Fit Note (UK)
A medical certificate issued by a UK doctor or approved healthcare professional that advises whether a patient is either not fit for work or may be fit for work with certain adjustments, replacing the old-style sick note since 2010.
- What Is a Fit Note?
- How the Fit Note System Works
- The Two Fit Note Assessments
- Employer Obligations When Receiving a Fit Note
- Fit Notes and Statutory Sick Pay (SSP)
- Digital Fit Notes: The Current System
- Best Practices for Managing Fit Notes
- UK Fit Note and Sickness Absence Statistics [2026]
- Frequently Asked Questions About Fit Notes
What Is a Fit Note?
Key Takeaways
- ✓A fit note (formally the Statement of Fitness for Work) is a medical document used in England, Wales, and Scotland that replaced the old 'sick note' in April 2010.
- ✓It gives one of two assessments: 'not fit for work' or 'may be fit for work' with suggested workplace adjustments. There's no 'fit for work' option because that's the default state.
- ✓Since April 2022, fit notes can be issued by doctors, nurses, occupational therapists, pharmacists, and physiotherapists, not just GPs.
- ✓Employees don't need a fit note for the first 7 calendar days of sickness. They can self-certify using their employer's own process or form SC2.
- ✓Employers aren't legally bound by a fit note's recommendations, but ignoring them without good reason creates risk under the Equality Act 2010 if the condition qualifies as a disability.
The fit note was introduced to change how Britain thinks about sickness absence. The old sick note asked one question: is this person too ill to work? The fit note asks a different one: what work could this person do? That shift in framing matters. Under the old system, a GP would sign someone off entirely, and the employee would stay home until the certificate expired. The fit note encourages a conversation about what's possible. A GP might say the patient isn't fit for their full role but could manage part-time hours, amended duties, or work from a different location. It doesn't guarantee a smooth process. Plenty of fit notes still just say 'not fit for work,' especially for short-term conditions where modified work doesn't make sense. But for longer absences, particularly those involving musculoskeletal issues or mental health conditions, the fit note creates an opening for employers and employees to discuss a supported return rather than an all-or-nothing choice. HR teams in UK organizations deal with fit notes constantly. Understanding what they mean, what they don't mean, and how to act on them is a basic requirement of the role.
How the Fit Note System Works
The fit note process has specific rules about timing, who can issue them, and what information they contain.
Self-certification period
For the first 7 calendar days of sickness (including weekends and non-working days), the employee self-certifies. They don't need a fit note. Most employers have their own absence notification process and may use form SC2 or their own version. The 7-day rule applies per period of sickness. If an employee is off for 5 days, returns to work, and then falls ill again with a new condition, the 7-day count restarts.
Who can issue fit notes
Since April 2022, the list of professionals who can issue fit notes expanded beyond GPs. Registered doctors, nurses, occupational therapists, pharmacists, and physiotherapists can all sign fit notes. This change was designed to reduce pressure on GP appointments. The professional must have assessed the patient, either in person, by phone, or by video consultation. Digital fit notes became the default format in 2022, replacing paper certificates.
What the fit note contains
The fit note includes the patient's name, the date of assessment, the professional's assessment ('not fit for work' or 'may be fit for work'), the diagnosis or condition (in general terms), the recommended duration, and for 'may be fit for work' cases, suggested adjustments. The adjustment categories are: phased return to work, amended duties, altered hours, and workplace adaptations. The doctor can tick one or more of these and add free-text details.
The Two Fit Note Assessments
Understanding the difference between the two options is essential for HR teams processing absence paperwork and planning return-to-work support.
| Assessment | What It Means | Employer's Response | SSP Implications |
|---|---|---|---|
| Not fit for work | The professional believes the employee can't do any form of their job during the stated period | Employee remains off work; no obligation to offer modified work but can choose to discuss it | SSP continues as normal if eligibility criteria are met |
| May be fit for work | The employee could return if specific adjustments are made | Employer should consider the adjustments; if they can't accommodate them, treat it as 'not fit for work' | SSP continues if the employer can't make the recommended adjustments |
Employer Obligations When Receiving a Fit Note
A fit note creates specific expectations for HR teams. How you respond depends on which assessment the professional has given.
Handling 'may be fit for work' notes
When a fit note says 'may be fit for work,' the employer should review the suggested adjustments and determine whether they're feasible. This isn't about whether you want to accommodate the changes. It's about whether you can. If the note suggests a phased return starting at 3 days per week, and the role can accommodate that, you should offer it. If it suggests amended duties that don't exist in the employee's team, you may need to look at alternative tasks. If none of the recommended adjustments are possible, the employee is treated as 'not fit for work' and SSP continues. Document the reason you can't accommodate the adjustments.
When fit notes expire
A fit note covers a specific period. When it expires, one of three things happens: the employee returns to work, the employee gets a new fit note extending the absence, or the employee returns without a new note (meaning they're self-certifying fitness). Employers don't need a 'fit for work' certificate. There's no such document in the UK system. If the fit note period ends and the employee comes back, that's it. Some employers conduct return-to-work interviews as a matter of policy, which is good practice but not a legal requirement.
Equality Act 2010 considerations
If the employee's condition qualifies as a disability under the Equality Act (a physical or mental impairment that has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities), the employer has a duty to make reasonable adjustments. The fit note's suggestions often align with this obligation. Dismissing an employee whose fit note recommends adjustments you haven't seriously considered can lead to disability discrimination claims. The fit note isn't legally binding, but ignoring it without documented justification is risky.
Fit Notes and Statutory Sick Pay (SSP)
Fit notes and SSP are closely linked. Understanding the connection prevents errors in sick pay administration.
SSP eligibility
To receive SSP, an employee must earn at least the lower earnings limit (currently set at a weekly amount reviewed annually), have been sick for 4 or more consecutive days (including non-working days), and provide evidence of incapacity. For the first 7 days, self-certification is sufficient. From day 8 onward, a fit note is the standard evidence. SSP is paid for qualifying days (days the employee would normally work) after the first 3 waiting days of a period of incapacity.
When SSP stops
SSP ends when the employee returns to work, when 28 weeks of SSP have been paid, when the employee's contract ends, or when the employee goes into legal custody. After 28 weeks, the employee may be able to claim Employment and Support Allowance (ESA) or Universal Credit. The employer should issue form SSP1 to the employee before SSP runs out, giving them time to arrange alternative benefits.
Digital Fit Notes: The Current System
Since 2022, fit notes have moved from paper to digital, changing how employers receive and process them.
How digital fit notes work
Healthcare professionals create fit notes digitally through their clinical systems. The patient receives the fit note via the NHS App or as a PDF download. They then share it with their employer by email, screenshot, or by showing it on their phone. Paper printouts are also available for patients who prefer them or can't access digital services. The digital format includes the same information as the paper version. It's not a different document. It's the same document in a different format.
Implications for HR systems
HR teams need processes for receiving and filing digital fit notes. This means accepting them via email or HR portal upload, verifying authenticity (digital notes include the issuing professional's name and registration number), and storing them in compliance with GDPR. Some employers have updated their absence management systems to accept digital uploads directly. Others still print and file them manually. Either approach works legally, but digital-first is more efficient and creates better audit trails.
Best Practices for Managing Fit Notes
Practical guidance for HR teams handling fit notes as part of absence management.
- Train line managers on what a fit note is, what the two options mean, and how to respond to 'may be fit for work' recommendations. Managers are usually the first point of contact when an employee wants to return.
- Create a template for return-to-work conversations that covers the fit note recommendations, what adjustments the employer can offer, and what the employee feels comfortable with.
- Don't treat 'may be fit for work' as 'fully fit.' The employee still has a medical condition. The fit note is saying they can do some work with support, not that they're back to normal.
- Keep fit notes in medical records separate from general personnel files. Access should be restricted to HR and the employee's direct line manager as needed.
- Track fit note patterns at a team and organizational level. High volumes of fit notes in one department may indicate a workload, management, or workplace environment issue.
- Review your absence policy annually to ensure it reflects current fit note rules, SSP rates, and Equality Act guidance.
UK Fit Note and Sickness Absence Statistics [2026]
Data on sickness absence trends and fit note volumes in the UK.
Frequently Asked Questions
Can an employer reject a fit note?
Can an employee come back to work before a fit note expires?
What if an employee keeps getting fit notes for the same condition?
Does a fit note cover mental health conditions?
Are fit notes used in Northern Ireland?
Can a fit note be backdated?
Written by Adithyan RK