If you are off work sick in the UK, there is a good chance you will hear the words “fit note” before long. A fit note is the official document that replaced the old-fashioned sick note. Its formal name is the Statement of Fitness for Work, also known as a Med 3 form, and it is the standard medical evidence used to support sickness absence, Statutory Sick Pay decisions and a safe return to work.

Despite the name, a fit note is not only about saying someone is unfit for work. It can also say that a person may be fit for work if certain changes are made, such as shorter hours, different duties or a phased return. That advice is meant to help people stay in work or get back to it sooner, rather than waiting until they are fully recovered. This guide explains what a fit note is, when you need one, who can issue one, how to get one and what it means for your pay and your job.

What is a fit note?

A fit note is written advice from a healthcare professional about how your health affects your ability to work. It is issued after an assessment and states whether you are “not fit for work” or “may be fit for work”, together with the period the advice covers. It may also include comments about the functional effects of your condition and suggestions for changes that could help you return to work.

There is no document in UK employment law formally called a “sick note”. The phrase survives in everyday language, but when an employer, a payroll department or the Department for Work and Pensions (DWP) asks for a sick note, they mean a fit note. A fit note is evidence, not a guarantee of pay. It does not by itself create a right to sick pay, and it does not decide whether your employer must pay you. Those questions depend on your contract, your employer’s sick pay policy and the statutory rules.

One point that surprises many people is that a fit note does not have to state your diagnosis. It usually focuses on what you can and cannot do at work, which limits the amount of personal medical information your employer sees. The note must show the name and profession of the person who issued it and the address of their practice. On older paper forms, it must be signed in ink; newer digital fit notes carry the issuer’s details electronically.

When do you need a fit note?

Whether you need a fit note depends entirely on how long you are off sick. If you are absent for seven or fewer consecutive calendar days, you do not need one. You can self-certify instead, which usually means completing your employer’s return-to-work form, filling in the employee’s statement of sickness (form SC2), or giving written confirmation of the dates and the reason for your absence.

The seven days are counted as consecutive calendar days, not working days. Weekends, rest days and bank holidays all count, even if you would not normally have worked on those days. So a Thursday-to-Monday absence, for example, is five calendar days and does not need a fit note. From day eight onwards, your employer can ask you for a fit note, and you will need one to cover the rest of your absence.

The same seven-day rule applies whether or not you qualify for Statutory Sick Pay. If you are still unwell when your fit note runs out, you should get a further note before the first one ends and give it to your employer. You do not need a new fit note simply because you return to work earlier than expected, as long as your employer agrees that it is safe for you to do so.

Who can issue a fit note?

You do not have to see a GP to get a fit note. Since 1 July 2022, fit notes in England, Scotland and Wales can be issued by doctors, registered nurses, occupational therapists, pharmacists and physiotherapists. The change was made to reduce pressure on GP services and speed up access to medical evidence. Northern Ireland introduced similar rules.

The person who issues the note should usually be the healthcare professional responsible for that part of your care, and they must have assessed your fitness for work first. A fit note cannot be issued simply on request or over the counter. In practice, that might be your GP, a hospital doctor after an operation, a nurse specialist, or a physiotherapist who is treating you. Fit notes can be printed or digital, and either version is valid as long as the issuer’s details are complete.

If your employer wants medical evidence for the first seven days of an absence, a healthcare professional may charge for a private note covering that period. GOV.UK guidance says that in that situation the employer should cover the cost. You will not have to pay for a fit note if you have been ill for more than seven days when you ask for one.

How to get a fit note

The usual route is to contact your GP practice and explain that you need a fit note because you have been off work for more than seven days, or because you expect to be. You may be offered an appointment in person, by phone or by video call, depending on your condition and the practice’s arrangements. The healthcare professional will assess how your health affects your work before deciding what the note should say.

It helps to go into the appointment ready to explain what your job involves day to day, which tasks you cannot do at the moment, and whether any changes at work might let you return sooner. A fit note is most useful when it describes the practical effects of your condition, so describing your duties clearly can make a real difference to the advice it contains.

Once issued, the fit note belongs to you. Your employer can take a copy, but you should keep the original. If you have a digital fit note, keep a copy of the file or the email it arrived in. If you lose a paper fit note, ask the practice for a duplicate, but be aware that a charge may apply in some circumstances.

What does “may be fit for work” mean?

A fit note gives one of two assessments. “Not fit for work” means the healthcare professional advises that you should remain off work for the period stated. “May be fit for work” means you could potentially return if certain changes are made. Those changes commonly include a phased return, altered working hours, amended duties or workplace adaptations such as specialist equipment.

The recommendations on a fit note are advisory, not legally binding. Employers should consider them carefully, but they are not obliged to make every change suggested. If the suggested changes cannot reasonably be accommodated, you can be treated as not fit for work for the duration of the fit note, without needing to obtain a further note. What matters is that the employer considers the advice properly and discusses it with you, rather than ignoring it or accepting it without thought.

You can also return to work before a fit note ends if you feel able to do so and your employer agrees. An early return should be managed safely, and your employer may ask for medical confirmation first, particularly where health and safety is a concern or the role involves risk. Occupational health can help assess an early return and any adjustments needed, but a referral requires your consent.

Fit notes and Statutory Sick Pay

A fit note is commonly used as evidence for Statutory Sick Pay (SSP), the minimum sick pay most employees are entitled to. From 6 April 2026, SSP is paid at £123.25 a week, or 80 percent of your normal weekly earnings if that is lower. From the same date, SSP is payable from the first day of sickness rather than after three waiting days, and the lower earnings limit that used to exclude the lowest-paid workers has been removed.

To qualify for SSP you must be classed as an employee, have done some work for your employer, and have been ill for at least one full working day. Tell your employer about your sickness before any deadline they have set, or within seven days if they have not set one, because GOV.UK warns that you could lose some SSP if you tell them late. SSP can be paid for up to 28 weeks. If you do not qualify, your employer must send you form SSP1 within seven days of your first day off sick, so that you can claim other support instead.

Repeated absences can also be linked together for SSP purposes. If absences are eight weeks or less apart, they may count as linked periods towards the same 28-week limit, and a continuous series of linked periods lasting more than three years can end eligibility. If you are unsure how this applies to you, check the GOV.UK guidance on Statutory Sick Pay or ask your employer’s payroll team.

Fit notes and benefits

Fit notes are also used as evidence for health-related benefits. If you claim New Style Employment and Support Allowance (ESA), you will be told during your application when to send your fit note. You can send it online through the GOV.UK “Send your fit note” service, using your National Insurance number and either a digital fit note or a photo or copy of a signed printed one. If you prefer paper, you can post it to Freepost DWP ESA 26, with no stamp needed. Any other medical evidence, such as a consultant’s letter, must also be posted.

For Universal Credit, the process is different: GOV.UK says you give the details from your fit note in your online account rather than sending the note itself. In both cases, send a new fit note before each one runs out until a decision is made on your claim. A fit note that is missing the issuer’s name or signature is not valid and could be rejected, so check those details before you send it.

Fit note reform: what is changing?

The fit note system itself is under review. The Government has said that around 11 million fit notes are issued every year, with more than nine in ten declaring the person “not fit for work”, and that the current tick-box approach does not offer patients support or guidance about staying in work. Pilots announced by the Department for Work and Pensions are testing personalised “stay in work” and “return to work” plans through selected NHS WorkWell sites and major employers, covering up to 100,000 appointments.

The trials follow the Keep Britain Working Review by Sir Charlie Mayfield, which described the fit note system as “not working as intended” and a barrier to contact with employers. Any wider reform would need legislation, so the current rules described in this guide still apply. If the pilots lead to change, the way fit notes are issued and what they contain could look different in future.

Common mistakes to avoid

The most common mistake is asking for a fit note too early. For the first seven days, self-certification is enough, and your employer should not ask for medical evidence. Another is leaving it too late: if your absence is going to pass seven days, contact your GP practice in good time rather than waiting until the note is already overdue. A third is assuming a fit note guarantees pay. It is evidence your employer uses to make decisions about absence and sick pay; your contract and the statutory rules decide what you are paid.

Finally, remember that a fit note is a starting point for a conversation, not the end of one. If it says you may be fit for work with changes, talk to your employer about what is realistic. If the changes cannot be made, you stay off work under the terms of the note. Either way, keeping in touch with your employer during your absence, and keeping copies of every fit note you are given, will make the whole process smoother. Rules and rates can change, usually each April, so check the GOV.UK fit note and Statutory Sick Pay pages for the latest position before relying on the figures in this guide.