Work, health and fit notes

In Great Britain, an employee normally self-certifies the first seven calendar days of sickness absence, including non-working days. A fit note is not required for that statutory period, although an employer seeking private evidence earlier may need to pay for it. After the seventh day, a fit note may support Statutory Sick Pay or benefit processes. The note should be issued only after an assessment that provides enough information to judge functional effect. Northern Ireland has its own employment framework; its current seven-day self-certification and authorised fit-note issuer rules are also set out by nidirect. Use that national guidance when advising patients in Northern Ireland.

Since July 2022, fit-note certification is not restricted to doctors. Doctors, registered nurses, occupational therapists, pharmacists and physiotherapists can issue notes, provided the professional is assessing the patient, works within competence and follows local processes. The extension does not allow administrative staff to sign on another clinician’s behalf or permit a clinician to certify a condition they have not adequately assessed. Digital and ink signatures must meet the current statutory requirements.

The form offers two conclusions. “Not fit for work” is appropriate when no reasonable adjustment is likely to permit work during the stated period. “May be fit for work taking account of the following advice” indicates potential capability if changes can be agreed. The advisory categories include a phased return, altered hours, amended duties and workplace adaptations. Free text should explain functional limitations and possibilities in language useful to the employer, while avoiding unnecessary confidential detail.

There is no statutory “fit for work” box. If a patient is fit, they generally do not need a note. A clinician can end a note earlier by indicating that another assessment will not be needed, and a patient may return before the end date if they feel able and the employer agrees appropriate arrangements; a separate “sign-off” note is not routinely required. Safety-critical roles may have distinct occupational standards, so return can still require employer or occupational-health assessment.

Assess the work, not merely the job title. Ask about physical load, posture, dexterity, concentration, driving, lone work, night shifts, temperature, noise, infection exposure, public contact and responsibility for others. Include travel to work and access to toilets, medication, food or rest. Explore whether home working, different start times, shorter shifts, task rotation, equipment or temporary redeployment could reduce the mismatch between current function and demands.

Describe effects rather than revealing more diagnosis than necessary. “Cannot lift repeatedly above shoulder height for four weeks; desk-based duties and short movement breaks may be feasible” gives actionable information. “Back pain” alone does not. Do not promise an adjustment that the clinician cannot guarantee or dictate operational details. The employer decides whether changes are available, in discussion with the employee and, where useful, occupational health. If none can be made, a “may be fit” note operates as “not fit” for the period.

Duration should match expected function and a meaningful review point. A short period can allow acute recovery; a longer period may avoid repeated appointments in stable prolonged illness. Guidance limits the maximum duration during the first six months of a condition and allows longer certification after that point, so check the current statutory guide rather than choosing an arbitrary interval. A note can cover a retrospective period when supported by a previous assessment or adequate clinical evidence, but it must not rewrite facts to resolve an employment dispute.

Consider treatment and work together. Sedation, hypoglycaemia, seizures, visual disturbance, severe pain, cognitive impairment or opioid use may affect driving, machinery or safety-critical decisions. Follow DVLA rules separately from the fit note and tell the patient when they must notify the agency. Infectious risk may require public-health or occupational guidance. Pregnancy is not illness, but pregnancy-related conditions may justify certification; workplace pregnancy risk assessment remains the employer’s responsibility.

Requests can carry conflict. A patient may fear dismissal; an employer may request diagnostic detail; the clinician may feel pressured to certify a preferred duration. Explain the statutory purpose, share information only with consent or another lawful basis, and do not act as an adjudicator of workplace performance. Immediate threats, exploitation, unsafe systems or occupational disease may require advice, reporting or escalation through other routes. A fit note should never conceal a safeguarding or public-safety problem.