Fit Notes Explained
What is a fit note? Understand how fit notes work, when you need one, and what 'may be fit for some work' means.
Last updated: 30 January 2025
Fit notes help manage sickness absence and support return to work where possible.
What Is a Fit Note?
Definition
A fit note (Statement of Fitness for Work):
- Medical certificate from doctor
- States whether you can work
- May suggest adjustments
- Replaced old-style "sick notes"
Purpose
| Old System | New System |
|---|---|
| "Sick note" | "Fit note" |
| Just said unfit | Can say "may be fit" |
| Binary (sick/not sick) | Options for adjustment |
| No employer guidance | Suggests accommodations |
When You Need One
Timeline
| Period | What's Required |
|---|---|
| Days 1-7 | Self-certification |
| Day 8 onwards | Fit note required |
| Long-term absence | Ongoing fit notes |
The 7-Day Rule
First 7 days:
- No fit note needed
- Self-certify (your own statement)
- Employer can provide their form
- Calendar days, not working days
From Day 8
After 7 days:
- Must get fit note from doctor
- Fit note can be backdated
- Need continuous coverage
- Doctor decides duration
Who Can Issue Fit Notes
Authorised Practitioners
| Practitioner | Can Issue? |
|---|---|
| GP | Yes |
| Hospital doctor | Yes |
| Nurse (registered) | Yes (since 2022) |
| Occupational health | Yes (some) |
| Physiotherapist (registered) | Yes (since 2022) |
| Pharmacist (registered) | Yes (limited, since 2024) |
| Dentist | No (dental only) |
Getting a Fit Note
Options:
- GP appointment (in-person or phone)
- Online consultation
- NHS App request
- Hospital discharge team
- Private healthcare provider
Fit Note Options
"Not Fit for Work"
Doctor believes:
- You cannot work at all
- Even with adjustments
- For specified period
- Medical reasons prevent working
"May Be Fit for Some Work"
Doctor believes:
- You could work with adjustments
- Specific recommendations given
- Employer should consider options
- Discussion needed
"May Be Fit" Adjustments
Types of Adjustment
| Adjustment | Example |
|---|---|
| Phased return | Fewer hours initially |
| Altered hours | Different shift pattern |
| Amended duties | Lighter work |
| Workplace adaptations | Different equipment |
How It Works
- Doctor suggests adjustment type
- Employer considers if possible
- Discussion with employee
- Implement if feasible
- Return to work
- Or treat as "not fit" if can't adjust
If Employer Can't Accommodate
If adjustments not possible:
- Treat fit note as "not fit"
- SSP continues
- No obligation to create new role
- Should explore options first
Duration of Fit Notes
Initial Notes
| Duration | Typical Use |
|---|---|
| 1-2 weeks | Short-term illness |
| 2-4 weeks | Recovery period |
| Longer | Established conditions |
Ongoing Notes
For longer absences:
- Doctor decides duration each time
- May extend period
- No maximum length
- Need continuous coverage
Gaps in Coverage
If gap between fit notes:
- Get backdated note if possible
- May affect SSP entitlement
- Explain to employer
- Get medical evidence
Self-Certification
First 7 Days
You can self-certify by:
- Completing employer's form
- Writing statement of illness
- Informing employer (their process)
What to Include
| Element | Content |
|---|---|
| Your name | Full name |
| Dates | When you were sick |
| Reason | General description |
| Signature | Confirm it's true |
Employer Forms
Many employers have:
- Standard self-certification form
- Return to work form
- Online absence system
- Specific process to follow
Reading a Fit Note
Key Information
| Section | Content |
|---|---|
| Date issued | When doctor wrote it |
| Your name | Who it's for |
| Assessment | Fit or may be fit |
| Duration | How long it covers |
| Condition | Diagnosis (sometimes) |
| Advice | Adjustments (if applicable) |
| Doctor details | Who issued it |
Functional Effects
Doctor may describe:
- What you can/cannot do
- Limitations on activities
- Relevant considerations
- Not always diagnosis
Diagnosis
| When Included | When Not |
|---|---|
| Relevant to work | Sensitive/private |
| Explains restrictions | Not necessary |
| Employee consents | Employee requests privacy |
Employer's Role
Receiving Fit Notes
Employer should:
- Accept valid fit notes
- Consider "may be fit" options
- Discuss adjustments
- Make reasonable accommodations
- Not demand diagnosis
Discussion
When fit note says "may be fit":
| Step | Action |
|---|---|
| 1 | Review suggestions |
| 2 | Discuss with employee |
| 3 | Assess what's possible |
| 4 | Implement or explain why not |
| 5 | Document discussion |
Common Questions
Can Employer Reject Fit Note?
No, they must:
- Accept valid fit notes
- Pay SSP accordingly
- Cannot demand different evidence
- Cannot challenge medical opinion
But they can:
- Refer to occupational health
- Ask for their own medical report
- Discuss return to work
Can I Return Early?
Yes:
- No obligation to stay off
- Discuss with employer
- May not need new fit note
- Consider if ready
What If Doctor Won't Give Fit Note?
If refused:
- Ask why
- May not be medically justified
- Could try different doctor
- Occupational health may help
Lost Fit Note?
If you lose it:
- Ask doctor for duplicate
- May be charged
- Keep copies in future
- Digital options available
Fit Notes and SSP
Proof for SSP
| Period | Evidence |
|---|---|
| Days 1-7 | Self-certification |
| Day 8+ | Fit note required |
| "May be fit" ignored | Treated as not fit |
If No Fit Note
Without fit note after day 7:
- Employer may withhold SSP
- Get note urgently
- Backdating may be possible
- Explain any delay
Long-Term Absence
Continuous Coverage
For extended illness:
- Keep getting fit notes
- No gaps in coverage
- Doctor decides duration
- May need review appointments
When Fit Notes Stop
Fit notes no longer needed when:
- You return to work
- 28 weeks SSP exhausted
- Employment ends
- You recover
Digital Fit Notes
Online Options
Since 2022:
- NHS App fit notes
- Email fit notes
- Electronic signatures
- PDF format acceptable
Employer Acceptance
Employers should accept:
- Digital fit notes
- PDF versions
- Screenshot of NHS App
- Same validity as paper
Return to Work
Using Fit Note Guidance
| Step | Action |
|---|---|
| Review adjustments suggested | What doctor recommended |
| Discuss with employer | What's possible |
| Agree arrangements | Put in writing |
| Start phased return | If appropriate |
| Monitor and adjust | As needed |
Phased Return
May include:
- Reduced hours initially
- Build up over weeks
- Regular check-ins
- Flexibility for appointments
No New Fit Note Needed
To return early:
- No "fit note to return"
- Just agree with employer
- Start when ready
- May help to have discussion
Related answers
Annual Leave and Sickness: Employer's Guide
Managing the interaction between annual leave and sickness. Accrual during sick leave, reclaiming holiday for illness, and carry-over rules.
SSP Eligibility
Who is eligible for Statutory Sick Pay? Understand SSP eligibility requirements, qualifying conditions, and who can't claim.
What is Statutory Sick Pay (SSP)?
SSP is the legal minimum amount UK employers must pay employees who are off sick. Learn the current rates, eligibility rules, and how long you can receive it.
Frequently Asked Questions
- When do I need a fit note?
- You need a fit note after 7 calendar days of sickness. For the first 7 days, you can self-certify. Your employer cannot insist on a fit note before day 8.
- What does 'may be fit for some work' mean?
- It means your doctor thinks you could work if your employer makes adjustments - like phased return, altered hours, amended duties, or workplace adaptations. Your employer should discuss these options with you.
- How long can a fit note last?
- There's no maximum - it depends on your condition. First fit notes are often 1-2 weeks. For longer-term conditions, doctors may issue notes for several weeks or months. After certain periods, your doctor may need to assess you in person.