If you’ve been off sick for more than a week, your employer will almost certainly ask you for a fit note. Understanding what this document actually is — and what it does and doesn’t mean for your job — can save you a lot of stress during an already difficult time.

Fit Notes in the UK Explained

A fit note (officially the “Statement of Fitness for Work”, and still often called a “sick note” out of habit) is the document a healthcare professional issues to confirm that your health condition affects your ability to work. It replaced the old-style sick note some years ago specifically to shift the focus away from simply signing people off, and towards what they might still be able to do at work with the right support.

This guide covers who can issue a fit note, when you actually need one, what the two possible outcomes mean, how fit notes interact with Statutory Sick Pay, and what employers can and cannot do with the information. It is general information only, not medical or legal advice — always check GOV.UK or speak to your GP practice, occupational health team or HR department for guidance specific to your situation.

Who Can Issue a Fit Note?

For a long time, only GPs and hospital doctors could sign fit notes. Since 2022, the list of professionals who can legally issue them has widened considerably. Depending on who is treating you, a fit note can now be issued by:

• GPs and hospital doctors, as before
• Registered nurses
• Occupational therapists
• Pharmacists
• Physiotherapists

The change was designed to reduce pressure on GP appointments and let people get signed off more quickly by the professional actually treating them — for example, a physiotherapist assessing a back injury, rather than needing a separate GP visit just for the paperwork.

When Do You Actually Need One?

Not every day off sick requires a fit note. In the UK, you can self-certify for the first seven calendar days of sickness — that means you simply tell your employer you’re unwell, following whatever process is set out in your contract or staff handbook (usually a phone call or message to your manager, sometimes a short form). No medical evidence is required for this initial week.

Once you’ve been off sick for more than seven calendar days in a row (including weekends and non-working days), you’ll typically need a fit note to continue receiving sick pay and to formally evidence your absence to your employer. Some employers ask for fit notes earlier than the seven-day mark as a matter of internal policy, so it’s always worth checking your contract or absence policy rather than assuming the statutory minimum applies to you.

“Not Fit for Work” vs “May Be Fit for Work”

This is the part of the fit note that trips people up the most. Every fit note gives the assessing professional two options, and the difference matters:

• Not fit for work — the assessment is that you should not be working at all during the period stated, with no scope for adjustments to change that.
• May be fit for work, taking account of the following advice — the assessment is that you could potentially work, but only with some form of support or change to your usual role.

If the “may be fit” box is ticked, the fit note will usually suggest one or more possible adjustments, such as:

• A phased return to work, building hours back up gradually
• Altered hours, such as a later start or shorter shifts
• Amended duties, temporarily removing tasks you can’t currently manage
• Workplace adaptations, such as equipment, seating changes or reduced physical demands

Crucially, these are suggestions for discussion, not instructions your employer is legally bound to implement exactly as written. If your employer cannot reasonably accommodate the suggested adjustments, the fit note is generally treated as if it said “not fit for work” for that period, and you would remain off sick.

Fit Notes and Statutory Sick Pay

Fit notes are the main piece of evidence employers use when assessing eligibility for Statutory Sick Pay (SSP) once self-certification runs out. Broadly, your employer needs medical evidence to keep paying SSP (or any enhanced company sick pay you’re contractually entitled to) beyond the first week. Missing or delayed fit notes can hold up sick pay, so it’s worth booking an appointment promptly if you know your absence is likely to run past a week. For the fuller mechanics of eligibility, waiting periods and how long SSP lasts, see our dedicated guide to statutory sick pay in the UK.

What Employers Can — and Can’t — Do

Employers are entitled to ask for fit notes to manage sickness absence fairly and consistently, and to use the information on them to plan cover, discuss a return-to-work plan, and assess SSP eligibility. What they generally cannot do is ignore a “not fit for work” assessment and pressure you back into your normal duties, or use the content of a fit note to discriminate against you because of a disability or health condition — which can overlap with protections under the Equality Act. If you feel a fit note or your absence is being handled unfairly, it’s worth raising it formally; our guide to the UK grievance procedure explains how to do that. Long-term sickness absence can also, in some circumstances, ultimately factor into a redundancy or dismissal process, so it’s worth understanding your wider rights — see our guides on redundancy pay and notice periods if things reach that stage.

Fit Notes, Job Applications and Employment Gaps

If you’ve had a period of sickness absence that shows up as a gap on your CV, you don’t need to disclose the details of a health condition to a prospective employer unless you choose to. It’s generally enough to describe the period honestly and briefly — for example, referencing a period of leave for health reasons — without going into medical specifics. Employers assessing your application are far more interested in your skills and experience than the exact reason for a gap, and UK equality law limits how health information can be used in recruitment decisions in any case.

Digital vs Paper Fit Notes

Fit notes can be issued either on paper or digitally, depending on the healthcare provider’s system. A digital fit note carries the same legal weight as a paper one; the format doesn’t change what it means for your employer or your entitlement to sick pay. What matters is getting it to your employer or HR team promptly, by whichever method they ask for — email, an HR portal upload, or a physical copy.

Frequently Asked Questions

Do I need a fit note for a one-day sick day?

No. You can self-certify for the first seven calendar days of sickness without any medical evidence, so a single day off doesn’t require a fit note.

Can a pharmacist really sign me off work?

Yes. Since 2022, pharmacists, nurses, occupational therapists and physiotherapists can all issue fit notes alongside GPs and hospital doctors, provided they are the professional actually treating you.

What happens if my employer can’t offer the adjustments suggested on my fit note?

If the suggested phased return, altered hours or amended duties genuinely aren’t feasible, the fit note is normally treated as if it said you’re not fit for work, and your absence continues on that basis.

Does a fit note guarantee I’ll be paid?

A fit note is evidence used to assess sick pay, but payment itself depends on meeting the eligibility rules for Statutory Sick Pay or your employer’s own sick pay policy.

Do I have to tell a future employer why I had time off sick?

No, you’re not obliged to share medical details. You can describe a period of health-related leave in general terms without disclosing your diagnosis.

Managing sickness absence, sick pay questions and job applications around a health-related career gap can all feel overwhelming at once. Atlas helps you search and apply for roles that fit your circumstances, tailor your CV honestly around any gaps, and keep your job search moving — register free to get started.