Sick Notes and Fit Notes Explained: When Employees Need One and How They Work

Fit notes — formerly known as sick notes — are medical certificates issued by a general practitioner that advise whether an employee is fit or unfit for work, and if unfit, whether they may be fit to work with certain adjustments. In the UK, a fit note is required for Statutory Sick Pay (SSP) purposes after seven consecutive days of sickness absence. The fit note replaced the old sick note system in April 2010 and shifted the focus from simply certifying absence to providing practical advice on how an employee can return to work.

Key Takeaways

• A UK fit note is required for SSP after seven consecutive days of sickness absence
• Fit notes can advise that the employee is unfit for work, or fit with specific adjustments
• The fit note system focuses on what employees can do, not just what they cannot do

What Is a Fit Note?

A fit note is a document issued by a GP or other registered medical practitioner that provides advice about the impact of an employee’s illness or injury on their ability to work. It replaced the traditional sick note in the UK in April 2010 as part of a broader shift towards supporting employees in returning to work rather than simply certifying their absence.

The fit note contains several key pieces of information. It states whether the employee is not fit for work, or whether they may be fit for work subject to certain adjustments. If the employee may be fit with adjustments, the GP will specify what those adjustments are, such as reduced hours, modified duties, a phased return to work, or workplace adaptations. The fit note also includes the period during which the advice applies.

The purpose of the fit note is twofold. For the employee, it provides medical guidance that supports a safe and timely return to work. For the employer, it provides actionable information that can be used to make reasonable adjustments and facilitate a return. The fit note system recognises that many employees can return to some form of work during their recovery, even if they cannot perform their full pre-illness duties.

Fit notes are not required for every absence. For absences of seven days or fewer, a self-certification form is sufficient. For absences of eight days or more, the employee must obtain a fit note from their GP. The employer should not request a fit note for absences of seven days or fewer, as this would impose an unnecessary burden on the employee and the NHS.

Who Needs a Fit Note?

United Kingdom

In the UK, a fit note is required when an employee has been absent from work due to sickness or injury for more than seven consecutive days. The employee must obtain the fit note from their GP or hospital consultant. The fit note is then provided to the employer, who uses it to manage the absence and plan the employee’s return to work. Employers cannot request a fit note for absences of seven days or fewer — the employee can self-certify for this period.

Australia

In Australia, there is no equivalent of the UK fit note. Employers may request a medical certificate from an employee after a certain number of days of absence, as specified in the relevant award or enterprise agreement. Typically, a medical certificate is required after two or three consecutive days of absence. The certificate is issued by a medical practitioner and confirms the employee’s illness or injury.

United States

There is no federal equivalent of the fit note. Employers may request a doctor’s note for absences, but the requirements vary by employer policy and state law. Some states restrict when employers can require medical certification — for example, New York City prohibits employers from requiring a doctor’s note for absences of three days or fewer. The FMLA requires medical certification for leave related to serious health conditions, but this is a different process from the UK fit note system.

Fit Note Requirements by Country

Country	Requirement	Trigger	Key Detail
UK	Fit note required	After 7 consecutive days of absence	Issued by GP, focuses on fitness with adjustments
AU	Medical certificate may be required	After 2-3 days (award-dependent)	Not a statutory requirement for all absences
US	Doctor’s note at employer discretion	Employer policy dependent	FMLA certification for serious health conditions

How to Use a Fit Note

1. Employee obtains the fit note — after seven consecutive days of absence, the employee should contact their GP to obtain a fit note.
2. Submit the fit note to the employer — the employee provides the fit note to their manager or HR department.
3. Review the advice — the employer should carefully review the GP’s recommendations, including any suggested adjustments.
4. Implement adjustments — where the fit note suggests the employee may be fit with adjustments, the employer should explore how these can be implemented.
5. Plan the return — develop a return-to-work plan that takes the fit note guidance into account, including phased returns, modified duties or workplace adaptations.
6. Review regularly — if the fit note covers an extended period, review progress and adjust the plan as needed.

Employer Obligations for Fit Notes

• Accept the fit note — employers should accept the fit note as the primary medical evidence for absence management purposes
• Act on the advice — where the fit note recommends adjustments, employers should make reasonable efforts to implement them
• Do not request fit notes too early — for absences of seven days or fewer, the employee can self-certify and a fit note is not required
• Keep fit notes confidential — fit notes contain sensitive medical information and should be stored securely
• Use fit notes proactively — the fit note is a tool for supporting the employee’s return, not just a record of absence

Common Mistakes

• Requiring fit notes for absences of seven days or fewer, which is contrary to the self-certification rules
• Ignoring the adjustments recommended in the fit note and requiring the employee to return to full duties immediately
• Treating the fit note as a binary fit/unfit determination without considering the suggested adjustments
• Failing to store fit notes securely, breaching the employee’s medical confidentiality
• Using fit notes punitively in absence management processes rather than as a supportive tool

FAQ

What is a fit note?

A fit note is a medical certificate issued by a GP in the UK that advises whether an employee is fit or unfit for work. It replaced the old sick note system in 2010 and focuses on what the employee can do, including suggesting adjustments that may enable a return to work.

When do I need a fit note?

In the UK, you need a fit note when you have been absent from work due to sickness or injury for more than seven consecutive days. For absences of seven days or fewer, you can self-certify by completing a self-certification form for your employer.

Is a fit note the same as a sick note?

The fit note replaced the old sick note in April 2010. The key difference is that the fit note provides positive guidance about what the employee can do, rather than simply certifying that they are unfit for work. The term “sick note” is still commonly used informally.

Do I have to pay for a fit note?

Fit notes are available free of charge from your GP when they are related to a health condition that affects your ability to work. You should not be charged for a fit note that is issued for employment purposes.