What Is a Fit Note in the UK? Rules, When You Need One & How It Works (2026 Guide)

Last updated: March 2026

This guide is based on official guidance from GOV.UK, the NHS, and ACAS.

If you’re off work due to illness in the UK, you may be asked to provide a fit note after a certain period of absence. But many people still wonder: what is a fit note, when do you need one, and who can issue it?

Quick Answer: What Is a Fit Note?

A fit note (officially called the Statement of Fitness for Work) is a medical document issued by a qualified healthcare professional in the UK confirming whether a person is able to work or needs time off because of illness. A fit note may state that the employee is “not fit for work” or “may be fit for work with adjustments.”

It helps employers understand an employee’s health situation and whether workplace adjustments might help them return safely.

Fit notes are commonly used for sick leave, workplace adjustments, and statutory sick pay (SSP) decisions. They replaced the old “sick note” system in the UK and are now issued by a wider range of healthcare professionals.

Fit notes are sometimes still informally called “sick notes,” although the official UK term is the Statement of Fitness for Work. In legal and payroll contexts, any reference to a “sick note” should be treated as a reference to a fit note, particularly when assessing entitlement under SSP eligibility rules.

This guide explains what a fit note is, when it’s required, who can issue one, and how it works for both employees and employers in the UK.

What Is a Fit Note in the UK? (Statement of Fitness for Work Explained)

A fit note is a medical statement provided by a healthcare professional that explains whether a person is fit for work or not fit for work due to a health condition. The document is formally known as the Med3 form and is the only form of medical evidence officially recognised in UK employment law for the purpose of managing sickness absence.

The document was introduced in the UK in 2010, replacing the traditional sick note. The goal was to shift the focus from simply signing people off work to helping them return to work safely where possible.

Instead of just confirming someone is sick, a fit note allows medical professionals to indicate:

• The employee is not fit for work, or
• The employee may be fit for work with adjustments
  

These adjustments might include changes such as:

• Reduced working hours
• Lighter duties
• Temporary workplace adaptations
• A phased return to work
• Working from home

According to official UK guidance, the fit note helps facilitate communication between healthcare professionals, employees, and employers about health and work capacity.

When Do You Need a Fit Note in the UK?

In most cases, a fit note is not required immediately when someone becomes ill.

According to GOV.UK guidance on taking sick leave:

• Employees can self-certify sickness for the first 7 calendar days of illness.
• A fit note is usually required if the illness lasts longer than 7 days.

This means employees normally do not need to see a doctor or healthcare professional during the first week of sickness absence unless their employer requests medical advice earlier for specific reasons.

After the first seven days, employers may ask for a fit note as evidence of illness before continuing sick leave or paying Statutory Sick Pay (SSP).

Charges for a Fit Note

You normally do not have to pay for a fit note if you have been off sick for more than 7 days, as it forms part of standard medical care covered by the NHS.

However, if an employer asks for medical evidence during the first 7 days of sickness (when self-certification usually applies), a healthcare professional may charge a fee for issuing a note. In most cases, the employer should cover this cost.

Private providers and online consultation platforms may also charge fees for issuing fit notes, particularly where there is no existing NHS patient–provider relationship.

Self-Certification vs Fit Notes: Key Differences

Understanding the difference between self-certification and a fit note helps both employees and employers follow the correct process.

The table below summarises the key differences between self-certification and a fit note.

Self-Certification (First 7 Days)

For the first seven calendar days of illness, employees can confirm their sickness themselves. This is known as self-certification.

Employees typically inform their employer:

• The reason for absence
• The dates they were ill

Some employers ask workers to complete a self-certification form (SC2 form) when they return to work. While there is no legal obligation to use the SC2 form specifically, many organisations include self-certification requirements in their sickness absence policy.

Fit Note (After 7 Days)

If illness continues beyond seven days, a fit note from a healthcare professional may be required to confirm that the employee is unable to work or needs adjustments.

This helps employers manage longer-term sickness absence and determine eligibility for Statutory Sick Pay (SSP).

Who Can Issue a Fit Note in the UK?

Originally, only doctors could issue fit notes. However, UK rules were expanded in July 2022 to allow other qualified healthcare professionals to provide them, following the Statutory Sick Pay (Medical Evidence) (Amendment) Regulations 2022 and the introduction of digital fit notes in April 2022.

A fit note can now be issued by:

• Doctors (GPs or hospital doctors)
  
• Nurses
  
• Occupational therapists
  
• Pharmacists
  
• Physiotherapists
  

The healthcare professional must be responsible for the patient’s care related to the condition.

For example, a physiotherapist treating a musculoskeletal injury may issue a fit note if the condition affects the person’s ability to work.

The professional must also be registered with the appropriate UK regulator, such as:

• General Medical Council (GMC) — doctors
• Nursing and Midwifery Council (NMC) — nurses
• Health and Care Professions Council (HCPC) — allied health professionals
• General Pharmaceutical Council (GPhC) — pharmacists
• Pharmaceutical Society of Northern Ireland (PSNI) – pharmacists in Northern Ireland

This change was introduced to reduce pressure on GP appointments and allow faster access to medical certification.

It is especially helpful for patients receiving care in hospitals, community clinics, or specialist services, as it eliminates the need to book a separate GP appointment solely to obtain a fit note.

What Information Does a Fit Note Include?

A UK fit note typically contains several key pieces of information that help employers understand the employee’s health situation.

Common details include:

• The employee’s name
  
• The date the assessment took place
  
• Whether the employee is “not fit for work” or “may be fit for work”
  
• The period of time covered by the note
  
• Optional medical advice or workplace adjustments
  
• The healthcare professional’s signature and profession
• A diagnosis or a brief description of the condition affecting your ability to work, as required by the Med3 form’s “because of the following condition(s)” field.

What a Fit Note Does NOT Need to Include

In most cases, a fit note does not need to include:

• Detailed medical history
• Test results
• Sensitive personal information beyond what is necessary
• Full details of treatment plans

It focuses on functional ability and work capacity, not the specifics of diagnosis or treatment.

It is worth noting that according to BBC analysis of NHS data, approximately 72% of fit notes issued in 2025 did not specify a reason for the sickness absence. Where reasons were recorded, mental health and behavioural disorders were the most frequently cited category, with more than 956,000 fit notes listing a mental health condition as the underlying reason in 2025.

“Not Fit for Work” vs “May Be Fit for Work”

Fit notes contain two main options that healthcare professionals can select.

Not Fit for Work

If this option is selected, it means the healthcare professional believes the employee should not work at all during the specified period.

This is typically recommended when the health condition would make working unsafe or significantly worsen recovery.

May Be Fit for Work

If this option is selected, the healthcare professional believes the employee may be able to work if certain adjustments are made.

Examples of suggested adjustments may include:

• Reduced working hours
• Temporary changes to duties
• Avoiding heavy lifting
• Working from home
• A phased return to work
• Amended workplace environment or equipment

These suggestions help employers consider reasonable adjustments that support recovery while keeping the employee productive.

However, employers are not legally required to implement every suggested adjustment.

If adjustments cannot reasonably be made, the employee can be treated as not fit for work for that period.

How Long Can a Fit Note Last?

The duration of a fit note depends on the healthcare professional’s assessment of the illness or injury.

Common timeframes include:

• A few days or weeks for short-term illnesses
• Several months for longer recovery periods

According to GOV.UK fit note guidance, the duration of a fit note depends on the healthcare professional’s clinical judgment. However, during the first six months of a health condition, a fit note can generally be issued for up to three months at a time.

A review date may also be included, where appropriate, so the healthcare professional can reassess the condition.

Healthcare professionals can also backdate a fit note if they believe the patient was not fit for work before the consultation took place.

Read our detailed guide on how long a doctor can give a sick note in the UK.

Do Fit Notes Affect Statutory Sick Pay (SSP)?

Yes. Fit notes often play an important role when employees are claiming Statutory Sick Pay (SSP).

Under UK rules:

• SSP may be paid when an employee is sick for four or more consecutive days.
• The first 3 qualifying days are “waiting days” – no SSP is paid.
• Employers may request a fit note after the first seven days of illness to confirm the absence.

The fit note acts as medical evidence supporting continued sickness absence.

However, the exact SSP eligibility rules depend on additional factors such as earnings and employment status.

Can You Get a Fit Note Online or Without Seeing a GP in Person?

Yes. In many cases, it is now possible to receive a fit note without attending a face-to-face GP appointment.

Healthcare professionals may issue fit notes following:

• Telephone consultations
  
• Video appointments
  
• Online consultations
  

Since the COVID-19 pandemic, digital or online fit notes have become more common. These electronic versions can be emailed directly to the patient.

Digital notes are legally valid and can be shared with employers electronically.

This has made the process quicker and more convenient, especially for people who cannot easily attend in-person appointments.

Here’s our detailed guide on how to choose an online fit note provider in the UK.

How to Get a Fit Note in the UK

If your illness lasts longer than 7 days, you may need to obtain a fit note from a qualified healthcare professional.

You can usually get a fit note by:

• Booking an appointment with a GP or another healthcare professional
  
• Receiving care from a hospital or specialist clinic
  
• Completing an online or telephone consultation
  

During the consultation, the healthcare professional will assess your condition and determine whether you are not fit for work or may be fit for work with adjustments.

If appropriate, they will issue a fit note (Med3 form) covering the period of illness.

In many cases, a fit note can be issued on the day of the consultation or shortly afterwards, depending on the healthcare professional’s assessment.

See our guide on how to get a fit note online in the UK.

Fit Notes and Mental Health

Mental health conditions are now the single most commonly cited category on fit notes where a reason is recorded. In 2025, more than 956,000 fit notes cited mental health and behavioural disorders, far exceeding any other condition category.

This reflects broader trends in UK public health. According to the Office for National Statistics, mental health conditions accounted for 9.8% of all sickness absence occurrences in 2024. In the UK Civil Service, mental ill-health was the largest cause of long-term sickness absence (47.1% of long-term absence days) for the year ending March 2025.

Fit notes can be issued for mental health conditions including:

• Depression
• Anxiety disorders
• Stress-related illness
• Burnout
• Post-traumatic stress disorder (PTSD)
• Adjustment disorders

The same rules apply: self-certification covers the first 7 days, and a fit note from a qualified healthcare professional is needed beyond that.

Healthcare professionals assessing mental health conditions consider the same functional questions as for physical conditions: can the person perform the tasks required by their job, and if not, what adjustments (reduced hours, quieter environment, altered responsibilities) might help?

If a mental health condition is long-term or recurring, it may qualify as a disability under the Equality Act 2010, meaning the employer has a legal duty to consider reasonable adjustments.

Read our detailed guide on stress leave in the UK.

What Should Employees Do With a Fit Note?

Employees should normally send the fit note to their employer as soon as possible after receiving it.

Employers may accept:

• A digital copy
  
• A scanned copy
  
• A photo of the note
  

Some employers may request the original version later for records, but this varies by workplace policy.

Providing the note promptly helps employers manage absence records and ensure correct sick pay processing. If there is a delay in obtaining a fit note (for example, due to difficulty booking a GP appointment), employees should communicate this to their employer, ACAS guidance states that employers should be understanding in such circumstances.

What Should Employers Do When They Receive a Fit Note?

Employers should review the fit note carefully and consider any medical advice provided.

If the note indicates “may be fit for work,” employers should assess whether suggested adjustments are reasonable and practical.

Possible actions include:

• Discussing options with the employee
• Conducting a workplace risk assessment
• Offering a phased return to work
• Modifying duties temporarily
• Consulting occupational health for specialist advice

Open communication between employers and employees is essential to support recovery and maintain productivity. ACAS guidance emphasises that a fit note is a starting point for a conversation, not a rigid instruction.

Can an Employer Question or Reject a Fit Note?

Employers generally should not ignore or reject a fit note outright, because it represents professional medical advice.

However, employers may:

• Seek clarification from the employee
• Request an occupational health assessment
• Discuss possible adjustments
• Ask the employee to attend a company-appointed medical examination (at the employer’s cost)

If adjustments cannot reasonably be implemented, the employee can be treated as not fit for work during the period covered by the note.

Learn more in detail about whether an employer can override a valid doctor’s fit note in the UK.

Employers should always handle such situations carefully to avoid employment law disputes or discrimination risks under the Equality Act 2010, particularly where the health condition may constitute a disability.

Can an Employer Contact the Doctor Who Issued a Fit Note?

Employers cannot usually contact the healthcare professional who issued a fit note without the employee’s permission.

Medical information is protected under UK data protection and confidentiality rules, so employers must obtain explicit consent from the employee before requesting additional medical information.

If further medical clarification is needed, employers may instead request an occupational health assessment. This is a workplace-focused evaluation that assesses the employee’s fitness for their specific role without requiring access to full medical records.

Fit Notes and Long-Term Health Conditions

Fit notes can also be used for long-term health conditions or recovery periods.

In these cases, the note may support:

• Gradual return-to-work plans
  
• Workplace adjustments under the Equality Act 2010
  
• Occupational health assessments
• Discussions about long-term work capacity

Employers may need to consider reasonable adjustments if the condition qualifies as a disability under UK law. The Equality Act 2010 defines a disability as a physical or mental impairment that has a “substantial and long-term adverse effect” on a person’s ability to carry out normal day-to-day activities. “Long-term” means the condition has lasted, or is likely to last, for at least 12 months.

These adjustments might include flexible hours, modified duties, assistive equipment, changes to the physical workspace, or permission to work from home.

Failure to make reasonable adjustments where a disability is involved can constitute disability discrimination under the Equality Act 2010, which may lead to claims before an employment tribunal.

Common Myths About Fit Notes

Many misunderstandings still exist about how fit notes work.

Myth 1: Only GPs can issue fit notes

Fact: Several healthcare professionals can now issue them, including nurses and physiotherapists.

Myth 2: A fit note always means the employee cannot work

Fact: Not necessarily. Many notes indicate “may be fit for work” with adjustments.

Myth 3: Employers must follow every recommendation

Fact: Fit notes provide medical advice, but employers may consider whether adjustments are reasonable and practical.

Myth 4: Fit notes must be paper documents

Fact: Electronic fit notes are now widely accepted across the UK.

Key Takeaways

• A fit note (Statement of Fitness for Work) confirms whether someone can work during illness.
• Employees can self-certify sickness for the first 7 days.
• After 7 days, employers may request a medical fit note.
• Fit notes may say “not fit for work” or “may be fit for work.”
• Several healthcare professionals (not just GPs) can issue fit notes in the UK.
• Digital fit notes are now widely accepted.

A fit note plays an important role in managing sickness absence in the UK. It provides medical guidance about whether someone can work and whether workplace adjustments might support recovery.

Understanding how fit notes work — from the 7-day self-certification rule to the “may be fit for work” option — helps both employees and employers manage sickness absence more effectively and fairly.

Sources

• GOV.UK – Statement of Fitness for Work
  

• NHS – Sick leave and fit notes

• ACAS – Managing sickness absence

Disclaimer: This article is for general informational purposes only and does not constitute legal or medical advice.