Fit notes

A fit note is the medical statement you give your employer when you have been off sick for more than 7 calendar days. For the first 7 days you self-certify. Since 1 July 2022, fit notes can be issued by doctors, nurses, occupational therapists, pharmacists and physiotherapists, not only by GPs.

When you need one

The 7-day count includes weekends and days you would not normally work. So if you fall ill on a Thursday, day 7 is the following Wednesday, and if you are still off after that your employer can ask for a fit note.

For shorter absences, your employer will usually ask you to complete a self-certification form, either their own or the government’s SC2 form. Some employers ask for medical evidence earlier than 7 days under their own sickness policy, but you cannot be refused Statutory Sick Pay for the first 7 days just because you have no fit note.

Who can issue one

Since 1 July 2022 these healthcare professionals can legally certify fit notes:

• doctors
• nurses
• occupational therapists
• pharmacists
• physiotherapists

In practice, most fit notes still come from GP practices and hospital teams. If you are being treated by a physiotherapist or seen in a hospital clinic, ask them. It can save a separate GP appointment. Fit notes are now usually issued digitally and can be emailed or texted to you, and a digital note does not need a handwritten signature.

What the note can say

The note gives one of two judgements.

“Not fit for work” means the professional thinks you should stay off for the period on the note.

“May be fit for work taking account of the following advice” means you could do some work if changes are made. The professional can tick one or more suggestions:

• a phased return to work
• altered hours
• amended duties
• workplace adaptations

They can add comments, such as avoiding heavy lifting or night shifts for a few weeks. The note also states how long it lasts, or that you will not need to be assessed again.

How a “may be fit” note works at work

This option is used a lot in the public sector, where many jobs can be adjusted. Suppose you are a ward nurse recovering from a back injury, and the note says you may be fit for work with amended duties and no heavy lifting. Your manager should talk to you about whether that can be done, perhaps through clinic work, admin or a role on a different ward. If they can make the changes, you return on adjusted duties. If they cannot, you stay off sick and the note is treated as if it said “not fit”. You do not need a new note.

The employer decides what is practical. The note is advice, and the employer does not have to follow every suggestion, though if your condition is a disability under the Equality Act 2010 the duty to make reasonable adjustments applies. Our guide to reasonable adjustments at work covers that. The government’s Access to Work scheme can also help pay for equipment or support that makes a return possible.

Fit notes and sick pay

A fit note is the evidence that keeps your sick pay going after the first week. For Statutory Sick Pay, your employer can stop payment if you do not provide reasonable evidence once you have been off more than 7 days. Occupational schemes, such as NHS sick pay and teachers’ sick pay, have the same requirement written into the policy.

Send each new note to your manager or HR as soon as you get it, and keep a copy. Gaps between notes are one of the most common reasons sick pay is stopped by mistake. If a note runs out before your next appointment, ask the issuer for the next one in good time.

Occupational health and second opinions

Most public sector employers have an occupational health service. A manager can refer you there during sickness absence, and OH may give its own advice on a return to work, which sometimes differs from the fit note. OH does not replace the fit note. It gives the employer specialist advice on what you can safely do.

If you disagree with what your employer decides about a fit note, raise it with HR in writing, and involve your union rep if you have one. ACAS gives free advice on sickness absence disputes.