Guidance

The fit note: guidance for patients and employees

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 was introduced in 2010. The fit note can be issued following a health and work assessment by the healthcare professional, either a doctor, nurse, occupational therapist, pharmacist, or physiotherapist, who may be responsible for your care plan. The fit note will provide advice to you and your employer about the impact of your health condition, where that may have an effect on your fitness for work.

The fit note is intended to support you stay in, or return to, work. It can also enable you to access health-related benefits or evidence eligibility for Statutory Sick Pay (SSP). You can use your fit note to support a claim to benefits. More information can be found on how to make a claim on the fit note itself, or on the benefits pages.

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 you can receive your fit note 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. This means you can receive a fit note from the healthcare professional treating you, for instance a physiotherapist, if it is appropriate for them to do so.

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 when you are discharged from hospital.

2. When to consider a fit note

2.1 If you are fit for work, you do not need a fit note. You also do not need one if you are off sick for 7 calendar days or less (including weekends and bank holidays), because you can self-certify your leave for this time – see guidance on employee’s statement of sickness to claim Statutory Sick Pay. If you need a fit note, contact the healthcare professional treating you. They will assess whether your health condition impacts on your ability to work and whether a fit note is required.

2.2 You will not have to pay for a fit note if you have been ill for more than 7 calendar days, including weekends and bank holidays. If your employer 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.

3. General rules of the fit note

3.1 The fit note is based on an assessment by a healthcare professional about their patient’s fitness for work. In order to complete a fit note, the healthcare professional can undertake an assessment, either through a face-to-face appointment, video call, telephone consultation or through considering a written report by another healthcare professional.

3.2 Your healthcare professional will only give you a fit note if your health affects your fitness for work, they cannot give you a fit note stating that you are ‘fit for work.’ The fit note is classed as advice from your healthcare professional to help you and your employer discuss ways to support you to stay in, or return to, work.

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

For further information on each section of the fit note, see Fit note: Explaining the form for patients and employees.

3.4 Healthcare professionals working in private practice or a private hospital that are not treating NHS patients may produce other forms of medical evidence, including private medical certificates or Allied Healthcare Professionals Work Report. These may be accepted by your employer as medical evidence in the same way as a fit note, but this would be subject to their agreement.

3.5 It is important that you are not signposted to other healthcare professionals when discharged from a hospital setting purely for the purposes of certifying a fit note. The healthcare professional responsible for your discharge should be the one who issues the fit note if possible, and you should discuss this with them before you are discharged.

3.6 Your healthcare professional cannot give you a fit note for non-medical problems (such as problems at home or relationship trouble at work). They may, however, be able to suggest other sources of help and support – some are listed in further support.

3.7 Fit notes can be handwritten or computer-generated and can be printed or shared with you digitally. It must include the issuer’s name, profession, and the address of the medical practice. If your fit note does not include the issuer’s name or signature it is not valid and could be rejected by your employer or the DWP and you may be asked to obtain a new fit note. Duplicate fit notes can only be issued if the original has been lost. The fit note belongs to you. Your employer can take a copy, if they want one, for their records.

3.8 If a healthcare professional has decided that you are not fit for work, this is evidence which an employer can accept as eligibility for SSP. If your employer does not pay you SSP, you can raise a dispute with HMRC. You may also wish to seek help from a trade union or ACAS (Advisory, Conciliation and Arbitration Service) in such situations.

3.9 You should go back to work as soon as you feel able to and with your employer’s agreement – this may be before your fit note expires. If you are receiving health-related benefit, then you can speak to your Jobcentre or work coach to discuss possible work opportunities. You do not need to go back to see your healthcare professional before going back to work.

4. Benefits of working

4.1 You do not always need to be 100% ‘fit’ to be able to do some work. Work can help your recovery from health problems or support your wellbeing if you have a long-term health condition. Research shows that work can be good for your physical and mental health, lowers the risk of experiencing financial difficulties, and improves your overall quality of life.

4.2 Your healthcare professional is there to help you with your health. Healthcare professionals understand that work can be good for your health and will talk to you about what you can do and whether you could return to work without making your health worse.

5. How your fitness for work will be assessed by a healthcare professional

5.1 Your healthcare professional will not automatically assess that you are not fit for work if you have a health condition. They will think about your fitness for work in general rather than just for your current job. They will discuss with you how your health affects what you can do at work. If your healthcare professional does not ask you about how your health affects what you can do at work, you should raise the issue yourself.

5.2 Your healthcare professional will assess your fitness for work by considering how your health condition affects what you can do at work (for example your stamina and concentration). They will decide whether you are fit for work, ‘may be fit for work’ or are ‘not fit for work.’

5.3 Your healthcare professional will give you advice on the fit note about how your health affects what you can do at work. Make sure you discuss this with them and understand their advice, particularly as they will not automatically assess that you are not fit for work. They will consider your fitness for work in general instead of just thinking about your current job.

5.4 If you have been assessed as ‘may be fit for work’ you and your employer will be provided with advice that may help you stay in, or return to, work. The healthcare professional may utilise the tick boxes on the form to indicate types of adaptation that you may benefit from. The tick boxes will relate to the functional effects of your health condition. This will give you an opportunity to discuss the advice with your employer to help you stay in, or return to, work. The options on the fit note form, along with some examples, 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 health condition, such as no heavy lifting
• workplace adaptations: changing aspects of the workplace, such as working from home

5.5 These options are not binding on you, and you should feel free to discuss other options. You should discuss the advice from your healthcare professional with your employer, to see if they can make any changes to help you stay in, or return to, work.

5.6 Your healthcare professional should use the comments box to give you more detailed advice about the impact of your condition on what you can do at work. It is helpful for your healthcare professional to give practical information, e.g., ‘should not drive, take regular breaks if using a display screen’ instead of simply ‘dry eyes.’ This gives you and your employer maximum flexibility to discuss ways to help you stay in, or return to, work. The information in the comment box is often very helpful for employers, so you should ask your healthcare professional to provide advice here, if possible, they should include details about how your condition affects what you can do at work, rather than simply a diagnosis or description of your symptoms.

5.7 You should then look at the tick boxes and comment box for advice on what you can do at work, and how your employer could support you. You should check the duration on your fit note and whether you are expected to be fit for work when it expires. You should think of possible changes or workplace adjustments to help you stay in, or return to, work.

5.8 If you have HIV, cancer, or multiple sclerosis you are automatically classed as disabled under the terms of the Equality Act from the 1st day of diagnosis. You will need to discuss your condition with your employer to seek ways to support you to stay in, or return to, work. See link for further information, Definition of disability under the Equality Act 2010

5.9 You should discuss anything that you think would help you stay in, or return to, work with your employer, for example; arranging for an occupational health assessment, changing duties or location, phased return to work, working from home or additional training. These discussions are very important to support your health and wellbeing.

5.10 Your local trade union representative may be able to help you with these discussions and may support you to prepare. We know that employers want to support their employees return to work and can often make changes to the workplace or job duties to help this. You and your employer should agree on regular keep in touch meetings during the workplace modification or reasonable adjustment period.

5.11 Your healthcare professional might advise that you cannot do any kind of work. If this is the case, then you can show your employer the fit note to discuss any sick pay you may be entitled to. They can take a copy, but you should keep the original. You should keep in touch with your employer while you are unable to work, so that you are ready when it is time to return to work. You can get advice about sick pay see information about sick pay.

Important: You can go back to work at any time you feel able to (including before the end of the fit note) without going back to see your healthcare professional, even if your healthcare professional has indicated that they need to assess you again.

6. Case studies

• Case study 1: Workplace changes based on healthcare professional’s advice – Working from home
• Case study 2: An employer makes changes – a delivery driver who can’t drive
• Case study 3: Short term illness due to long COVID
• Case study 4: History of lower back pain and return to employment
• Case Study 5: Phased return following an acute short-term illness
• Case Study 6: Mental health review for patient with low mood

Read the case studies.

7. Further support

Access to Work

Access to Work is 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. The grant contributes to the disability related extra costs of working faced by disabled people and those with a health condition that are beyond reasonable adjustment, but it does not replace an employer’s duty under the Equality Act to make reasonable adjustments.

The Health Adjustment Passport

The Health Adjustment Passport (HAP) is used to support patients with a new or an existing health condition to identify what help and changes are available to support them to stay in, or return to, work. Patients may use this form to talk to their organisation about reasonable adjustments and support that they may need and support any Access to Work applications.

Help with personal or social problems

Fit notes can only be issued for medical problems. Your healthcare professional may be able to refer you to support for other personal or social problems. For example:

• ACAS - ACAS

• Carers - NHS Social care and support guide, Carers Trust and the support page on Care Information Scotland (careinfoscotland.scot)

• Debt issues - Debt and money guide from Citizen’s Advice and National Debt line
• Careers Advice - National Careers Service
• Relationships - Relate
• Bereavement advice - Get help with grief after bereavement or loss - NHS (www.nhs.uk)

Problems at work

• Your local trade union or safety representative may also be able to help with issues at work.
• For help on dealing with bullying, harassment or discrimination and preventing or managing disputes and conflict at work, for further information visit Dealing with problems at work, Acas.

Managing sickness absence, disputes, and sick pay

• Statutory Sick Pay (SSP): Overview - GOV.UK (www.gov.uk)
• The Health and Safety Executive has provided guidance for employers and managers on managing sick leave and return to work.
• Guidance on managing sickness absence is available from the Health and Safety Executive (HSE)
• For help on avoiding or managing work related disputes, visit ACAS

Additional Healthcare Advice

Occupational Health Advice Service

Occupational health support can be very helpful in complex cases and when work may be affecting your health. You may be offered in-house occupational health services, 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:

• 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)

More information on the fit note

For more information on the fit note see fit note guidance.

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.