember the long-term health risks of worklessness when advising your patient that they are not fit for work.

    You should use the fit note to give advice about the functional effects of your patient’s condition on their fitness for work in general. You are not expected to have specialist knowledge of workplaces or occupational health, and you do not need to suggest possible changes to your patient’s workplace or job.

    When stating a patient may be fit for work you should tick whichever return to work boxes relate to your advice. Use the comments box to give further information. If you do have specialist occupational health knowledge you can go into further detail about possible adaptations if you think this would help.

    Fit notes can be completed and sent digitally, or a copy printed and handed to patients if you have access to relevant GP IT systems. If required, clerical fit notes pads or sheets can still be ordered through the DWP ordering websites, for further information see DWP leaflets and how to order them.

    Healthcare professionals providing primary medical services under the National Health Services Acts are required, under the Social Security Acts, to issue free of charge a fit note (Statement of fitness for work) to patients for whom they provide clinical care.

    The benefits of using the fit note to its full potential

    The fit note is designed to help you provide fitness for work advice to your patients. This guide will help you use the fit note to its maximum potential to improve your patient’s health and wellbeing.

    In particular, using the fit note to its full potential enables you to:

    • effectively manage your patient’s expectations about their capability for work
    • give a clear clinical assessment to your patient about the impact of their condition on their fitness for work
    • improve the likelihood of your patient keeping their job, by helping them to discuss ways they could be supported at work with their employer
    • support the vital role that work can play in your patient’s health, as set out in the evidence behind the fit note

    On the other hand, incomplete fit notes can make it hard for employers to support your patient and cause unnecessary delays to your patient’s return to work, with associated consequences for their health. They can also cause additional work for you as patients ask you for new fit notes when they may not need to.

    The role of healthcare professionals to certify fit notes

    Doctors, nurses, occupational therapists, pharmacists, and physiotherapists can all provide fitness for work advice to patients using the fit note to help them return to work and aid their recovery. This can be based on a written report by another healthcare professional, including those that are not eligible to certify fit notes.

    It is then up to your patient and their employer to discuss your advice and consider possible changes.

    There is a general consensus that healthcare professionals:

    • play a key role in advising patients about work and return to work
    • agree that work and return to work is an important health outcome for clinical management
    • facilitate return to work through shared decision making
    • enable patients to effectively communicate with their employers

    Supporting clinical management

    Work is now recognised as an important health outcome. Healthcare professionals may:

    • discuss fitness for work with your patients where appropriate
    • consider if they may be fit for some work
    • complete all relevant sections of the fit note, to provide as much useful advice as possible to your patient and their employer
    • in particular, complete the comments box with advice on the functional effects of your patient’s health condition
    • consider your own training needs on health and work, and build your knowledge of other support and resources

    Clinical setting

    Fit notes can be issued in any relevant setting where an assessment of patients’ fitness for work is made. It is important that the healthcare professional responsible for the episode of care is the one who issues the fit note if it is within their ability. It is critical that patients are not signposted to other healthcare professionals purely for the purposes of certifying a fit note where this is avoidable, such as part of hospital discharges.

    Access to the fit note as set out in regulations is limited to those providing relevant NHS services. Mainly this is eligible professionals with access to general practice IT systems or those working in other settings where they can order pads of fit notes directly from Department for Work and Pensions.

    It is also possible for a fit note to be based on consideration of a written report by another healthcare professional involved with the diagnosis or care planning of the patient. This does not need to be one of the five professions listed in regulations.

    Do you need to issue a fit note? How do you assess a patient’s fitness for work?

    If you assess that your patient’s fitness for work is not impaired by their health condition, they are fit for work and do not need a fit note. This is the default position for all patients.

    You also do not need to issue a fit note for the first 7 calendar days of a patient’s sickness absence. Patients can self-certify for this period.

    If you assess that your patient’s health affects their fitness for work, you should give them a fit note indicating whether your patient is not fit for work OR may be fit for work.

    Assessing your patient’s fitness for work

    Your assessment about whether your patient is fit for work is about their fitness for work in general and is not job-specific. The following factors may be useful when making this assessment:

    • any functional limitations of your patient’s health condition. The duration of their health condition and any likely fluctuation and whether doing any work – not necessarily their current job – will make their health condition worse. For example:
      • stamina e.g. better in the morning or the afternoon
      • mobility e.g. walking, bending, stooping
      • agility e.g. dexterity, posture, co-ordination
      • insight or stability e.g. mental state, mood
      • treatment e.g. side-effects, duration of
      • intellectual e.g. cognitive abilities
      • sensory e.g. hearing, vision, touch
    • the duration of their health condition and any likely fluctuation
    • the impact of any ongoing clinical management
    • whether doing any work – not necessarily their current job – will make their health condition worse

    Deciding between ticking may be fit for work or not fit for work

    May be fit for work taking account of the following advice

    Your patient may be fit for work, taking account of your advice about the functional effects of their condition.

    You should tick this box if your patient could do some form of work (not specifically their current job). This gives maximum flexibility to your patient and their employer to discuss ways to accommodate your patient’s condition, which may include changing their duties for a while or reducing their hours.

    For example, a delivery driver who cannot drive may still be able to do other tasks and so may be fit for work – as described in case study 4.

    Not fit for work

    Your patient is not fit for work of any kind.

    You should tick this box only if your patient cannot do any form of work at all. Always consider if your patient could do work of some kind. Assessing that your patient is not fit for work when there are still things they can do risks depriving them of the chance to discuss ways they could do some work with their employer; and increases the long-term health risks of worklessness.

    If you assess that your patient is not fit for any work, make sure that you continue to review their fitness for work at regular intervals.

    See case study 5 for an example of a situation when it may be appropriate to assess that someone is not fit for work of any kind.

    You now need to fill in the rest of the fit note. See Filling in the fit note for advice on how to do this.

    Discussing patient beliefs about health and work

    Patient beliefs about health and work vary widely and normally become apparent during a consultation. As with other health advice, you should emphasise the advantages to the patient’s health of being at work. This information will not always be embraced enthusiastically.

    Sometimes, reluctance to consider work stems from a belief that work will exacerbate the health problem or delay recovery, or that patients always need to be fully fit before they return to work. You may be able to ease any apprehension in these cases.

    At other times, people may have issues at work, low expectations of gaining enjoyable work, concern about the effects on benefit receipt or other personal problems. In these circumstances it may be in your patient’s best interest if you refer them to other available support.

    Where appropriate, the following approaches may help in discussing work with your patients:

    • discussing the health benefits of work, and the health risks of not working
    • explaining that people do not need to be 100{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} fit to do some work
    • issuing fit notes for shorter periods of time
    • using the fit note to actively engage patients in goal setting
    • telling your patient about other support services if they have non-medical issues that are affecting their attitude towards work
    • specialist occupational health services can help address complex issues at work, including if your patient’s work may be affecting their health

    Filling in the fit note: instructions for completion

    If you assess that your patient is not fit for work, or may be fit for work (see advice on making this assessment), you will need to issue them with a fit note.

    From April 2022 GP IT systems are being updated with a new fit note template. This change will mean the fit note captures the name of the doctor issuing the form in place of it being signed in ink. Fit notes can still be printed and the issuer’s name completed by hand if necessary.

    While the update is taking place the existing fit note template (MED 3 01/17) must still be used and as long as it is signed in ink is legally valid.

    Fit note issued without signature in ink (Med3 2022 template)

    Filling in the fit note: instructions for completion by GPs. Post April 2022 sample form.

    You can issue a fit note on the day that you assess your patient; or on any day afterwards.

    The fit note should be completed as follows:

    1. The date on which you assessed your patient. This can be via either:

    • a face-to-face or telephone consultation
    • consideration of a written report from another doctor or healthcare professional (for example, nurses, occupational therapists, physiotherapists)

    2. Describe the condition or conditions that affect your patient’s fitness for work. Give as accurate a diagnosis as possible, unless you think a precise diagnosis will damage your patient’s wellbeing or position with their employer.

    3. Tick not fit for work, or may be fit for work, taking account of the following advice – advice on making this assessment.

    4. The comments box must be completed when you tick may be fit for work, and may be useful to complete when you have ticked not fit for work. See giving advice in the fit note for more information.

    5. Indicate the period that your advice applies for. This may be the date that you expect your patient to have recovered by, or your judgement about an appropriate time to review their fitness for work even if they are unlikely to have fully recovered.

    You can either:

    • specify a period from the date of the assessment (as entered in box 1) e.g. this will be the case for 2 weeks; or
    • specify a particular start and end date. e.g. this will be the case from 5 May to 19 May.

    In the first 6 months of a patient’s condition, a fit note can cover a maximum of 3 months. If a condition has lasted longer than 6 months, a fit note can be for any clinically appropriate period up to ‘an indefinite period’.
    The dates are inclusive, (so a fit note dated from 2 April to 10 April will no longer apply from 11 April onwards).

    6. This section is mandatory – it gives your patient an indication about whether they can expect to be fit for work when the fit note expires, which helps them and their employer plan for the future. If you expect that your patient will be fit for work at the end of their fit note, indicate that you will not need to assess them again. If you don’t expect them to be fit for work, or you aren’t sure, indicate that you will need to assess them again.

    7. Please insert the name of the issuer. If you are using the computer-generated fit note, this will be completed automatically by your IT software. If not, ensure that this section is filled in.

    8. Please insert the profession of the issuer.If you are using the computer-generated fit note, this will be completed automatically by your IT software. If not, ensure that this section is filled in.

    9. Complete the date of statement. This is the date that you issue the fit note – which may not necessarily be the same as the assessment date in box 1.

    Fit note with signature in ink (Med3 2017 template)

    Filling in the fit note: instructions for completion by GPs. Pre April 2022 sample form.

    Complete sections 1 to 6 as above.

    7. Sign the fit note using ink. If you are using the computer-generated fit note, the statement date and address of your practice will be completed automatically by your IT software. If not, ensure that these sections are filled in. If you are a nurse, occupational therapist, pharmacist or physiotherapist, you must strike out ‘doctors’ and replace with your own profession.

    8. Complete the date of statement. This is the date that you issue the fit note – which may not necessarily be the same as the assessment date in box 1.

    Important: Your patient can go back to work at any point they feel able to, even if this is before their fit note expires. They do not need to come back to see you in order to do so, or get a new fit note. This is the case even if you have indicated that you need to assess them again.

    GP computer generated fit notes

    Most fit notes are produced through GP IT systems, but they can be handwritten, system generated and printed, or system generated and sent digitally. System generated fit notes have the added benefits of:

    • automatically completing certain parts of the fit note to save you having to fill them in each time you issue one
    • automatically including the name of the health professional completing the fit note to authorise it, removing the need to print and sign the fit note in ink
    • ensuring that your advice is easy to read for patients and employers
    • removing the need for you to re-write fit notes if duplicates are required, as other staff members can print out duplicate copies
    • enabling clinical management and fitness for work advice to be monitored together for patients with long-term conditions
    • improving the continuity of patient care generally – for example if patients are seen by different healthcare professionals
    • allowing you to share knowledge and learning points with colleagues in your practice by carrying out appropriate internal audits

    All GP practices have access to computer generated fit notes.

    Giving advice in the fit note – the comments box

    The comments box must be completed when you have assessed your patient as may be fit for work, and can be useful to complete when you have assessed them as not fit for work.

    You should use the free text section to give advice about the functional effects of your patient’s health condition, and tick boxes to provide an overview of the factors your advice covers.

    The free text section

    The important information to include in this box is advice about the functional effects of your patient’s condition on their fitness for work. Your patient and their employer should then discuss possible adaptations and changes to accommodate your advice.

    Your advice should focus on what your patient can do at work rather than their diagnosis and symptoms. It is helpful to give advice that is as practical as possible. See some examples in the checklist opposite.

    You do not need to be an occupational health expert to provide this advice, and you do not need to refer to their current job. If you do have occupational health expertise or information about your patient’s job, you can describe possible adaptations if you think this would help. But remember not to be too prescriptive and inadvertently reduce your patient’s potential to be able to return to work.

    Otherwise, the only reference to your patient’s current job should be if you feel that it may be affecting their health. In these cases, you should explain why this is the case, so that your patient’s employer can try to address the issue. An occupational health assessment is often helpful in these cases.

    The checklist below may be useful when considering what to include in the comments box:

    • are there things your patient cannot do in terms of mobility, strength and fitness? e.g. ‘avoid kneeling and squatting or cannot lift heavy objects’
    • are there types of activities that should be avoided or altered? e.g. ‘removal of tasks which cause emotional distress or avoid driving’
    • how long is this likely to be the case, or will it be permanent? e.g. ‘condition expected to improve within 2 months’
    • will medical appointments be needed during working hours? e.g. ‘will need to attend physiotherapy for 1 hour twice a week’
    • are there features of the workplace which may impact the patient’s condition? e.g. ‘their chair may be aggravating their back condition’
    • could they benefit from an occupational health assessment?
    • is there return to work guidance available from Royal Colleges or other groups on your patient’s specific condition or operation?

    Your liability for the advice you provide goes no further than your responsibility to carry out a suitable clinical assessment of your patient’s health condition. Your patient’s employer is responsible for undertaking a suitable risk assessment to accommodate your clinical judgment.

    The tick boxes

    You should use the tick boxes to indicate the kind of general adaptations that might help your patient return to work. Tick whichever boxes relate to the functional effects of your patient’s condition. These are not binding on your patient and their employer, but help to give them a broad idea about changes to discuss. The options are:

    • a phased return to work: a gradual increase in work duties or hours
    • altered hours: changes to the times or duration of work
    • amended duties: changing duties to take account of a condition
    • workplace adaptations: changing aspects of the workplace

    For example, if your advice is that somebody cannot use their right arm, this may impact on the tasks they can perform and they may need physical changes in the workplace, so you should tick ‘amended duties’ and ‘workplace adaptations’ and them explain in the comments box so the employer will understand what they can and cannot do.

    If your advice is that somebody tires easily and so should not work for longer than 3 hours a day, this may affect their duties and also the times they can work, so you should tick ‘amended duties’ and ‘altered hours’, again with relevant comments provided.

    The fit note in action section has examples of using the comments box to its full effect.

    How your patient will use their fit note

    If your patient is employed and you have indicated that that they are not fit for work, they can use the fit note to claim sick pay. Your patient should keep their original fit note in case they go on to need it for benefit or other purposes (their employer may take a copy for their records).

    If your patient is employed and you have indicated that they may be fit for work, they should discuss your advice with their employer to see if there are changes which could support them to return to work – for example changing their duties, adjusting work premises or providing special equipment.

    You do not need to suggest any of these changes, although you can if you believe it may help guide the conversation. Your advice is purely on the impact of your patient’s health condition and it is up to your patient and their employer to discuss ways to accommodate it.

    If their employer cannot make any changes to accommodate your advice, the fit note is treated as if it stated that your patient was not fit for work. Your patient should not return to you for a new fit note stating this because they do not need one.

    If your patient is out of work, they can use a fit note to support a claim for health-related benefits or to show that they have been unable to fulfil certain benefit requirements.

    They can also use it in any discussions with prospective employers about supporting a health condition.

    The fit note in action shows how patients can use the fit note in a variety of different situations.

    There is more information about the role of employers and the benefits system in additional questions, and specific guidance on the fit note for patients and employers.

    There is a short guide the benefit system for GPs available. Information about benefits for patients is available, or can be found on the back of the fit note.

    The fit note in action – case studies

    These illustrative case studies show how you can use the fit note to help patients in a number of situations.

    Case study 1: An employer makes changes based on your advice

    Your patient works for a publisher and has relatively mild cystic fibrosis. He visits you complaining of a sore throat and runny nose. You diagnose the common cold and having consulted his treatment plan, take a throat swab and prescribe antibiotics. You then move the discussion to work issues.

    Your patient expects to be signed off work as he has been on other occasions, and says he is looking forward to some ‘down time’ because he’s ill and will be spending time and energy on physiotherapy.

    You explain that he does not need to be 100{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} ‘well’ to do some work, and that it will not damage his health – it may actually help his recovery by providing a routine and keeping him focussed on getting better. Keeping in touch with the office and doing some work will also make his eventual transition back to full time work easier.

    You and Your patient discuss how his health affects his fitness for work, and agree that he can still perform non-physical tasks. His cystic fibrosis means he is at higher risk of secondary bacterial infection, it is the middle of winter, his commute is very crowded and he often has to wait in the cold. He is worried about becoming very ill with a chest infection as he was last year after a cold.

    You state on the fit note that Your patient may be fit for work and write ‘cannot come into the office as he is at risk of infection, but can work from home. Should avoid strenuous physical tasks as he will tire more easily’.

    You do not discuss which tasks he should do from home – these are discussions for him and his employer to have. You tick ’workplace adjustments’.

    You set the duration of the fit note to ten days. Because you think that his employer can expect him to return to his previous function after this time, you indicate that you do not need to see him again once the fit note has expired.

    Your patient calls his employer, and discusses your advice with them. His employer agrees that they will email him some work to do and he should work from home for the next ten days. He is not recorded as being on sick leave and so keeps his full pay and stays in touch with work.

    After ten days, Your patient’s swab was negative; he has not developed any symptoms of a secondary bacterial infection and has recovered from his cold. He goes back to work without coming back to see you.

    Case study 2: Someone who is out of work

    Your patient is out of work and visits you with a recent exacerbation of multiple sclerosis (MS). His records indicate that his MS occasionally relapses, with periods of good health in between.

    He is keen to find a job and asks about work during the consultation. He seems despondent about his recent flare-up as he thinks it means he won’t be able to find a new job until he is better.

    You explain to your patient that although his flare-up means he won’t be able to perform certain tasks while it lasts, he may well be able to perform others.

    You find that your patient has reduced power in his left arm and Romberg’s sign is positive. You also use your own knowledge of MS and the side-effects of his medication to assess his general fitness for work.

    You indicate on your patient’s fit note that he may be fit for work. Your advice reads ‘Mild left arm weakness but this is the arm he writes with. Should not do heavy lifting, and needs a workstation assessment if working at a desk. Can still perform all other physical tasks and his mental capabilities are unaffected by his health condition’. You tick ‘amended duties’ and ‘workplace adjustments’. You set the duration of his fit note to 3 months.
    You explain to your patient that you will leave it to him to come back and see you if his condition worsens, and indicate that you will not need to see him again after his fit note expires.

    Your patient is offered a job as a data analyst the following week. After the job offer has been made, his employer asks him about any health conditions he has and he passes on the advice in his fit note. His employer uses it to provide your patient with a tailored workstation and keyboard.

    Case study 3: A delivery driver who can’t drive

    Your patient is a delivery driver for a major logistics firm. He has just had laser eye surgery and his post-op instructions include advice that he should not drive for 2 weeks. He comes to see you expecting to be signed off from work.

    You explain to your patient that, although he can’t do his driving role, your advice on his fit note is about his general fitness for work. You explain that this means he and his employer can discuss whether he could do something else. You explain that if there isn’t another role for him, they can treat the note as a not fit for work note.

    You use the comments box to write ‘Dry eyes, may experience temporary blurring of vision. Should not drive for 2 weeks. Can still perform other reasonable physical tasks. Mental function unaffected. If he uses a VDU he should take regular short breaks as per standard guidance’. You tick ‘amended duties’.

    You state that you will not need to see your patient again at the end of the period because you expect him to be back to normal after this time.

    Your patient and his employer discuss your advice. Although your patient should not drive, his knowledge of the company and its operations means they decide to use him in a back office role for the 2 weeks.

    Your patient therefore retains his full pay, and keeps in the routine of working. After 2 weeks he goes back to work as normal without coming back to see you.

    Case study 4: Someone who is not fit for work

    Your patient works for an accountant, and comes to see you with his wife. His sleep has been poor for a month or two and he has been feeling hopeless and miserable. You prescribed an antidepressant for him and referred him to the practice counsellor when he attended 2 weeks ago. For the last week he has been unable to sleep, lacks motivation and has not been into work.

    This morning he disclosed to his wife that he is thinking about committing suicide and has a detailed plan of how he is going to do this. You assess that he is a risk to himself. He refuses to go to A&E for an assessment so you arrange an emergency psychiatric assessment at his home and hand over his care to the emergency psychiatric team.

    He is unfit for work. You indicate on his fit note that he is not fit for work due to depression and complete a fit note for 4 weeks.

    Case study 5: Relationship issues at work

    Your patient comes to see you, complaining that she does not get on with her manager, she is feeling very stressed and asks to be signed off work. During the consultation you determine that although her situation is upsetting her, she does not have a mental illness and she is fit for work.

    You explain to your patient that you can see that she is being affected by her situation at work. However, because she does not have a health condition, you cannot issue her with a fit note. Your patient initially reacts badly, and tells you that her manager has been really horrible to her and she is finding it difficult to cope.

    You agree that although this may well be the case, the situation is not making your patient ill. You reassure her that if it was, you would issue her with a fit note and that you are acting with her health interests in mind. You explain that this is not a medical problem but a management issue. Going off sick will not resolve the problem, nor help her find another job if that is what she decides to do.

    You discuss whether she can talk to someone at work to help her resolve her problems with the manager or if there are other resources she can use – for example speaking to Human Resources (HR), contacting a trade union rep or speaking to ACAS. Your patient decides to approach another colleague at work for advice tomorrow, and to check the internet and ACAS for help on managing conflicts at work tonight. You ask your patient to come and see you again if she carries on feeling stressed.

    Additional questions

    General

    What should l do if someone has requested a fit note to be issued by a doctor?

    Please advise patient that other healthcare professionals are now able to issue fit notes, but they can request the fit note being issued by a doctor if this is their preferred choice and a doctor is available.

    What should l do if my system has not yet been updated?

    Please continue to issue fit notes using the existing templates ensuring it is ‘signed in ink’. The current template will be replaced when your IT supplier updates your system.

    What if I am asked for a fit note saying someone is fit for work?

    People do not need to be signed back to work and there is no option on the fit note to do this. When the fit note expires, your patient should return to work as normal. If they don’t feel able to go back to work, they should make a new appointment to see you.

    For a small number of jobs there are existing procedures for stating someone is fit for work (e.g. the DVLA Form D4 for LGV/PCV drivers). If this is the case, your patient’s employer will contact you about this.

    Otherwise, if your patient or their employer requests that your patient is formally signed off as fit for work, they need to make a private arrangement with a healthcare professional or occupational health specialist.

    Can I back-date a fit note?

    Yes: in certain situations, parts of the fit note may need to include dates, which are earlier than the date of the statement.

    If you are issuing a fit note based on an assessment conducted at an earlier date, you should enter the date of this earlier assessment in the date of assessment field.

    If your patient’s condition has affected their function for some time without a previous fit note being issued, you must enter an estimated date that their function was affected from in the ‘this will be the case from’ field.

    Can I issue a new fit note before the old one expires?

    Yes – in certain situations it is possible that you might be asked for a fit note whilst the old one is still valid. Following your latest assessment of their fitness for work you may issue a new (overlapping) fit note if appropriate.

    If I am completing a fit note using evidence from another healthcare professional, what should be the date of the fit note?

    The assessment date would be the date that you considered a report from another healthcare professional, not the date of that report itself.

    Can I issue a fit note with a future start date?

    No. The date of statement must always be the date that you issue the fit note.

    Can someone other than a doctor or GP certify a fit note?

    Yes, from July 2022 nurses, occupational therapists, pharmacists, and physiotherapists can certify fit notes in addition to doctors.

    My patient has 2 jobs, should I issue 2 fit notes?

    No, only 1 fit note should be issued per assessment.

    Your patient should show their fit note to each employer and keep hold of the original. The employer can take a copy for their own records if needed. A duplicate (clearly marked ‘duplicate’) should only be issued by you if the original has been lost.

    If you use computer-generated fit notes, other staff in your practice can quickly and easily print out duplicate fit notes and thereby save you time.

    What if my patient fears job loss, stigma or discrimination if I reveal their health condition (or its effect on their work functioning) on their fit note?

    If you feel that revealing a particular diagnosis or limitation would harm your patient’s wellbeing or compromise their position with their employer, you can enter a less precise diagnosis on the fit note.

    My patient has a personal or social problem and is asking for a fit note (for example caring for relatives). What should I do?

    You can issue fit notes only to cover your patient’s own health condition. If a personal issue is causing them stress resulting in ill health, it may be appropriate to issue a fit note – this will depend on your clinical opinion.

    So for example, if someone has suffered a bereavement and you assess that they are too distressed to work, it may be appropriate to write ‘distress due to bereavement’. This should only be the case if your clinical judgement is that their fitness for work has been affected. You cannot however write bereavement as a diagnosis on a fit note.

    If this is not the case, you should explain to your patient that you cannot issue a fit note as they do not have a medical problem. See case study 6 for an example of this situation. Many employers offer special leave or compassionate leave in these circumstances, and your patient may be able to discuss the issue with their line manager, HR department or trade union. If they are unemployed, they should contact Jobcentre Plus.

    Please see further information for support available on a range of personal or social problems that people may be struggling with.

    What if my patient feels their health is being damaged by their work?

    If there are parts of your patient’s job which you think may be affecting their health, you should explain these in the comments section of the fit note so that their employer is aware of them. In these cases, it may be helpful to recommend an occupational health assessment.

    Remember that your assessment of your patient’s fitness for work is not linked to their particular job, so if they are still able to perform some tasks you should assess them as may be fit for work and explain what their limitations are in the comments box.

    What should I do if my patient wants to change jobs due to their health condition? You are not expected to provide employment advice to your patient -Jobcentre Plus or local employment networks can help with this. In the meantime, you should use the fit note to help your patient to stay in work if appropriate.

    What other sources of help are there for people with health conditions to return to or look for work?

    There are a wide range of independent organisations that provide advice and support to help people stay in work or find a job. There are also further resources to help people with particular conditions or following surgical procedures – these are listed in further information.

    If your patient is in work, they may be able to get help from their employer’s occupational health department, trade unions or NHS occupational health specialists. An occupational health assessment can often help. If they are out of work, Jobcentre Plus can provide support and they should discuss this with their Jobcentre Plus adviser.

    Is there guidance for patients and employers on the fit note?

    Yes, there are guides available for patients and employees and employers and line managers.

    The fit note and employers

    Is my assessment or advice binding on my patient’s employer?

    No. Your assessment on whether your patient is not fit for work or may be fit for work (and any other advice in the fit note) is classed as advice. It is for employers to determine whether or not to accept your advice. They may decide to seek alternative advice and give this preference to yours. If so, they should be able to demonstrate that the quality of this alternative advice was at least comparable to yours, should a dispute between employer and employee lead to an employment tribunal.

    You are not expected to get involved in such disputes between your patient and their employer. If your patient has a grievance with their employer they need to pursue this through their own arrangements, but may wish to consider organisations like ACAS. All employers have legal duties towards employees who meet the criteria of the 2010 Equality Act.

    How does the fit note affect Statutory Sick Pay (SSP)?

    The arrangements for SSP have not changed. If the fit note states that someone is not fit for work, or that they may be fit for work but the patient and their employer agree that they should remain off work, then they can still receive SSP.

    If your patient is in doubt about their rights to SSP, they can seek advice from their trade union or an advice centre. Find detailed information about SSP.

    Do I have to confirm to an employer that I have issued a fit note?

    You should not provide medical information to your patient’s employer without your patient’s consent. If an employer contacts you asking if a fit note is genuine, you may choose to check the fit note serial number and confirm to the employer that you have issued it – this does not reveal any medical information, but will confirm that the fit note has been issued.

    The British Medical Association has issued helpful guidelines on disclosing patient information.

    The fit note and being out of work or claiming benefits

    Do I use the fit note differently if my patient is claiming benefits?

    No. Your assessment should still be based on your clinical judgement about the functional effects of your patient’s health condition, and you should issue a fit note only if your patient has a health condition which impacts on their general fitness for work.

    How does the fit note apply to people who are out of work?

    People who are out of work may ask you for a fit note for a number of reasons. There is a short guide the benefit system for GPs available. Information about benefits for patients is available, or can be found on the back of the fit note.

    Further information

    Guidance for patients, employers and hospital doctors

    There are guides available for patients and employees and employers and line managers.

    The patient guide makes clear what patients can expect from their healthcare professional – for example they should not expect healthcare professional to issue a fit note that says not fit for work if they are fit for some work.

    The employers and line managers guide explains how they should use the advice in a fit note – and that if they can’t accommodate this advice, the fit note should be treated as if it stated that the patient was not fit for work.

    Support for patients with personal or social problems

    Fit notes can only be issued for medical problems. If your patient is dealing with a problem that is not making them ill, they should not be issued with a fit note. However there are resources available to help people with a range of other issues, which you may wish to refer patients to.

    ACAS

    ACAS
    Telephone: 0300 1231100

    Carers

    NHS Social care and support guide

    Carers Trust

    Debt issues

    Debt and money guide from Citizen’s Advice

    National Debtline

    Careers Advice

    National Careers Service

    Relationships

    Relate

    Benefit advice

    Benefit guides

    HSE guide to managing sick leave and return to work: gives advice to employers and managers about supporting people while on sickness absence and helping them to return to work.

    Occupational Health Advice Service

    Free professional occupational health support for individual patient cases or about occupational health in general.

    England
    NHS Health at Work Network

    Scotland
    Healthy Working Lives
    Telephone: 0800 019 22 11

    Wales
    Healthy Working Wales
    Telephone: 0800 107 0900

    Details of occupational health providers

    Occupational health support can be very helpful in complex cases and when work may be affecting your patient’s health. Occupational health services are sometimes provided by NHS or local authority services. To find details of providers in your area, contact:

    Commercial Occupational Health Provider Association

    NHS Health at Work Network – Support for Business

    Supporting organisational health and well being professionals

    Safe Effective Quality Occupational Health Service: list of approved occupational health providers.

    Return to work support

    Access to Work

    Access to Work is a discretionary grant that can provide practical and financial support to people with a disability or health condition to help them start work or keep a job. The grant can contribute towards the disability related extra costs in the workplace that are beyond standard reasonable adjustments, but it does not replace an employer’s duty under the Equality Act to make reasonable adjustments. Access to Work offers personalised support and workplace assessments and can fund support such as travel to/in work, support workers, and specialist aids and equipment.

    Access to Work also provides Mental Health Support Services to support people with a disability or health condition in employment with; tailored coping strategies, advice on adjustments and support for employers to enable them to better understand the challenges faced by their employees in the workplace.

    Disability Employment Advisers

    Disability Employment Advisers are based in Jobcentres, and work with claimants facing complex employment situations because of a disability or health condition. They can act as an advocate with prospective employers if necessary, aiming to identify work solutions that will overcome or minimise any difficulties related to an individual’s disability in the work place.

    Jobcentre Plus

    Jobcentre Plus provides services that support people of working age from welfare into work, and helps employers to fill their vacancies. Find your local Jobcentre.

    Work Choice

    Work Choice is a specialist disability employment programme that provides tailored support to help disabled people who face the most complex barriers to employment.

    Guidance and support for specific conditions

    Royal College of Surgeons of England – Recovering from surgery: provides practical tips and advice about getting back to work after common surgical procedures.

    Royal College of Obstetricians and Gynaecologists patient leaflets: provides advice on recovery, including return to work, following gynaecological surgery

    Royal College of Psychiatrists – Work and Mental Health: provides advice about returning to work after mental ill health for employees, employers, clinicians and carers.

    Macmillan – Work and cancer: provides information about work and cancer for patients, carers, employers and healthcare professionals.

    Royal College of Physicians – Upper limb disorders: Occupational aspects of management: Evidence-based guidance for employees.

    NICE guidance on long-term sickness absence and incapacity for work

    Important information about this leaflet

    This is only a guide and does not cover every circumstance. We have done our best to make sure that the information is correct as of July 2022. It is possible that some of the information is oversimplified, or may become inaccurate over time, for example because of changes in the law.

  • Are pricey pet foods really better? Read these tips on finding the best food to fit your budget. | Entertainment/Life

    Are pricey pet foods really better? Read these tips on finding the best food to fit your budget. | Entertainment/Life

    Choosing the right doggy or cat meals can be a overwhelming job. With all of the options out there, and in this age of natural and organic and specialty decisions — I necessarily mean, there is a refrigerated portion for pet dog foodstuff now — how is one to know what is finest for their pet?

    Regardless of which doggy food stuff you get, it is essential to know that dry food is essential to a pet’s well being and for maintaining enamel and gums in very good ailment.

    Although individuals very little packages of moist food items may possibly search captivating and are often gulped down by pets, they nevertheless must have dry, challenging foods.

    So, which foods is very best, and does costly suggest improved? In this article are some points to look at:

    Examine THE Components: The very first ingredients ought to consist of meat (hen, beef, turkey, salmon). That is commonly followed by a lengthy listing, which include preservatives. Do not enable preservatives discourage you — we try to eat them, also, and they are what give the product or service its shelf daily life.

    Having said that, meat byproducts and corn need to not be a person of the to start with a few components.

    EXTRAS: The additional highly-priced foods ordinarily have excess oils, like salmon oil, and fatty acids that assistance a pet’s coat as perfectly as common health and fitness.

    All those with a lot more than one or two animals, specially significant puppies, may well not want to shell out the cash to get big quantities of these costly foods. Having said that, this type of foodstuff can be acquired in more compact quantities and blended with a pet’s common food stuff to improve it.

    Shifting Meals: It is important, nonetheless, in no way to transform a pet’s food overnight. Unexpected variations in diet regime can trigger an upset stomach and diarrhea. When creating a change to a new foods, do it step by step by introducing a very little of the new meals to the existing food until finally the sought after combine ratio is fulfilled, or until finally the new meals has absolutely changed the outdated.

    Basics, Plus: Most of the key nationwide model meals (Purina, Pedigree, and so forth.) normally give a pet what he requires, and these food items can usually be increased with salmon oil, probiotics, fatty acids and/or oils — the components that make the high-priced foodstuff so expensive.

    Even fresh-steamed snap beans, slice-up carrots, pumpkin and frozen or clean peas all incorporate nutritional worth to a packaged dry food stuff. But yet again, make these improvements progressively so the pet’s stomach is eased into these new foods.

    Exclusive Treatment: If your pet has exclusive dietary wants, talk to with your veterinarian to determine what food is finest. The two of my puppies are on prescription diet plans, 1 for kidney care and the other mainly because he needs to lose a few pounds.

    Look at THE Bundle: Irrespective of what form of food items you decide to get, make absolutely sure to look at the date on the packaging in advance of obtaining, and when residence, take a look at the food items to make certain no bugs are within. All it takes is 1 microscopic gap in the bag and bugs can get in.

    STORAGE: If the pet food stuff is stored in a plastic bin, make confident to scrub out that bin at the very least after a thirty day period. Oils are absorbed into the plastic and can step by step spoil regardless of what goes into the bin.

    Traci D. Howerton is the volunteer coordinator for Animal Rescue New Orleans, a nonprofit, volunteer-centered, no-eliminate shelter. For extra data on ARNO, visit www.animalrescueneworleans.org.

    Buys made by means of backlinks on our web page may gain us an affiliate fee

  • Fit Together Community Health Initiative Celebrates 10 Years and Counting

    Fit Together Community Health Initiative Celebrates 10 Years and Counting

    Youngsters, families and communities in the northwest corner have benefitted greatly from the perform of In good shape Collectively for 10 several years, and the potential is brilliant for building on their accomplishment for quite a few years to appear.

    In good shape Collectively NWCT is a partnership designed in 2011 by a group of community-based corporations and initially funded by a Sam’s Club grant by way of the YMCA of the Usa. Their mission is to empower individuals to make wholesome way of living alternatives – building the balanced preference the effortless decision. Suit Collectively partners contain Hartford HealthCare’s Charlotte Hungerford Clinic, NWCT YMCA, Torrington Place Overall health District, Helpful Palms Foodstuff Lender, Community Wellbeing and Wellness of Larger Torrington, New Chances, the City of Torrington and the Town of Winsted. This team started by supporting college gardens, advertising and marketing the relevance of day-to-day actual physical exercise and getting their information out at group wellness fairs.

    In two many years, Match Jointly employed its initial Coordinator and adopted Maine’s 5210 Let’s Go! design, a nationally identified childhood being overweight prevention program, that focuses on escalating alternatives for healthy taking in and active residing in a simple, easy to fully grasp format: 5 servings of fruits and veggies, 2 nutritious screen time behavior, 1 hour of actual physical activity and sugary beverages each and every working day.

    Utilizing this design, Healthy Together started by producing programs with early childcare facilities in the area and carries on to extend the message of 5210 Let us Go! via educational facilities, just after faculty applications, health care methods, workplaces and local community outreach. Collaborating internet sites established up wellness teams and operate to make Gold Level Associate standing as they instill 5210 Let’s Go! evidenced-based mostly methods in their daily things to do.

    In 2018, by way of their affiliation with Charlotte Hungerford Healthcare facility in Torrington, Hartford Healthcare awarded a five 12 months, $500,000 grant to In shape With each other NWCT. This has permitted Healthy Alongside one another to give 22 mini grants, therefore considerably, to northwest Connecticut businesses for initiatives that align with their mission these as outside play equipment, workout stations for health and fitness trails, university and local community gardens, bottle filling stations and much additional. With the enable of the mini grants, these initiatives by senior centers, colleges, childcare facilities and other charitable groups advance the nicely-staying of our communities and make them much better and more healthy.

    NWCT In good shape Together’s get the job done did not end all through the last two years of the COVID-19 pandemic, but instead they executed new and imaginative situations to interact families, good friends and neighbors such as Check out the Park contests, greenway scavenger hunts, farmers industry meals demos, games and hike fests. Digital cook dinner and master lessons with a registered dietician and fitness instructors helped households stay related even as they had been staying risk-free at home.

  • Nursing students promote healthy lifestyle at FIT Camp: Indiana University Kokomo

    Nursing students promote healthy lifestyle at FIT Camp: Indiana University Kokomo

    KOKOMO, Ind. — A healthful way of life begins with healthier habits – no issue the age.

    That is what Match Camp is all about this summer time – selling overall health and wellness among young children ages 6 to 10.

    College and college students at Indiana College Kokomo will produce a enjoyment and instructional ambiance during the weeklong day camp that teaches about physical fitness and good diet. College student-athletes will provide as mentors, sharing expertise and presenting up some substantial-fives. The camp is arranged by the University of Nursing and Allied Wellness Professions.

    “In health and fitness care, we’re looking for means to be proactive in advertising nutritious living and wellness, fairly than just reacting in dealing with illnesses,” said Samantha Fouts, clinical assistant professor of nursing, who is leading this year’s camp.

    The camp will take position from 9 a.m. to 3 p.m. starting Monday, June 13, by way of Friday, June 17, with drop off at the Kelley College student Center on the IU Kokomo campus. Price tag is $40 for the 7 days, with economic help out there via camperships. On the net registration can be discovered at go.iu.edu/4ltg.

    “Knowing that diabetes and coronary heart disease and hypertension are some of the frequent continual circumstances we see in our grownup inhabitants, if we can access the children previously and educate them superior means to boost wellbeing in their personal lives, hopefully above time we can decrease some of the wellness complications we see in our adult populations,” Fouts explained.

    The camp has experienced an influence, with far more than 6,700 children attending given that it was started in 1997 as an educational application for people with asthma and/or diabetes. It later on expanded to include things like healthful living, and wholly shifted aim to wellness and wellness in 2017. Extra than 300 nursing learners have served as camp counselors.

    Fouts noted that CDC information displays advancement — Indiana used to have nearly 37 p.c of children considered to be overweight or chubby, based mostly on excess weight and top. At the moment, 30 p.c are in that selection.

    “There are advancements staying designed, but we even now have quite a bit of perform to do,” she mentioned.

    Pupils in a summer time pediatric nursing course will produce diet classes primarily based on the My Plate program, to educate how to choose wholesome foodstuff for a well balanced eating plan. There will also be a great deal of bodily exercise. IU Kokomo pupil athletes will guide game titles and drills for the campers for 90 minutes to two hrs of every working day.

    “I know our athletes will appear in with a target on educating their activity, but it even even more boosts the camp by just giving the young ones a probability to interact with them,” she extra.

    A reward to the method is that individuals can positively affect their family members by having residence what they’ve realized — maybe suggesting a household stroll to get anyone active or inquiring for fruits and veggies they’ve tried at camp.

    The nursing pupils who guide camp also benefit, learning how to advocate for wellness and use their competencies to gain some others.

    “It’s crucial that our faculty has a voice in the local community,” she claimed. “We have a great deal of understanding and expertise we can share. It’s vital that our pupils get out there and use the awareness and capabilities they’ve learned in college to positively aid and encourage health in our group.”

    For far more facts, check out iuk.edu/nursing-allied-health/summer season-camp or get in touch with Fouts at 765-455-9307.

    Education is Crucial at Indiana University Kokomo.

  • 4 Nourishing And Strengthening Foods to Keep You Fit And Healthy

    4 Nourishing And Strengthening Foods to Keep You Fit And Healthy

    The onset of the pandemic has manufactured absolutely everyone a lot more conscious of their wellbeing, and wellbeing has grow to be a major priority for the greater part of individuals. In the process, greater emphasis is getting supplied to the worth of healthy having –that is, a well balanced intake of carbohydrates, proteins, drinking water, nutritional vitamins, and a part of fat– and its position in total physical and psychological wellness. The procedure of consuming the right foodstuff –in conditions of the two style and quantity – not only allows in reaching and retaining the perfect body weight, but also plays a important part in safeguarding you from a number of unwanted health problems.Also Go through – Fasting Strategies For Men and women With Diabetes During Ramadan

    For one particular, research demonstrate that premature heart conditions – a main trigger of demise worldwide – can be prevented by up to 80{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} by adopting a balanced diet regime and raising physical action. Also Go through – Entire world Well being Working day 2022: 5 Straightforward But Productive Health Guidelines You Should really Stick to Just after Each Food

    Large blood force – a growing worry in metropolitan towns and cities – can direct to heart attacks, coronary heart failure and strokes. The variety of foodstuff eaten can assistance decrease and manage blood pressure at ideal ranges, which in switch retains the coronary heart healthful. An great food plan should really involve loads of veggies, fruits, whole grains, extra fat-free of charge or minimal-unwanted fat products and solutions, and large-fibre foods, as these engage in an important purpose in cutting down heart disorders and strokes. The intake of drinks and foodstuff with included sugar should really also be averted. Blood strain can also be diminished by limiting your salt ingestion. Also Read – Entire world Pores and skin Health and fitness Day : Skincare Myths Debunked | Check out Video clip

    The odds of speaking to an additional dreaded ailment – cancer – can be decreased by feeding on foodstuff laden with antioxidants, this kind of as fruits, veggies, nuts, and legumes. These foods forms lessen a person’s hazard of acquiring cancer, as anti-oxidants safeguard cells in the human body from hurt. It is a recognised point that the existence of cost-free radicals in the system improves the danger of cancer. Antioxidants assist do away with these, generating them an essential aspect of cancer prevention.

    The partnership involving a person’s diet program and moods is a lesser acknowledged but similarly vital element. The usage of meals with better glycaemic content material – the existence of glucose in the blood – may enlarge signs or symptoms of depression and exhaustion. Veggies, fruit, and full grains have a reduced glycaemic load, even though refined carbohydrates and bakery products and solutions should really be averted as they have a increased percentage of the similar.

    Imbibing the ideal sort and quantity of foods performs a key function in other aspects way too, this kind of in excess weight decline, improved memory, heathy digestion and far more.

    However, as is rightly claimed, Rome was not crafted in a day. This adage applies to our food items and eating routines way too. Our overall body receives accustomed to new procedures slowly. A unexpected alter in these could be unsafe, but when performed correctly, results in being an intrinsic aspect of our everyday living. The most straightforward way to do this is to concentrate on what we consume, and, pretty literally, independent the grain from the chaff. A nutritious diet regime includes a combine of carbs, proteins, fat, vitamins, and minerals.

    Broad food items categories include things like:

    • Fruits: These are nourishing, and laden with wellness. Hunting at a couple of, we see that apples and oranges are a loaded source of Vitamin C, blueberries consist of anti-oxidants, and avocados are substantial in fibre, potassium, and Vitamin C.
    • Nuts and seeds: These are wealthy in fibre, and a need to for bone well being. Flax seeds, pumpkin seeds and sesame seeds assistance management cholesterol, and minimize swelling wherever in the physique. Chia seeds are a rich resource of magnesium and calcium, and walnuts are loaded with fibre, vitamins, and minerals.
    • Veggies: Greens type a crucial role in our each day eating plan. With a broad wide range accessible, they are a quality resource of vitamins. The listing is considerable, and illustrations are a lot of. Acquire, for occasion, broccoli, a vegetable that can be eaten each in the raw and cooked forms. It is an exceptional supply of fibre, and natural vitamins C and K. An additional case in point is that of garlic, which assists to improve the body’s immunity. Carrots, tomatoes, radish– the list is countless. An vital rule– Do not neglect your greens.
    • Grains: These contain lots of nutrition, fibre, ‘B’ group vitamins (thiamine, riboflavin, niacin, and folate) and minerals (iron, magnesium and selenium). Grains are commonly superior on carbs. Total grains – like oats, brown rice, quinoa – are loaded with fibre, natural vitamins and minerals.

    These ‘must haves’ in your diet are important, so be picky about your food items, as it is an essential investment decision in your physique – and head- now and in the potential.

    (Authored short article by Pranay Jain, Founder & CEO, BodyFirst)

  • Pujols Returns Home, Finds Fit With Cardinals

    Pujols Returns Home, Finds Fit With Cardinals

    With a wave of his hand and a suggestion of the cap, Albert Pujols walked again into the planet of the St. Louis Cardinals.

    Putting on a large smile and his acquainted purple No. 5 jersey, Pujols emerged from over and above the correct area wall at Roger Dean Stadium concerning the first and next innings of a sport versus Houston on Monday.

    Cardinals pitchers, catchers and coaches sitting down on chairs much down the line stood to acknowledge the 3-time NL MVP, as did the enthusiasts in the stands. Pujols strolled all over to the St. Louis dugout on the third base facet, the place he was greeted with hearty hugs and large-fives.

    All these many years later on, the slugger who served the Cardinals acquire two Globe Sequence championship was house.

    The Cardinals and Pujols have achieved settlement on a one particular-yr agreement valued at $2.5 million, supplying him a prospect to stop his profession in the place exactly where it begun.

    The 42-calendar year-old Pujols used section of Monday movie conferencing with veteran St. Louis catcher Yadier Molina. The two invested 8 a long time as teammates in St. Louis.

    “I’m happy for him to be below,” Molina stated. “It’s likely to be a pleasurable 12 months.”

    Pujols played the initial 11 many years of his occupation in St. Louis, teaming with Molina to guide the Cardinals to the 2006 and 2011 Earth Collection titles.

    “We’ve only received one particular point in mind – winning a further championship,” Molina said.

    Prior to Monday’s Graprefruit League recreation, Cardinals heart fielder Harrison Bader posted a image on social media of what appeared to be a No. 5 Pujols jersey hanging in a Cardinals’ locker.

    Pujols doesn’t swing nearly as fearsome a bat as he did throughout his St. Louis hey-day, but the Cardinals determined they have a place for a designated hitter who can strike remaining-handed pitching.

    That is one particular matter Pujols even now does properly.

    Pujols strike a mixed .236 for the Los Angeles Angels and Dodgers past year, but strike .294 with a .939 OPS towards lefties.

    Pujols wants 21 homers to grow to be the fourth job big leaguer to strike 700 in a vocation.

    “Adding anyone like that is ridiculous critical,” initial-calendar year manager Oliver Marmol reported. “What he does with that clubhouse exterior of his ability established is unbelievable.”

    The deal delivers Pujols back again to exactly where he turned a single of the game’s most effective and dangerous all-all-around hitters. The NL Rookie of the Calendar year in 2001 hit at least .300 with at minimum 30 homers and 100 RBIs in every of his initially 10 seasons in St. Louis.

    A wildly well known participant in St. Louis, Pujols played his final recreation for the Cardinals on Oct. 28, 2011, a Activity 7 get more than Texas in the Environment Sequence.

    Pujols won those three MVP awards and produced 9 All-Star groups with the Cardinals right before signing a 10-12 months, $240 million deal with the Angels in 2012. He was waived by the Angels previous May well although hitting .198, and signed with the Dodgers, for whom he strike 12 homers and drove in 38 runs in 85 video games.

    With the Nationwide League now adopting the DH rule, the Cardinals located a healthy with Pujols as opening day on April 7 from Pittsburgh at Busch Stadium approached.