Fit notes: what UK employers need to know

What a fit note actually is

The Statement of Fitness for Work — universally called the fit note — is a doctor's (or other healthcare professional's) record of an employee's ability to work. It replaced the old "sick note" in 2010 to shift the conversation from "you can't work" to "you can work, with these adjustments" wherever possible.

A fit note has two boxes the issuer can tick:

• Not fit for work — the employee cannot work at all for the period stated
• May be fit for work — the employee could work with reasonable adjustments

The "may be fit" option is the substantive change introduced in 2010 and the one most often mishandled by employers.

When an employee needs one

For sickness absences of seven calendar days or fewer, no fit note is needed. The employee self-certifies (typically using HMRC's SC2 form or the employer's own form). Self-certification is the evidence both for paying SSP and for managing the absence.

From day eight onwards (counting weekends and non-working days, not just working days), a fit note is required. The seven-day clock starts on the first day of incapacity for work.

Who can issue one

This is the area where employer practice often lags behind the law. Since July 2022, fit notes can be issued by:

• Doctors (GPs and hospital doctors)
• Registered nurses
• Occupational therapists
• Pharmacists
• Physiotherapists

Before 2022, only doctors could issue them — leading to GP appointment bottlenecks. The widening was a deliberate move to relieve primary care pressure.

A fit note from any of the above professionals is equally valid. Employers cannot ask for a doctor's note specifically.

"May be fit for work" — the adjustment options

When a healthcare professional ticks "may be fit for work," they can suggest one or more of:

• A phased return to work
• Altered hours (reduced or different)
• Amended duties (modified tasks)
• Workplace adaptations (equipment, location, environment)

The employer then has to make a choice:

• Implement the adjustments as suggested — work with the employee on how
• Treat as not fit for work — if the adjustments aren't practical, ignore the suggestion and treat the note as a standard "not fit" note

There is no third option. Specifically, you cannot reject the adjustments and still bring the employee back without them.

The format question

Until April 2022, fit notes required a wet signature from the issuing healthcare professional. Since then:

• Fit notes can be issued digitally with no signature
• A scanned, photographed, or emailed copy is acceptable evidence
• Original physical fit notes are still valid but no longer required

This matters because fit notes were a common drag on absence management — employees had to physically deliver them, employers had to file paper. The 2022 changes let the entire process happen digitally.

What the fit note records

A valid fit note shows:

• The patient's name
• The date of issue
• The condition or symptoms (sometimes generic — "flu," "back pain," "anxiety")
• The expected period of incapacity
• The "not fit" or "may be fit" decision
• Any adjustment recommendations
• The issuing professional's name and qualification

The condition or symptom field is often kept deliberately vague at the patient's request. Employers cannot demand more clinical detail.

Reasonable adjustments and the Equality Act

If the underlying condition is a disability under the Equality Act 2010 (a physical or mental impairment with a substantial, long-term effect on day-to-day activities), the employer's duty to make reasonable adjustments under section 20 of the Act may be triggered.

A "may be fit" fit note often signals an underlying condition that meets the disability threshold. Even if the absence is short, the recommendations may form part of a broader reasonable-adjustment conversation. Documenting both the fit note and the wider adjustment discussion is good practice and good legal protection.

Repeated and rolling fit notes

Some conditions require ongoing certification. The healthcare professional can issue a fit note covering a defined future period (typically up to 14 weeks). After that, a fresh assessment is needed.

For very long-term absence, a typical pattern is:

• Initial fit notes covering 1–4 weeks
• Subsequent rolling fit notes covering 4–12 weeks
• An occupational health referral for return-to-work planning
• A formal capability process if return is not foreseeable

The fit note is the gateway to the next stage, not a final diagnosis.

What employers can and can't do

Can:

• Require a fit note from day eight of any absence
• Ask the employee to clarify the recommended adjustments
• Refer the employee to occupational health
• Treat a "may be fit" note as "not fit" if adjustments aren't viable
• Keep fit-note copies for the duration of employment plus three years (for SSP purposes)

Cannot:

• Reject a fit note as evidence of incapacity
• Demand additional clinical information beyond what's on the note
• Insist on a doctor (rather than nurse / physio / etc) as the issuer
• Withhold SSP from a worker with a valid fit note covering the period
• Require a fit note for absences of seven days or fewer

Putting it into practice

A fit-note process needs to:

1. Track absences by start date (calendar days, not just working days)
2. Trigger a fit-note request automatically at day eight
3. Capture the fit note as a digital file in the employee record
4. Flag any "may be fit" notes for an explicit adjustment decision
5. Reference any adjustment decisions in subsequent absence-management actions

Most fit-note disputes come from employers either over-requiring (asking for one inside seven days) or under-actioning (filing a "may be fit" note without making the adjustment decision visible). Document both the receipt of the note and the response to it.