What is a Fit Note?
A fit note, formally called a Statement of Fitness for Work, replaced the old-style sick note in April 2010. Rather than simply declaring an employee "sick" or "well," the fit note allows healthcare professionals to advise on whether an employee could return to work with appropriate adjustments.
Since July 2022, the following healthcare professionals can issue fit notes:
- GPs (general practitioners)
- Hospital doctors
- Registered nurses
- Occupational therapists
- Pharmacists
- Physiotherapists
The Two Options on a Fit Note
A fit note provides one of two assessments:
1. "Not fit for work"
The employee is not well enough to do any work. The employer cannot require them to work during this period.
2. "May be fit for work taking account of the following advice"
The employee could return to work if certain adjustments are made. The healthcare professional may suggest:
- Phased return: Gradually increasing hours or workload
- Altered hours: Changed start/finish times or reduced hours
- Amended duties: Lighter or different tasks temporarily
- Workplace adaptations: Physical changes to the workspace
If the employer cannot accommodate the suggested adjustments, the fit note is treated as a "not fit for work" certificate for SSP and absence purposes.
When is a Fit Note Required?
| Absence Duration | Evidence Required |
|---|---|
| Days 1-7 | Self-certification only |
| Day 8 onwards | Fit note from an approved healthcare professional |
The 7-day period includes weekends and non-working days.
Employer Obligations
When an employee provides a fit note, the employer must:
- Accept it at face value -- you cannot override a fit note or demand a second opinion (though you can refer the employee to occupational health separately)
- Consider the adjustments suggested under "may be fit for work" -- discuss them with the employee and try to accommodate them where reasonable
- Record the absence accurately for SSP and absence management purposes
- Store the fit note securely as it contains sensitive health data under UK GDPR
- Continue paying SSP if the employee is "not fit for work" and meets SSP eligibility criteria
Fit Notes and SSP
A fit note serves as evidence for Statutory Sick Pay purposes:
- SSP is payable from the 4th qualifying day of absence
- For the first 7 days, self-certification is sufficient
- From day 8, a fit note is needed to continue SSP
- SSP is paid at £118.75 per week (2025/26) for up to 28 weeks
Challenging or Questioning a Fit Note
Employers cannot reject a fit note, but they can:
- Ask the employee for clarification about the condition (with sensitivity)
- Refer to occupational health for a workplace-focused medical opinion
- Obtain a medical report under the Access to Medical Reports Act 1988 (with the employee's consent)
- Contact the GP (with the employee's written consent) if the fit note lacks detail
Common Fit Note Issues
- Back-dated fit notes: GPs can back-date fit notes in certain circumstances, but the employee should try to obtain them promptly
- Expired fit notes: If the fit note has expired and the employee is still unwell, they need a new one. The absence between expiry and renewal may not be covered for SSP
- "May be fit" but employer cannot accommodate: Treat it as "not fit for work" and continue SSP
- Digital fit notes: Since April 2022, most fit notes are issued digitally and sent to the employee's NHS account or printed
How Grove HR Helps
Grove HR tracks fit note dates and expiry, sends automatic reminders to employees and managers when a fit note is about to expire, records any adjustments recommended, and integrates with SSP calculations to ensure payments are accurate.
Frequently Asked Questions
Can my employer ignore a fit note?
No. An employer must accept a fit note as valid medical evidence. They cannot override it or force the employee to return to work against the advice on the fit note. However, the employer can refer the employee to occupational health for additional guidance.
What if my fit note says 'may be fit for work' but my employer cannot make the adjustments?
If the employer genuinely cannot accommodate the recommended adjustments, the fit note is treated as though it says 'not fit for work.' The employee remains off sick and continues to receive SSP if eligible.
Do I need a fit note for stress or mental health?
Yes, the same rules apply. If you are off work for more than 7 calendar days due to stress, anxiety, depression, or any other mental health condition, you need a fit note. GPs can issue fit notes for mental health conditions and may recommend phased returns or adjusted duties.