Fit Notes: What They Say, Who Can Issue Them and How to Use One

A fit note is the form a healthcare professional gives you when an illness or injury affects your ability to work. In England, Scotland and Wales you do not need one for the first seven days you are off sick, and that count includes days you would not normally work. For that first week you self-certify, which means you tell your employer yourself. If you are off for more than seven days in a row, your employer can ask for a fit note.

Since July 2022, GOV.UK guidance says fit notes can be issued by doctors, registered nurses, occupational therapists, pharmacists and physiotherapists. In practice most still come from GP surgeries and hospitals. A fit note says one of two things: that you are not fit for work, or that you may be fit for work with some changes. Most people have never heard of the second option, and it is often the more useful one.

Plenty of people still call it a sick note. The name changed in 2010 for a reason. The form is meant to say what you can do, not just what you cannot. Here is how it works and how to get the most out of it.

When you need a fit note and when you do not

The first seven days: self-certification

If you are off sick for seven days or fewer in a row, you do not need medical evidence. You let your employer know you are ill, following whatever process your workplace uses, and when you go back they may ask you to fill in a short form. Some employers use their own form. Others use the one HMRC provides for employees.

The seven days are calendar days, so weekends and days off count. If you fall ill on a Friday and your usual working week is Monday to Friday, the following Thursday is day seven.

Your GP surgery is not there to provide notes for that first week. If your employer insists on medical evidence before day eight, a surgery may say no, or may charge, because it is not something the NHS has to provide. Check your employer's sickness absence policy before you ring the surgery. It will usually tell you exactly what they expect and when.

From day eight

Once you have been off for more than seven days in a row, your employer can ask for a fit note to cover the absence. It is also the evidence employers use for sick pay, including Statutory Sick Pay. Sick pay rules are not covered by the fit note itself, so if you are unsure what you should be paid, check the current Statutory Sick Pay guidance on GOV.UK and your contract.

Do not wait until you are already a fortnight in. If you can see you will be off for more than a week, contact your GP practice around day five or six so the note can start when you need it. A fit note can be backdated to cover time you have already been off, but sorting it out late is more hassle for everyone.

If you have been in hospital

If you have had an operation or an admission, the hospital team should be able to give you a fit note that covers your expected recovery, so you are not left chasing your GP from the sofa a week later. Ask for it before you leave the ward. Write it on the list of questions for discharge, along with medicines and follow-up appointments, because it is easy to forget on the day.

Not just for employees

Fit notes are also used as evidence for some benefits when you cannot work because of illness, including Universal Credit. If you are self-employed or not currently working and are claiming, you may be asked for them too. The Jobcentre or the benefit guidance on GOV.UK will tell you what is needed for your claim.

Who can issue a fit note

Under the rules that have applied in Great Britain since July 2022, the following professionals can legally issue a fit note:

• Doctors
• Registered nurses
• Occupational therapists
• Pharmacists
• Physiotherapists

They must be registered with their professional regulator, and they must have assessed you. That assessment does not have to be face to face. It can happen in person, by phone or video, or be based on a written report from another healthcare professional involved in your care.

Being legally allowed to issue fit notes is not the same as every one of these professionals doing so. Guidance says a professional should only issue one when your condition is within their area of practice and they are in a position to judge how it affects your work. Many work in jobs where fit notes simply are not part of the role, or where they do not have access to the system that produces them. The pharmacist at your local chemist is unlikely to write you one for a chest infection, for example.

The sensible rule is to ask the professional who is most involved in your care right now. That might be:

• Your GP, or a nurse in the practice, for most illnesses
• A physiotherapist in your GP practice or an NHS musculoskeletal service, if you are being treated for a back, neck or joint problem
• The ward or clinic team, including occupational therapists and physiotherapists, after a hospital stay or operation
• Your community mental health team, if you are under their care

What a fit note actually says

The form records your name, the date you were assessed, and your condition, described in plain terms. Then the professional chooses one of two options.

'Not fit for work'

This means their view is that you should not work at all for the period stated. Your employer treats you as off sick for that time.

'May be fit for work taking account of the following advice'

This means you could do some work if certain things change. The professional can tick one or more boxes:

• A phased return to work - building back up gradually, for example a few half days in the first week, increasing over several weeks.
• Amended duties - changing what you do, such as no heavy lifting, no driving for work, or office-based tasks instead of site visits.
• Altered hours - changing your working pattern, such as starting later because mornings are hardest, working fewer hours for a while, or avoiding night shifts.
• Workplace adaptations - physical changes or equipment, such as a different chair, a workstation on the ground floor, or working from home for part of the week.

There is also a comments box. This is the most important part of the form. Good comments describe how your condition affects what you can do, in practical terms, rather than repeating the diagnosis.

Finally, the note gives the period it covers and says whether the professional needs to assess you again at the end of it.

What useful advice looks like

Compare these two comments. "Light duties." And: "Recovering from wrist fracture. Can type for short periods with breaks every 30 minutes. Should not lift more than a kettle's weight with the right hand or drive for work until review." The first leaves your manager guessing. The second gives them something to plan around. If you know what your job involves, tell the person writing your note. They cannot write useful advice about a job they know nothing about.

How to use a 'may be fit' note with your employer

A 'may be fit' note is a starting point for a conversation, not an instruction. Here is a sensible way to use one:

1. Send it promptly. A photo, scan or digital copy is usually fine. Do not sit on it until the day you are due back.
2. Ask for a short meeting or call with your manager or HR before you return. Go through the boxes and comments together.
3. Turn the advice into specifics. "Phased return" means nothing until someone writes down which days, which hours and which tasks, week by week.
4. Get it in writing. A short email confirming the plan protects both of you and stops it drifting.
5. Set a review date. Agree when you will check how it is going, ideally before the note runs out.
6. Speak up early if it is not working. Pushing through and relapsing helps nobody. A plan can be changed.

Your employer does not have to follow the advice on a 'may be fit' note. If they cannot make the changes suggested, GOV.UK guidance says the note should be treated as if it said you were not fit for work. You do not need to go back to the professional for a new one.

Separately, if your condition counts as a disability under the Equality Act 2010, your employer has a legal duty to make reasonable adjustments. That is a different and stronger obligation than a fit note. Our guide to reasonable adjustments at work explains how to ask, and Access to Work may help pay for support or equipment your employer would not normally provide.

Digital fit notes and the practical admin

Fit notes no longer need an ink signature. Many GP practices and hospitals now issue them digitally, often sending a link by text or email so you can download the note and forward it straight to your employer. Employers can accept a printed or electronic copy.

A few practical points:

• Keep your own copy. Save the file or photograph the paper version before you send it anywhere.
• If you lose it, ask the person or service that issued it for a copy.
• You can go back early. If you feel well enough before the note runs out, you can return to work. There is no 'fit for work' option on the form and you do not need anyone to sign you back on, though it is sensible to talk to your employer first.
• If you need longer, contact the issuer before the current note ends, not after.

Northern Ireland is different

Everything above describes the system in England, Scotland and Wales. Northern Ireland has its own fit note arrangements, and the rules on who can issue them may not match. If you live or work there, check the current guidance on nidirect or ask your GP practice.

When you need more than a fit note

A fit note is paperwork. It is not a review of your health. If you are not getting better as expected, see your GP rather than simply asking for another note. Call NHS 111 if you are worried and unsure where to go. Call 999 for chest pain, signs of a stroke such as a drooping face, arm weakness or slurred speech, severe difficulty breathing, or anything that feels like an emergency.

If you have been off for a while, your employer may refer you to an occupational health service. That is different from an occupational therapist: occupational health advises your employer about your fitness for work, and may be run by doctors, nurses or other specialists.

Where an occupational therapist fits

Occupational therapists focus on what people do every day, and for most adults that includes work. That makes them well suited to the 'may be fit' side of the form: working out what you can manage, what needs to change and how to build back up.

If you are seeing an NHS occupational therapist, for example in hospital, a community rehabilitation team, a hand therapy clinic or a mental health service, ask whether they can issue your fit note or contribute advice to it. Some can. Others will pass their assessment to your GP.

Private occupational therapists are a different picture. The law allows them to issue fit notes, but many do not, and you should not book a private assessment assuming you will come away with one. Ask first. Your GP or hospital team remains the usual route.

Where a private occupational therapist visiting at home can help is with the return itself. That might mean:

• Looking at what your job actually demands and planning a realistic phased return
• Assessing your home-working or office set-up after an injury, operation or flare-up
• Helping you manage fatigue, which is often what derails a return after illness. Our guide to fatigue management and pacing covers the basics
• Writing a report for your employer describing what you can and cannot do

Our guide to getting back to work after illness or injury goes into this in more detail, and our work and ergonomics page explains what an assessment involves.

An occupational therapist is not the right person for diagnosis or medication. That is your GP or specialist. A physiotherapist usually leads on treating muscle and joint injuries, and mental health services lead on treatment for mental health conditions. An occupational therapist works alongside them on the practical side of getting back to normal life.

Frequently asked questions

Can an occupational therapist give me a fit note?

Yes, if they are registered and have assessed you, under the rules in Great Britain since July 2022. In practice it depends on their role. Occupational therapists in NHS settings are more likely to issue them. Many private occupational therapists do not, so always ask before booking.

Do I need a fit note for the first week off sick?

No. For seven calendar days or fewer in a row you self-certify. Your employer can ask you to fill in a form, but they cannot usually expect medical evidence for that period. Check your sickness absence policy for how to report it.

Can my employer refuse a 'may be fit' note?

They do not have to make the changes suggested. If they cannot, the note is treated as if it said you were not fit for work, and you do not need a new one. If you are disabled, the separate duty to make reasonable adjustments still applies.

Can I go back to work before my fit note ends?

Yes. You do not need a note saying you are fit to return. Talk to your employer first so any adjustments are ready.

Can I get a fit note without seeing someone in person?

Yes. The assessment can be by phone or video, or based on a written report from another healthcare professional involved in your care. Whether a face-to-face appointment is needed is up to the professional.

Is a fit note the same as a sick note?

It is what most people mean by a sick note. The official form changed in 2010 so that it could also say you may be fit for some work with the right changes.

Next steps

If you are planning a return to work after illness or injury, see our work and ergonomics or functional assessments and reports pages, or current guide prices, and choose your area below.