Fit Notes: What Employers Need to Know

Fit notes replaced "sick notes" in 2010 to focus on what employees can do, not just what they can't. Here's how they work and what you need to do with them.

What Is a Fit Note?

A fit note (officially "Statement of Fitness for Work") is a document from a doctor advising whether someone is fit to work.

Key change from old sick notes: Doctors now consider whether someone could work with support, not just whether they're too ill to work at all.

When Is a Fit Note Required?

Absence Length	Certification Needed
Days 1-7	Self-certification only
Day 8 onwards	Fit note from doctor

The 7 days includes:

• Weekends
• Bank holidays
• Days they don't usually work
• Any calendar days

Example: Employee is ill from Monday. They need a fit note from the following Monday (day 8).

Who Can Issue Fit Notes?

Since July 2022, fit notes can be issued by:

• GPs
• Hospital doctors
• Nurses
• Occupational therapists
• Pharmacists
• Physiotherapists

The Two Categories

1. Not Fit for Work

The doctor believes the employee cannot work at all currently.

Your response:

• Accept the fit note
• Pay SSP (if eligible)
• Maintain contact
• Await next fit note or return

2. May Be Fit for Work

The doctor believes the employee could work with adjustments.

Common adjustment suggestions:

• Phased return to work
• Amended duties
• Altered hours
• Workplace adaptations

Your response:

• Consider the suggested adjustments
• Discuss with the employee
• Implement adjustments if reasonably possible
• If you can't accommodate, treat as "not fit"

Understanding "May Be Fit"

When a fit note says "may be fit for work," the doctor is saying:

"This person isn't fully recovered, but with the right support, they might be able to work"

What the Adjustments Mean

Phased return:

• Start with reduced hours
• Build up gradually
• Might be 2-4 weeks typically

Amended duties:

• Avoid certain tasks
• Lighter work
• Different responsibilities

Altered hours:

• Later start (medication effects)
• Shorter days
• Different shift pattern

Workplace adaptations:

• Equipment changes
• Desk/location changes
• Environmental adjustments

Your Options

When you receive a "may be fit" note:

Option 1: Make the adjustments

• Implement what's suggested
• Employee returns to work
• Review regularly

Option 2: Partially accommodate

• Make some adjustments
• Discuss what's possible
• Document what you can/can't do

Option 3: Cannot accommodate

• If adjustments aren't possible
• Treat as "not fit for work"
• Employee stays off on SSP
• Explore alternatives

You Don't Have to Accept Every Suggestion

You should consider the recommendations, but:

• You know your business
• Some adjustments may not be feasible
• Health and safety may prevent some
• Cost may be prohibitive

Document why if you can't implement suggestions.

How Long Do Fit Notes Last?

Fit notes can cover:

• A specific period (e.g., 2 weeks)
• An open-ended period (ongoing)

Specific Period Notes

• States exact dates
• New note needed if still unwell
• Employee should see doctor before it expires

Open-Ended Notes

• No end date specified
• Used for long-term conditions
• You can still request updates

What Information Is on a Fit Note?

A fit note includes:

• Patient's name
• Date of examination/assessment
• Fitness category (not fit / may be fit)
• Diagnosis (if patient consents)
• Adjustment recommendations (if may be fit)
• Duration
• Doctor's details and signature
• Date issued

The Diagnosis

Doctors should include the diagnosis if the patient agrees. You may see:

• Specific conditions (anxiety, back pain)
• General descriptions ("stress-related problem")
• Sometimes left blank

You cannot demand to know the diagnosis, but it helps you support the employee.

Digital Fit Notes

Since April 2022, fit notes are usually digital:

• Sent to patient electronically
• No wet signature required
• Patient forwards to you
• Print-outs are valid

Common Scenarios

Scenario 1: Employee Disagrees with Fit Note

Employee thinks they're fit; doctor says not fit.

Response: Follow the fit note. The medical opinion takes precedence. If you allow them to work against medical advice and something goes wrong, you're liable.

Scenario 2: You Disagree with Fit Note

You think they could work; doctor says not fit.

Response: You can:

• Accept the fit note (safest)
• Seek Occupational Health opinion
• Ask employee to get GP clarification
• Not override the fit note

Scenario 3: "May Be Fit" But You Can't Adjust

Response: Treat as "not fit for work." The employee stays off sick. Consider:

• OH referral for more specific advice
• Alternative adjustments you could make
• Whether adjustments will become possible

Scenario 4: Fit Note Expires, Employee Still Unwell

Response: They should get a new fit note. If they don't:

• Chase them for it
• You can stop SSP without valid certification
• Be reasonable about GP appointment availability

Scenario 5: Employee Returns Before Fit Note Expires

Response: This is allowed. If they feel better:

• Hold return-to-work meeting
• Check they're genuinely ready
• They don't need GP sign-off to return early
• Document the early return

Fit Notes and Disability

If the condition on the fit note might be a disability:

• Consider whether adjustments are reasonable adjustments duty
• "May be fit" suggestions may be legally required
• Get OH advice if unsure
• Document your considerations

Occupational Health vs Fit Notes

Fit Note	Occupational Health
From GP/healthcare professional	Workplace health specialist
Patient's perspective	Employer referral
General fitness advice	Job-specific advice
What patient tells them	Can see job requirements
Free to patient	Employer pays

OH can provide more detailed, workplace-specific advice. Consider referral for:

• Long-term absence
• Complex conditions
• When you need job-specific guidance
• Unclear fit note advice

Record Keeping

Keep fit notes:

• Securely (medical information)
• With absence records
• For duration of employment plus 6 years
• Separate from main personnel file (optional)

Challenging Fit Notes

You can question a fit note if you have genuine concerns:

Steps to Take

1. Discuss with the employee first
2. Refer to Occupational Health
3. Ask employee to request GP clarification
4. Write to GP (with employee consent) asking specific questions

What You Cannot Do

• Refuse to accept a valid fit note
• Demand the employee returns against medical advice
• Penalise them for being off with valid certification
• Contact their GP without their consent

Self-Certification

For the first 7 days:

• No fit note needed
• Employee self-certifies
• Your form or SC2 form
• Completed on return to work
• States dates and reason for absence

Tips for Managers

1. Don't ignore "may be fit" notes - They're an opportunity to get someone back
2. Talk to the employee - Understand what would help
3. Be creative with adjustments - Small changes can make the difference
4. Document everything - Keep records of fit notes and your response
5. Refer to OH when needed - For complex cases or long-term absence
6. Update your absence records - Track fit notes received
7. Chase missing fit notes - Don't let certification lapse without follow-up