Fit note: what UK employers need to know

Published Wednesday 19 August 2026

Table of contents

• What is a fit note?
• When do employees need a fit note?
• What should you do when you receive a fit note?
• How do fit notes affect statutory sick pay?
• How do you plan a safe return to work?
• Are there charges for a fit note?
• How do you keep records and stay compliant?
• Simplify sickness absence records with Xero
• FAQs on fit notes for UK employers

Key takeaways

• A fit note is medical evidence required after seven days of sickness absence, and digital versions are fully valid without a wet signature.
• You must review the healthcare professional's advice, discuss adjustments with your employee, and document your decision with clear review dates.
• Statutory Sick Pay eligibility depends on qualifying days and continuous absence, and you can combine SSP with wages when an employee works reduced hours.
• Keep fit note records secure, limit access to protect employee privacy, and maintain a clear sickness absence policy that sets expectations for reporting and evidence.

What is a fit note?

A fit note is a medical statement that confirms whether an employee is fit for work. In the UK, it's also called a sick note, though the official term is a "statement of fitness for work." The form replaced the old "sick note" system in 2010 to focus on what people can do, not just what they can't.

You'll need a fit note when an employee has been off sick for more than seven calendar days. It's issued by a registered healthcare professional and provides evidence for Statutory Sick Pay (SSP) purposes and helps you plan a safe return to work.

The fit note is a specific UK employment document that plays a central role in managing sickness absence compliantly. The terms “fit note” and “sick note” are often used interchangeably. Both refer to the same UK document.

Who can issue one and is a digital fit note valid?

Several registered healthcare professionals can issue a fit note. The following are all authorised to do so:

• Doctors (general practitioners (GPs) and hospital doctors)
• Registered nurses
• Occupational therapists
• Physiotherapists
• Pharmacists working in National Health Service (NHS) settings

Digital fit notes are fully valid. There's no requirement for a wet signature, but the issuer's details must be clear. Employees can share a digital fit note via the NHS App, email, or a printout, and you should accept it as evidence.

The form has two main options:

• Not fit for work: The employee should not work at all
• May be fit for work: The employee might be able to work if you make adjustments

The healthcare professional may suggest changes such as a phased return, amended duties, altered hours, or workplace adaptations. These are recommendations, not legal requirements, but you should consider them seriously.

When do employees need a fit note?

An employee needs a fit note after seven calendar days of sickness absence. For absences of seven days or less, they can self-certify under your company policy, usually by completing a simple form or notifying their manager.

The seven-day rule includes weekends and bank holidays. If someone is off sick from Monday through the following Monday (eight days), they need a fit note to cover the absence from day eight onwards.

How do employees get a fit note?

Employees should contact the healthcare professional supporting their care. This could be their GP, a hospital doctor, or another registered professional listed above. The appointment can be arranged in a number of ways:

• In person at a surgery or clinic
• By telephone consultation
• Via video call

Many NHS services now offer digital access. Employees can request a fit note during a consultation, and it may be issued electronically and made available via the NHS App for easy sharing with you.

Encourage employees to request a fit note in good time if their absence will continue beyond seven days. This keeps the evidence continuous and helps you manage SSP and absence records without gaps.

After seven days of sickness absence, the employee must obtain a fit note from their GP or another qualified healthcare professional to continue claiming SSP. The healthcare professional will assess whether the employee is not fit for work or may be fit for work with adjustments, then issue a note covering the relevant period.

What if there's a delay getting a fit note?

Sometimes employees may not get a GP appointment straight away. In that situation, you still have several options while you wait.

You can ask the employee to keep you updated and to request the fit note as soon as they can. In the meantime, you can accept other evidence of sickness to support your records:

• a letter from a GP or hospital confirming the employee is unwell
• a hospital appointment letter or discharge summary
• a written explanation from the employee with a commitment to provide the fit note promptly

Once the fit note arrives, it can be backdated to cover the full period of absence. Keep a note of when you asked for it and when it was received, so your records stay complete.

What other proof of sickness can you accept?

A fit note is the standard form of medical evidence for absences over seven days, but it isn't always the only option. In some circumstances, you can accept alternative documentation.

Acceptable alternatives may include:

• a letter from a GP, consultant, or hospital doctor confirming the employee's condition
• a hospital discharge letter or outpatient appointment confirmation
• an occupational health report if your business uses an occupational health provider
• a self-certification form (SC2) for absences of seven days or less

You decide what evidence to accept for absences that don't require a fit note. For absences over seven days, a fit note from a registered healthcare professional remains the recognised standard. See the GOV.UK guidance on taking sick leave for the authoritative list.

What should you do when you receive a fit note?

When you receive a fit note, your employer obligations include the following steps:

1. Read the advice carefully. Note whether the employee is "not fit for work" or "may be fit for work," and review any suggested adjustments.
2. Speak with the employee. Have a supportive conversation to understand their situation and discuss what adjustments might help.
3. Agree on a plan. Decide together what you can offer, set a trial period if needed, and fix a review date.
4. Record your decision. Document what you agreed, why, and when you'll check progress.

This process protects both you and your employee. It ensures you're meeting your duty of care and considering reasonable adjustments, and it gives the employee clarity on what happens next.

What adjustments could you offer?

If the fit note says "may be fit for work," the healthcare professional may suggest a range of changes to help the employee return safely. Common options include:

• Phased return: Gradually increasing hours or days over a set period
• Amended duties: Temporarily removing heavy lifting, customer-facing tasks, or other stressors
• Altered hours: Shorter shifts, flexible start times, or remote working
• Workplace adaptations: Ergonomic equipment, a quieter workspace, or adjusted lighting
• Additional support: Closer supervision, mentoring, or training refreshers

Match the adjustments to the employee's role and the medical advice. Set a clear time limit and review date so both parties know when you'll assess progress. For example, "You'll work four-hour days for two weeks, then we'll meet on [date] to review."

What if you cannot make the suggested changes?

If the suggested adjustments aren't practical for your business, you should consider the following options:

• Explore alternatives: Discuss other changes that might work and document your reasoning
• Consider temporary redeployment: Can the employee do different work while they recover?
• Keep them off work if necessary: If no adjustments are feasible, the employee may need to remain on sick leave
• Assess SSP eligibility: If they stay off, check whether they qualify for statutory sick pay

Always document your decision and the reasons. If you can't implement the healthcare professional's advice, explain why in writing and keep a record. This protects you if the employee later raises a grievance or claim.

How do fit notes affect statutory sick pay?

A fit note is the evidence you need to support SSP decisions for absences lasting more than seven days. SSP is the legal minimum you pay employees who are off sick and meet the qualifying conditions.

The key SSP qualifying conditions are as follows:

• Employees must earn at least the lower earnings limit (check HMRC for current rates).
• They must be off work for at least four consecutive days, including non-working days.
• SSP is paid from day four of sickness absence, and the fit note provides medical evidence from day eight onwards.

If an employee is working reduced hours under a "may be fit for work" note, you can combine wages for hours worked with SSP for hours not worked. This is called part-work SSP, and it helps employees return gradually without losing all income.

What should you record for SSP?

Keep clear records to support SSP payments and meet HMRC requirements. You'll need to retain the following for each absence:

• Employee details: Full name, National Insurance number, and qualifying days (the days they normally work)
• Absence evidence: Dates covered by self-certification and fit notes, with copies of each fit note
• SSP payments: Dates SSP was paid, amounts, and how many SSP days were used
• Part-work arrangements: Hours worked, wages paid, and SSP paid for non-working hours
• Decisions and communications: Notes from return-to-work meetings, agreed adjustments, and review dates

Accurate records protect you during audits and help you track absence patterns. They also make it easier to answer employee queries and resolve disputes quickly.

For detailed SSP rules and rates, see the GOV.UK guidance on employers' sick pay.

How do you plan a safe return to work?

Use the fit note advice to build a simple return-to-work plan. The goal is to bring the employee back safely, support their recovery, and maintain productivity without added risk.

A good return-to-work plan includes the following elements:

• Clear goals: What does success look like? (for example, back to full duties within four weeks)
• Specific adjustments: List what will change (hours, duties, location)
• A timeline: When will adjustments start, and how long will they last?
• Review points: When will you check progress and decide next steps?

Return-to-work steps for employers

Follow these steps to manage a return to work after a fit note period:

1. Review the fit note. Take note of the suggested adjustments. Check whether the note says "not fit for work" or "may be fit for work," and identify any specific recommendations from the healthcare professional before you speak with the employee.
2. Meet the employee. This is to agree on duties, hours, and a review date. Keep the conversation supportive and focused on what they can do. This meeting is also a good opportunity to check how the employee is feeling and whether they need any additional support before returning.
3. Update systems. Adjust the rota, update the risk assessment if needed, and brief the team on any handovers or changes. Make sure any temporary adjustments are clearly communicated so colleagues know what to expect during the transition period.
4. Record the plan. Log the absence, the agreed adjustments, and SSP decisions in your HR or payroll system. A written record protects both you and the employee if questions arise later about what was agreed.
5. Check progress on the review date. If the employee is coping well, you might increase hours or duties. If not, extend the adjustments or seek further medical advice. Don't wait until the review date; if the employee raises concerns earlier, address issues as they come up.
6. Close the case. Do this when the employee returns to normal duties or when a new fit note arrives with updated advice. Update your records to reflect the outcome and note any patterns that might inform future absence management.

This structured approach ensures you're compliant, supportive, and clear about expectations. It also makes it easier to spot patterns if the same employee has repeated absences.

For more guidance on managing employee health and absence, see the GOV.UK fit note guidance for employers and line managers.

Are there charges for a fit note?

NHS-issued fit notes are free. Employees registered with an NHS GP or treated in an NHS hospital won't pay for a fit note. Charges only arise when an employee uses a private GP or private healthcare provider.

Private providers set their own fees, and these vary. You can't require an employee to use a private provider to get a fit note faster, and you're not legally required to reimburse the cost. If you choose to reimburse, treat it as a taxable benefit and record it through payroll.

How do you keep records and stay compliant?

Confidentiality and data protection are critical when handling fit notes. Medical information is sensitive personal data under UK GDPR (General Data Protection Regulation), so you must handle it carefully. Your obligations include:

• Limit access. Only HR, payroll, and line managers who need to know should see fit notes
• Store securely. Use password-protected files or locked cabinets, and avoid sending fit notes by unencrypted email
• Retain appropriately. Keep fit notes for as long as your policy states (often three to six years after the absence ends), then securely destroy them
• Respect privacy. Don't share details of an employee's condition with colleagues unless the employee consents or it's essential for a reasonable adjustment

Set a clear sickness absence policy

A written sickness absence policy sets expectations and helps you manage absence consistently. Your policy should cover the following areas:

• Reporting rules: How and when employees must notify you of sickness absence
• Self-certification: The process for absences up to seven days
• Fit note requirements: When a fit note is needed and how to submit it
• Return to work: What happens when an employee comes back, including return-to-work meetings
• Adjustments and support: How you'll consider fit note advice and what support is available

Train managers to run supportive, non-judgmental return-to-work meetings. These conversations help you understand the absence, check the employee's well-being, and agree on next steps. They also deter unnecessary absence and show you care about your team.

For more on managing absence and employee wellbeing, explore related guidance on sick leave and workplace health.

Simplify sickness absence records with Xero

Clear records help you manage fit notes, statutory sick pay, and return-to-work plans. Xero makes it easier to track sickness absence, keep payroll accurate, and store key information securely so you can focus on running your business.

Get one month free to see how Xero can support your payroll and record-keeping.

FAQs on fit notes for UK employers

These FAQs answer common questions UK employers ask about fit notes so you can act quickly and stay compliant.

Can I ask for a fit note during the first 7 days?

No. For the first seven days, employees can self-certify, but you can ask them to complete a self-certification form (SC2) so you have the absence recorded for Statutory Sick Pay (SSP) purposes.

Is a photo or printout of a digital fit note acceptable?

Yes. Digital fit notes are valid, and a photo, PDF, or printout is acceptable evidence. The key requirement is that the issuer's details are clear and the note covers the relevant dates. You don't need a wet signature.

How long can a doctor issue a fit note for?

There's no fixed maximum. A healthcare professional can issue a fit note for any period they consider appropriate, from a few days to several months, depending on the employee's condition. For long-term absences, fit notes are often issued in stages, so plan regular review points and keep your SSP records updated as each new note arrives.

Do employees need a fit note to return to work?

No. A fit note is evidence of unfitness for work or fitness with adjustments. Employees do not need a separate "return to work" note. Once the fit note period ends and the employee feels ready to return, they can come back to work.

Can an employer refuse a fit note?

You must accept any valid fit note issued by a registered healthcare professional. However, you are not legally required to follow the suggested adjustments if they are not reasonable or practical for your business.

You must consider them carefully, discuss alternatives with the employee, and document your decision. If you cannot make the changes, you should explain why and explore other options.