If you manage people in the UK, you'll deal with fit notes sooner or later. Whether it's a week-long cold or months of long-term sickness, understanding how fit notes work — and what your obligations are as an employer — is essential. This guide covers everything from self-certification to digital fit notes, adjustments, SSP, and dismissal considerations.
A fit note — formally called a Statement of Fitness for Work— is a medical document issued by a healthcare professional that advises whether an employee is fit or unfit for work. Fit notes replaced the old "sick note" system in April 2010.
The key change was philosophical. Under the old system, a doctor simply declared someone "sick" and off work. The fit note system shifted the focus to what an employee cando, not just what they can't. This was designed to reduce the number of people stuck on long-term sickness absence when they could have returned to work with reasonable adjustments.
Fit notes are used across the UK — England, Scotland, Wales, and Northern Ireland — and apply to all employees regardless of contract type, hours worked, or length of service.
An employee only needs a fit note after 7 consecutive calendar daysof sickness absence. This includes weekends, bank holidays, and any days they wouldn't normally work. The 7-day count starts from the first day of illness, not the first working day missed.
For absences of 7 days or fewer, employees self-certifytheir absence. No doctor's note is required. Most employers ask employees to complete a self-certification form on their return, recording the dates of absence and the reason for sickness.
Important: You cannot require an employee to provide a fit note for absences of 7 days or fewer. While you can ask them to fill in a self-certification form, insisting on a GP appointment for a short absence is unreasonable and could put unnecessary pressure on both the employee and the NHS.
During the first 7 calendar days of sickness, the employee self-certifies. In practice, this means:
Self-certification doesn't require any medical evidence. The employee simply states the reason for their absence in their own words. If you suspect abuse — for example, repeated Monday absences — the appropriate response is a return-to-work interview and absence monitoring, not demanding a doctor's note.
Until July 2022, only GPs and hospital doctors could issue fit notes. The rules were expanded significantly, and the following healthcare professionals can now sign a fit note:
This expansion was introduced to reduce pressure on GPs, who were spending a significant portion of their time issuing fit notes. It also means employees can sometimes get a fit note faster — for example, a physiotherapist treating a musculoskeletal condition can issue one directly without the employee needing a separate GP appointment.
Note:The healthcare professional must be involved in the patient's care. A random pharmacist cannot issue a fit note for a condition they haven't assessed.
A fit note can only contain one of two assessments:
This means the healthcare professional advises that the employee should not work at all during the period stated on the fit note. As an employer, you should treat this as medical advice that the employee cannot attend work. The employee remains off sick, and SSP continues to apply if they're eligible.
This is where the fit note system really differs from the old sick note. The healthcare professional is saying the employee couldreturn to work if certain adjustments are made. This doesn't mean the employee must return — it means you should have a conversation about whether the suggested adjustments are feasible.
If you can accommodate the adjustments, the employee returns to work under the modified arrangements. If you cannotaccommodate them, the fit note is treated as a "not fit for work" note, and the employee stays off sick.
When a fit note says "may be fit for work," the healthcare professional will recommend one or more of these four adjustments:
A gradual increase in working hours or days over a set period. For example, the employee might start with 3 days a week for the first fortnight, then move to 4 days, then back to full-time. This is common after operations, mental health conditions, or long-term illness. See our detailed guide on phased returns to work.
Temporarily changing the employee's responsibilities to avoid tasks that would aggravate their condition. For example, removing heavy lifting for someone recovering from back surgery, or reducing client-facing work for someone with anxiety.
Changing the employee's working hours rather than their total days. This might mean starting later, finishing earlier, or avoiding shift patterns that conflict with medication schedules. It could also mean moving from night shifts to day shifts temporarily.
Physical or environmental changes to the workplace. Examples include providing an ergonomic chair for back problems, moving a desk to a quieter area for someone with concentration difficulties, allowing remote working, or installing a screen reader for visual impairment.
When you receive a fit note with adjustments, you have legal obligations:
Equality Act 2010 warning:A condition counts as a disability if it has a substantial and long-term adverse effect on the person's ability to carry out normal day-to-day activities. "Long-term" means 12 months or more, or likely to last that long. Many conditions you might not immediately think of as disabilities — depression, anxiety, diabetes, cancer, MS — are covered. If in doubt, treat the condition as a disability and make adjustments.
Employers sometimes feel a fit note doesn't reflect reality — perhaps the employee seems well enough to work, or the recommended adjustments seem excessive. Here's what you can and cannot do:
Never pressure an employee to return to work against medical advice. This could result in a personal injury claim if their condition worsens, as well as potential tribunal claims for disability discrimination.
Since April 2022, fit notes have been issued digitally rather than on paper. Here's how the new system works:
The shift to digital fit notes has several advantages for employers: they're harder to forge, easier to store, and can be uploaded directly into absence management software like LeaveManager.
Practical tip: Update your sickness absence policy to reflect digital fit notes. Specify how employees should submit them (email, HR portal upload, etc.) and confirm that digital copies are accepted without needing a paper original.
Fit notes and SSP are closely connected but serve different purposes. A fit note is medical evidence of incapacity; SSP is the statutory payment during sickness absence.
The current SSP rate is £116.75 per week (2025/26 tax year). SSP is paid for up to 28 weeks. After that, the employee may be able to claim Employment and Support Allowance (ESA) from the DWP.
Key point:You need a fit note to continue paying SSP beyond 7 days. If an employee doesn't provide one, you can stop SSP — but you should give them reasonable time to obtain one and document your communications.
This is one of the most difficult situations for UK employers. An employee who is repeatedly or continuously absent with fit notes is still protected by employment law. However, dismissal for long-term sickness is possible if you follow the correct procedure.
Unfair dismissal risk: Dismissing someone on long-term sick leave without following a fair procedure is likely to be found unfair at tribunal. If the condition is a disability under the Equality Act, it could also be discriminatory — which has no cap on compensation.
Repeated short-term absences are handled differently from a single long-term absence. Typically:
Fit notes contain sensitive health data, which is a special category under UK GDPR. You must handle them carefully:
| Old "sick note" (pre-2010) | Fit note (2010 onwards) |
|---|---|
| Binary: "sick" or "not sick" | Two options: "not fit" or "may be fit with adjustments" |
| Focus on incapacity | Focus on what the employee can do |
| Paper only | Digital by default since 2022 |
| GPs and hospital doctors only | GPs, nurses, pharmacists, physiotherapists, occupational therapists |
| No adjustment recommendations | 4 specific adjustment types recommended |
| Wet signature required | Electronic signature valid |
Managing fit notes manually — paper copies in filing cabinets, Excel spreadsheets, or email threads — creates gaps, security risks, and missed follow-ups. LeaveManager brings everything together: