Guidance

Getting the most out of the fit note: guidance for employers and line managers

Updated 6 October 2023

What is a fit note?

The Statement of Fitness for Work, commonly known as the ‘fit note’ or Med 3 form is used to record details of the functional effects of your employee’s health condition. The fit note should allow the employer and employee to discuss the employee’s health condition and consider ways to help them stay in, or return to, work.

Fit notes may be issued by doctors, nurses, occupational therapists, pharmacists, and physiotherapists. The law requires one of these healthcare professionals to undertake an assessment, either through a face to face, video call, telephone consultation or through considering a written report by another healthcare professional, to complete a fit note.

1. Fit note policy changes

1.1 In 2022, Department for Work and Pensions (DWP) implemented two significant changes to the fit note. A new version of the fit note was introduced to replace the signature in ink with the name and profession of the issuer, which means that your employee can receive fit notes through digital channels (where the local IT system support this).

1.2 DWP have also enabled nurses, occupational therapists, pharmacists, and physiotherapists, in additions to doctors, to certify fit notes.

1.3 Digital fit notes have been embedded within primary care settings (GP IT systems) and we are working towards making fit notes available within secondary care settings (hospitals) from later this year. In the interim, you may receive a pre-printed fit note form if your employee has been discharged from hospital.

2. General rules of the fit note

2.1 People can only be given a fit note if their healthcare professional considers their fitness for work is impaired. If someone is considered fit for work, they will not be given a fit note. The employee does not require a ‘fit for work’ fit note if their fitness for work is not impacted.

2.2 Employees can self-certify for the first 7 calendar days of their sickness absence, which includes weekends and bank holidays. For further information, visit Employee’s statement of sickness to claim Statutory Sick Pay. If your organisation requires medical evidence for the first 7 days of sickness absence, the healthcare professional may charge a fee, and this cost should be covered by the employer.

2.3 The length of a fit note will depend on healthcare professional’s clinical judgement, however in the first six months of a person’s health condition, a fit note can only be issued for a maximum of three months at a time. A review date can be set, if required, to reassess the employee’s condition.

2.4 Healthcare professionals working in private practice or a private hospital that are not treating NHS patients may produce a report or form that includes the same information set out within the fit note form, which you can take into consideration. For further information see complies with ‘the Rules’. Alternative forms of medical evidence, including private medical certificates or Allied Healthcare Professionals Work Report, can be accepted as medical evidence in the same way as a fit note subject to your agreement. In this instance you do not need to ask your employee to obtain a further fit note.

2.5 Fit notes can be handwritten, computer-generated and printed out or sent digitally to your employee. It must include the issuer’s name, profession, and the address of the medical practice. Occasionally you may also be presented with an older version of the fit note form which will be signed in ink. If they are sent digitally or printed from a healthcare professionals IT system, it will contain a barcode. You can scan the barcode using a QR code scanner, so that you can add it to your sickness records.

2.6 If a healthcare professional has issued the fit note following hospital treatment, you may also receive a Med10 form. This will contain the dates your employee has spent as an inpatient in hospital and the period of health condition or disability it covers. This must be signed by a healthcare professional and not cover a period of more than 26 weeks.

2.7 A fit note can help an employer to make an informed decision about their employee’s health at work. On some occasions an employer may request an employee’s medical records from the healthcare professional to support an employee’s health and work. An employer must get their employee’s permission to ask for a report about their health.

2.8 An employer must keep the employee’s information confidential, the information should only be available to those who genuinely need it, for example Human Resources (HR). The employee should also be informed about how their information will be stored and for how long.

2.9 The employer and employee should agree on how they intend to stay in touch during the sickness absence period and agree on how much contact is reasonable. For further information, ACAS provides advice on keeping in touch during absence.

For further information, see Fit Note: Checklist for Employers.

3. Your employee’s fitness for work assessment

3.1 Your employee’s healthcare professional will have carried out a fitness for work assessment, and by using their clinical judgement they will have assessed if the employee is ‘may be fit for work’ or ‘not fit for work.’ The fit note should cover the duration that the employee is likely to require adaptation or is unable to work. If required a review date will be set by the healthcare professional.

For further information on each section of the fit note, see Fit Note: Form Details for Employers.

3.2 The healthcare professional says your employee ‘may be fit for work.’

Following on from the assessment, the healthcare professional may have utilised the tick boxes on the fit note to indicate the kind of general adaptations or reasonable adjustment your employee may require to stay in, or return to, work. The tick boxes will relate to the functional effects of your employee’s condition. This will give you the opportunity to discuss any reasonable adjustments with your employee to help them stay in, or return to, work. The options from the fit note form and examples of the general adaptions to consider are:

• a phased return to work: a gradual increase in work duties or hours
• altered hours: changes to the times or duration of work
• amended duties: changing duties to take account of a condition
• workplace adaptations: changing aspects of the workplace, including working from home

3.3 Your employee’s healthcare professional may also use the comment box to give you more detailed advice about what your employee can do at work. This advice will be about their general fitness for work, not just related to their current role, so that you have maximum flexibility to consider how you could support your employee to stay in, or return to, work. If there are particular aspects of your employee’s role that may be affecting their health, these will be mentioned in the comment box. For example, the advice may be ‘altered hours’ with further advice within the comment box, that somebody tires easily and so should not work for longer than 3 hours a day. This may affect their duties and the times they can work, so you can discuss options to support their ‘amended duties’ or ‘altered hours.’

3.4 You should have health and work discussions with your employee to see whether there are any changes which could support them to stay in, or return to, work. These discussions should be interactive as the employee is best placed to determine how their symptoms affect their ability to perform certain tasks as well as what can trigger their health condition. These discussions can involve line managers, HR, trade unions or occupational health specialists.

3.5 You may need to carry out a risk assessment to accommodate the advice on the fit note, for example, if it states that your employee should avoid lifting, you are liable if you give them work that involves manual handling. Guidance on risk assessments is available on the HSE website. You may need to make a referral to occupational health specialists, for work that may be affecting your employee’s health condition, this can be useful when dealing with complex cases.

3.6 Employers should consider the Equality Act when thinking about the management of sick leave and the return to work, with reasonable adjustments as needed. People who have HIV, cancer or multiple sclerosis are automatically classed as disabled under the terms of the Equality Act from the 1st day of diagnosis. For all other conditions, to count as disabled a person must experience substantial and long-term impact on their ability to do normal, day-to-day activities. For further information see link, Definition of disability under the Equality Act 2010.

3.7 We recommend you record any changes, so that everyone is clear on what has been agreed. In general, any changes should last at least until the fit note expires – although this will depend on the advice in the fit note and your discussions with your employee. You should also agree on a reasonable keeping in touch plan with your employee, so everyone has a clear understanding on next steps. For further information, ACAS - keeping-in-touch-during-absence.

For further information on each section of the fit note, see Fit note: Explaining the form for employers and line managers.

3.8 Possible changes to take into consideration

Consider how long your employee’s fitness for work is expected to be affected. There is a wide range of support available to help you make these changes. Check the further support section for additional help and condition-specific guidance.

You may take into consideration some temporary changes listed below when discussing your employee’s fitness for work - remember that this list is not exhaustive, and the best changes are ones that are tailored to your organisation and your employee:

• changing to a different job or location
• working from home
• changes to work equipment
• reduced or flexible hours
• adjustments to work premises
• a phased return to work
• giving some of their tasks to somebody else
• providing training or additional supervision
• providing a reader or interpreter
• voice activated software
• arranging a mentor or work buddy
• working in a team instead of by themselves (or vice versa)
• arranging for an occupational health assessment

The healthcare professional’s advice on the fit note could indicate the employee ‘may be fit’ for work - remember that this is advice, and you are not obligated to agree, although we recommend that you take any supporting information into consideration. If you are unable to agree on any workplace modification or adjustments, then you can use the same fit note as evidence for your sick pay procedures. The employee does not require a new or revised fit note from the healthcare professional. Always consider taking a copy of the fit note, this may be a digital or paper copy for your records (your employee should keep the original).

3.9 The healthcare professional says your employee is not fit for work

Your employee’s fit note will tell you how long they will not be fit for work, and whether they can expect to return to work as before once it expires. You should treat this as evidence for your sick pay procedures (see more information about sick pay). You can take a copy of the fit note for your records, your employee should keep the original as they may need it for benefits or other purposes.

4. Supporting your employee to stay in, or return to, work

4.1 Using the fit note to its full potential helps you reduce your sickness absence costs (for example sick pay, staff cover and lost productivity), and minimises the disruption caused by employees being off sick unnecessarily. Helping someone with a health condition to stay in, or return to, work can save you money and minimise disruption caused by employees being off work longer than necessary within your organisation. People can often return to work before they are 100% fit – in fact, work can even help their recovery and wellbeing.

4.2 If your employee is assessed as ‘may be fit’ for work, then their fit note will help you facilitate health and work discussions on changes to support their stay in, or return to, work. The right type of work is usually good for people’s physical and mental health. Often, a few simple changes can help someone with a health condition stay in, or return to, work. The fit note will not tell you what changes need to be made but will give you medical advice about how your employee’s health affects what they can do at work.

4.3 The advice in the fit note is about your employee’s fitness for work in general, and not specifically about their current job. This gives you maximum flexibility to discuss changes to help them stay in, or return to, work (which may include changing their duties for a while). The fit note acts as a catalyst for conversations about the employee’s health or adjustments during the return to work or stay in work process. You may not be able to make any changes based on the healthcare professional’s clinical judgement, but we recommend any advice is taken into consideration to help your employee stay in, or return to, work. Your employee can return to work at any time, even if this is before their fit note expires. They do not need to go back to their healthcare professional first.

5. Fit note related – FAQs

Can any healthcare professionals issue a fit note?

No. Only eligible healthcare professionals can issue fit notes. The healthcare professionals named in legislation are nurses, occupational therapists, pharmacists, physiotherapists, and doctors. Not all individuals within these professions will be suitably experienced and qualified to certify and issue fit notes so will only do so where they have the relevant training and knowledge to make an assessment of a person’s fitness to work. Additional guidance and training has been provided for healthcare professionals in order to support them in being able to establish that they can do so.

Can an employee obtain a fit note form from a community, private or high-street pharmacy?

Community pharmacists will not/do not have access to the ‘Med3’ form - which is the technical name for the fit note. Fit notes should only be certified following a full assessment of an individual’s fitness for work, and therefore should be provided by a clinician with a holistic oversight of the individual’s condition. Pharmacists working in multidisciplinary teams within general practices or hospital settings who are able to assess an individual’s fitness for work will have access to the official Med3 form.

What does the new fit note mean for me as an employer?

From April 2022, a fit note can be issued to your employee in a variety of ways. The only difference is the way in which the form is authorised; rather than being printed and signed the new fit note can be authorised digitally and will include the name of the healthcare professional who has issued it. It could be sent to the patient digitally, so your employee may not have a paper copy. Your employee could be issued with the previous version of the fit note while the new template is being rolled out across the healthcare professional IT system, this is still legally valid provided it has been signed by the healthcare professional.

How long will I continue to receive the previous version of the fit note?

Until all GP IT practices, and hospital systems are updated, the previous version (2017) fit note can be issued to your employee. We intend to notify you and update this guidance when this is complete.

What if the fit note is not signed or does not include the name of the healthcare professional?

Fit notes are required to be signed or to include the name of the healthcare professional that authorised it to be legally valid. Whether it is the previous or new version of the fit note, if it does not include the healthcare professional’s signature or name then it should not be accepted as it may not be genuine.

Does my employee need a fit note saying they are fit for work?

No. People do not need to be signed back to work and there is no option on the fit note to do so. If your employee’s healthcare professional assesses that they are fit for work, they will not be issued with a fit note. Your employee should return to work once their fit note expires (if they have not already done so) or will need to be issued with a new fit note.

Can other forms of medical evidence be accepted as proof of sickness absence?

Other forms of medical evidence including private medical certificates or Allied Healthcare Professionals Work Report can be accepted as medical evidence in the same way as a fit note subject to your agreement. In this instance you do not need to ask your employee to obtain further fit notes.

What should I do if I do not understand the advice on the fit note?

First, see if your employee can provide any more information. If you are still unsure, you could, if possible, consider advice from an occupational health specialist. You can write to the healthcare professional for more information although you may have to pay for this service and the healthcare professionals may not be able to respond immediately.

What if a fit note says my employee’s job may be affecting their health?

You should consider this carefully and bear in mind your responsibilities under Health and Safety Executive (HSE) regulations. The law requires you to record work related injury and illness and report certain cases to the relevant enforcement authority. It is very easy and straightforward to do this – see further information on types of reportable incidents.

What if a fit note recommends that I seek occupational health advice?

It is your decision whether to act on this advice and in some cases, you may be able to support your employee without needing additional expertise. For complex or possible work-related conditions, if applicable you may contact your in-house occupational health service for advice.

What should I do if I offer support to an employee, and they refuse?

Your first step should always be to ask your employee why they believe they cannot stay in, or return to, work, as there may be something you have not considered. If you cannot reach agreement, you may want to consult your in-house occupational health service if possible. If necessary, you should consider your organisational policy for absence disputes, which may give you guidance about sick pay rules when suitable work is refused.

You can get more information from ACAS and your employee may wish to seek advice from their trade union or an advice centre.

How does the fit note affect sick pay?

The fit note can be used as evidence for your sick pay procedures. If your employee’s fit note states that they may be fit for work, but you agree that they should remain off work, then they can still receive sick pay (because in these circumstances you treat the fit note as if it stated not fit for work). If your employee returns to work on reduced hours, you should consider whether your employee might be financially disadvantaged. In such cases you may decide to pay occupational sick pay for the hours not worked, or to pay full pay despite the reduced hours. Your employee’s absence must form a period of incapacity for work before Statutory Sick Pay is paid. More guidance about Statutory Sick Pay.

Can I challenge a fit note?

The fit note is based on an assessment by a healthcare professional about whether your employee is not fit for work or may be fit for work. If the healthcare professional has decided that an employee is not fit for work, this is evidence which you can accept as eligibility for Statutory Sick Pay.

Occasionally, you may think that your employee could do some work when they have been assessed as ‘not fit for work’ by their healthcare professional. You may request that the employee undertakes further assessment with a healthcare professional to determine their fitness to do such work. An employee cannot be required to provide further medical evidence beyond a fit note.

If you decide either before or after receiving medical advice, to stop paying Statutory Sick Pay to your employee, you should explain your decision to them. They are entitled to a written statement from you and can seek a formal decision on their entitlement to Statutory Sick Pay from HMRC. Further guidance on how to deal with a disagreement between yourself and an employee can be found here Statutory Pay entitlement: how to deal with disagreements - GOV.UK (www.gov.uk)

Am I still covered by Employers’ Liability Compulsory Insurance?

Your liability insurance does not prevent employees who may be fit for work from returning to work. You should ensure that you take account of the advice in the fit note, perform any relevant safety procedures, and consider whether a risk assessment is necessary. Contact your insurer if you have any concerns.

What if a fit note is for an ‘indefinite’ period but I cannot accommodate any of the advice?

You should consider as many ways as possible to help your employee back to work, including moving them to a different role. There may be additional legal issues to consider, for example your duties under the Equality Act.

Dismissal is a last resort and could be unfair if not handled properly, see further information on Dismissing staff. Ideally you should follow the ACAS Code of Practice on disciplinary and grievance procedures.

6. Case studies

See the document ‘Employer guidance - Case Studies’ from ‘Fit note: guidance for employers and line managers’ main page for more information.

• Case study 1: An employer makes changes based on healthcare professional advice – working from home
• Case study 2: An employer makes changes – a delivery driver who can’t drive
• Case study 3: An employer makes changes - phased return to work
• Case study 4: Short term illness due to long COVID – employer and occupational therapist supports employee to return to work.
• Case study 5: History of lower back pain and return to employment
• Case study 6: An employer makes changes based on physiotherapist advice

7. Further information

For more information on the fit note see fit note guidance

Return to employment advice

Access to Work

Access to Work is a discretionary grant that can provide practical and financial support to people with a disability or health condition to help them stay in, or return to, work.

Health Adjustment Passport (HAP)

The Health Adjustment Passport can be used to help an employer think about what support and reasonable adjustments an employee may need to stay in, or return to, work.

Support with employee health and disability

Support with employee health and disability

Is a new self-service resource to help businesses support and manage health and disability in the workplace. The service provides a step-by-step guide to handling common health and disability situations, making it easier for employers to take the right action at the right time, and signposting to expert advice.

Reasonable adjustments for workers with disabilities or health conditions

Reasonable adjustments for workers with disabilities or health conditions

Employers must make reasonable adjustments to make sure workers with disabilities, or physical or mental health conditions, are not substantially disadvantaged when doing their jobs.

NICE guidance on long-term sickness absence and incapacity for work

NICE guidance on long-term sickness absence and incapacity for work

This guide covers how to help people return to work after long-term sickness absence, reduce recurring sickness absence, and help prevent people moving from short-term to long-term sickness absence.

HSE guide to managing sick leave and return to work

HSE guide to managing sick leave and return to work

Gives advice to employers and managers about supporting people while on sickness absence and helping them to return to work.

Managing sickness absence, disputes, and sick pay

• Statutory Sick Pay (SSP): employer guide
• Guidance on managing sickness absence Health and Safety Executive (HSE)
• British Occupational Health Research Foundation has also developed guidance for managing rehabilitation and return to work following sickness absence
• The Employer’s Charter helps employers understand what they can do in respect of a number of issues
• For help on avoiding or managing work related disputes, visit ACAS

Support for employees with personal or social problems

Fit notes can only be issued for medical problems. If your patient is dealing with a problem that is not making them ill, they should not be issued with a fit note. However, there are resources available below to help people with a range of other issues, which you may wish to refer patients to.

• ACAS - ACAS
• Carers - NHS Social care and support guide, Carers Trust and Support on Care Information Scotland
• Debt issues - Debt and money guide from Citizen’s Advice and National Debt line
• Careers Advice - National Careers Service
• Relationships - Relate
• Bereavement advice - Bereavement Advice

Additional Healthcare Advice

Occupational Health Advice Service

Occupational health support can be very helpful in complex cases and when work may be affecting your employee’s health. You may offer an in-house occupational health service which are often provided by large employers and sometimes by the NHS or local authorities. Trade or regional business associations may have details of occupational health providers or other sources of help. For general and professional occupational health support see links below, to discuss costs, services, and potential benefits;

• England NHS Health at Work Network
• Scotland Healthy Working Lives and Scotland’s Service Directory on NHS inform
• Wales Healthy Working Wales

Details of occupational health providers

Occupational health services are sometimes provided by NHS or local authority services. To find details of providers in your area, contact:

Commercial Occupational Health Provider Association

NHS Health at Work Network – Support for Business

Using occupational health at work: Occupational health - Acas

Supporting organisational health and wellbeing professionals

Safe Effective Quality Occupational Health Service

Home (salus.co.uk) (Scotland)

Guidance and support for specific conditions

Provides practical tips and advice.

Royal College of Surgeons of England – Recovering from surgery

Royal College of Psychiatrists – Work and Mental Health

Macmillan – Work and cancer

Royal College of Physicians – Upper limb disorders: Occupational aspects of management

Chartered Society of Physiotherapy – reasonable-adjustments advice

Workplace guidance - Healthy Working Lives (Scotland)

Important information

This is only a guide and does not cover every circumstance. We have done our best to make sure that the information is correct as of August 2023. It is possible that some of the information is oversimplified, or may become inaccurate over time, for example because of changes in the law.