Fit note guidance for employers

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Fit note guidance for employers

  • Posted

From July 2022 the Department for Work and Pensions has updated the law for the fit note so that it can now be issued by nurses, occupational therapists, pharmacists and physiotherapists in addition to doctors.

This means that employees may be issued a fit note by someone other than a doctor as long as they are discussing their fitness to work with them. These healthcare professionals should be treating your employee under NHS services.

You may notice changes to the fit note you receive as a new version of the fit note was introduced in April 2022. The requirement for the healthcare professional to sign the form in ink has been removed and replaced by the issuer’s name and profession. It could be sent to the patient via SMS, e-mail, an App or other digital channels so your employee may not have a paper copy.

There will be a period during which both the new and previous versions of the fit notes are legally valid. The previous fit note could be issued to your employee until all GP IT practice systems are updated. We intend to notify you and update this guidance when this is complete and the previous version should no longer be accepted.

General guidance: things to keep in mind

  • Providing support to employees with a health condition to come back to work can save you money and minimise disruption
  • A few simple changes can often help employees with a health condition come back to work sooner
  • Access to Work can help employees with a disability or health condition. This includes paying towards equipment or support
  • If your employee is assessed as may be fit for work, their fit note will help you discuss with them what these changes might be
  • The fit note won’t tell you what changes to make but will give you advice about how your employee’s health affects what they can do at work
  • If your employee’s healthcare professional thinks they are fit for work, they will not be issued with a fit note
  • Your employee can come back to work at any time, even if this is before their fit note expires. They do not need to go back to their healthcare professional first
  • The fit note belongs to your employee and they should keep the original. You may decide to take a copy for your records where an employee has been issued with a handwritten fit note.

General rules of the fit note

People can only be given a fit note if their healthcare professional considers their fitness for work is impaired.

Fit notes cannot be issued by healthcare professionals during the first seven days of sickness absence. Employees will need to self-certify for this time. Employers may request medical evidence for the first seven days of absence, however, it is their responsibility to arrange and pay for this.

Fit notes can be handwritten, computer-generated and printed out or computer-generated and sent digitally to your employee. It must include the issuer’s name and profession and the address of the medical practice. Whether it is the previous or new version of the fit note, if it does not include the healthcare professionals signature or name then it should not be accepted.

If they are sent digitally or printed from a GP’s system, it will contain a bar code. The bar code can then be scanned using a QR code scanner and added to the employee’s sickness record.

Where an employee has been issued with a fit note following hospital treatment, they may also receive a yellow Med 10 form stating the time they have spent as a hospital inpatient.


1. Can any healthcare professionals issue a fit note?

Only eligible healthcare professionals (HCP) can issue fit notes. The legislation defines these as registered nurses, occupational therapists, pharmacists, physiotherapists, and doctors. Not all individuals within these professions are suitably experienced and qualified to certify and issue fit notes so will only do so where they have the relevant training to make an assessment of a person’s fitness to work.

2. Can an employee obtain a fit note from a community, private or high-street pharmacy?

Fit notes are not part of the NHS services which community pharmacies provide and community pharmacists do not have access to the official ‘Med3’ form – which is the technical name for the fit note provided for free under NHS provision.

The policy change is aimed at pharmacists working within general practices or hospital settings where they are able to assess patient’s fitness for work.

3. Does an employee need a fit note saying they are fit for work?

Employees do not need to be signed back to work once they have been issued with a fit note. Employees should return to work once their fit note expires (if they have not already done so) or they will need a new fit note.

For a limited number of jobs, there are separate procedures to ensure someone is fit to carry out their role. Your organisation’s HR, occupational health or legal department should know if this applies to your company.

If your organisation has a separate policy which requires someone to obtain medical evidence that they are fit for work, this should be arranged through a private arrangement with a healthcare professional or occupational health specialist. Once your employee’s healthcare professional has assessed them as fit for work, they cannot issue any further fit notes to cover a period while they are waiting for additional health checks required by your organisation.

4. Can other forms of medical evidence be accepted as of sickness absence?

Other forms of medical evidence including private medical certificates and Allied Healthcare Professionals reports can be accepted as medical evidence in the same way as a fit note subject to the employer’s agreement. In this instance, employers do not need to request employees to obtain further fit notes.

5. What if an employer disagrees with the advice given in a fit note?

There may be occasions where you believe that your employee is not fit for work when they have been assessed as ‘fit for work’, or you may think that the employee could do some work when they have been assessed as ‘not fit for work’ by their healthcare professional.

In situations like this you are within your rights to seek other evidence about your employee’s fitness for work from other healthcare professionals provided you obtain your employee’s consent. The employee’s contract of employment may also contain an express right for the employer to require an employee to undergo a medical examination, where refusal would mean a breach of contract or even misconduct. Your organisation’s sickness absence policy may also include a similar provision.

6. What should employers do if they do not understand the advice on the fit note?

First, speak to the employee to see if they can provide any more information. You may also consider advice from an occupational health specialist. You can contact the healthcare professional who issued the fit note for more information however you may have to pay for this service and they may not be able to respond immediately.

7. What if a fit note says an employee’s job may be affecting their health?

You should consider this carefully and bear in mind your responsibilities under health and safety regulations. You may also want to consider asking the employee to undergo an occupational health assessment. This will provide you with an objective review of their fitness for work, with specific recommendations based on the employee’s job role and condition as to the types of reasonable adjustments that are available and likely to assist.

8. What if a fit note recommends that an employer should seek occupational health advice?

It is up to the employer as to whether or not to act on this advice and in some cases a solution can be found without needing additional expertise. However, for complex or possible work related conditions, additional support from an occupational health specialist should be seriously considered. The team at AHRC can assist if you need further guidance or support to arrange an occupational health referral.

9. What happens if an employee fails to cooperate with the employer implementing advice on a fit note?

Ask your employee to explain why they feel they should not return to work, as there may be something you have not considered. If you can’t reach agreement, consider asking the employee to undergo an occupational health assessment to obtain further specific recommendations as to the type of support that is available and likely to assist.

If necessary, consider your company’s sickness absence policy which may give you guidance about sick pay rules where an employee fails to cooperate with the company in implementing the advice.

10. How does the fit note affect sick pay?

The fit note can be used as evidence for your sick pay procedures. If your employee’s fit note states that they may be fit for work but you agree that they should remain off work, then they can still receive sick pay.

If your employee returns to work on reduced hours, you should consider the financial impact this may have on your employee. In such cases it’s at the employer’s discretion as to whether to pay sick pay for the hours not worked, or to pay full pay despite the reduced hours.

11. Where a fit note is for an ‘indefinite’ period, what happens if the organisation cannot accommodate any of the advice?

You should consider as many ways as possible to help your employee back to work, which may include a phased return to work, altered hours, amended duties and so on.

N.B. There may be additional legal issues to consider, for example your duties under the Equality Act. If an employee has a disability, then employers must make reasonable adjustments to help the employee return to work and to help them to do their job.

Dismissal is a last resort and could be unfair if not handled properly, you should seek professional HR & Employment Law advice if considering dismissal as an outcome.

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