Phased return to work in the NHS

The NHS Terms and Conditions of Service Handbook tells employers to allow a return to work on reduced hours or, where possible, to encourage working from home, “without loss of pay” during a rehabilitation period. That is paragraph 14.14 in the England text (14.13 in the Scotland and Northern Ireland numbering). It adds that any such arrangement needs to be consistent with statutory sick pay rules. The handbook does not set the length of a phased return or a standard pattern of hours, so those are agreed locally.

What the handbook and NHS Employers say

NHS Employers describes a phased return as a way for staff to work towards fulfilling all their duties within an agreed timeframe while keeping their normal pay. The sickness absence toolkit calls it a helpful way to ease back into work after long-term absence. It says phased returns should follow occupational health advice, have a time limit and be recorded separately from sickness absence.

The statutory sick pay reference matters because of how NHS sick pay is built. The handbook says full pay must include any statutory benefits, and that statutory sick pay added to half pay must not come to more than full pay. In practice your employer and payroll team need to work out how any days you are still off, and any reduced hours, are paid under those rules. The guide to NHS sick pay and SSP explains the basics.

Fit notes and “may be fit for work”

A fit note says either “not fit for work” or “may be fit for work”. With the second, gov.uk says your employer should discuss changes that could help you return, with different hours or tasks as an example. NHS Employers says a fit note may recommend a phased return where a gradual increase in hours or duties could help.

If the employer cannot support what the note suggests, it can treat you as “not fit for work”. You do not usually need a new note. NHS Employers tells managers to look at phased return, temporary redeployment and tailored adjustments before reaching that point. Where your condition is a disability under the Equality Act 2010, the employer should also consider reasonable adjustments.

The occupational health role

Occupational health can advise managers on reasonable adjustments, and the toolkit says phased returns should be guided by that advice. Managers are told to focus on how your health affects your ability to do the role, not on medical details. They should explain why they are referring you and give you a copy of the referral letter. What the appointment involves, and what you can see, is covered in our guide to occupational health referrals.

Pay during the return

The handbook’s wording is about pay without loss during a rehabilitation period, and NHS Employers says staff keep normal pay on a phased return. Neither the handbook paragraph nor the NHS Employers pages say how a phased return affects the sick pay allowance on the Section 14 scale, or what happens if your pay is reduced for part of it, so ask your payroll team before you agree a plan and get the answer in writing.

Two handbook provisions may apply. The first is paragraph 14.13: employers have discretion to extend sick pay on full or half pay beyond the scale where a return to work is expected in the short term and an extension would materially support a return or assist recovery. Particular consideration should be given to staff without full sick pay entitlements.

The second is injury allowance. If your absence is attributable to your NHS employment and your pay is reduced during an employer approved period of rehabilitation, paragraph 22.13 says you can get injury allowance as a top up to 85 per cent of pay, within the 12 month limit in paragraph 22.12. The conditions are in NHS injury allowance.

What to ask your manager

Acas suggests the return to work meeting is the place to agree a plan, a phased return being one example. Questions to put to your manager or HR:

• How many weeks will the plan run, and who reviews it?
• What hours and duties apply in each week?
• Can any of it be done from home?
• Will I be paid my normal pay throughout?
• Has occupational health seen the plan, and can I have a copy of their advice?
• Will the phased return be recorded as sickness absence, and does it count towards any trigger in the sickness absence policy?

Ask for the agreed plan in writing, with dates. Your trust’s own policy decides the details, and a union rep or HR can tell you what it says.