Fit Note (Sick Note) UK: Self Certification, Who Can Issue One, and What It Requires

A fit note is the medical statement your employer can ask for once you have been off sick for more than 7 days in a row. For the first 7 days, including weekends, you can self certify with no medical evidence at all, and since 1 July 2022 a fit note no longer has to come from a doctor.

What a fit note is, and when you need one

A fit note, officially a Statement of Fitness for Work, is the document a healthcare professional gives you to say whether you are fit to work while you are ill. You only need to give one to your employer once you have been off sick for more than 7 days in a row, counting weekends and bank holidays as well as working days (gov.uk: taking sick leave).

For the first 7 days, you self certify. No fit note and no other medical evidence is required. This threshold comes directly from regulation 2(2) of the Statutory Sick Pay (Medical Evidence) Regulations 1985: an employee "shall not be required... to provide medical information in respect of the first 7 days in any spell of incapacity for work" (legislation.gov.uk: Statutory Sick Pay (Medical Evidence) Regulations 1985, regulation 2). Many employers ask you to confirm the absence some other way during those first 7 days, such as a phone call, an internal form or an email, but that is a matter of the employer's own procedure, not a fit note.

Who can issue a fit note since 1 July 2022

Fit notes used to come only from a doctor. That changed on 1 July 2022, under the Social Security (Medical Evidence) and Statutory Sick Pay (Medical Evidence) (Amendment) (No. 2) Regulations 2022, which replaced references to "doctor" with a defined "healthcare professional," meaning a registered medical practitioner, a registered nurse, a registered occupational therapist, a registered physiotherapist, or a registered pharmacist (legislation.gov.uk: SI 2022/630). Gov.uk's own guidance confirms the same list in practice: "fit notes can now be certified by doctors, nurses, occupational therapists, pharmacists and physiotherapists" (gov.uk: fit note guidance for employers and line managers).

Northern Ireland made the identical change on the same date, under its own mirrored instrument, the Social Security (Medical Evidence) and Statutory Sick Pay (Medical Evidence) (Amendment) (No. 2) Regulations (Northern Ireland) 2022, which "come into operation on 1st July 2022" and use the same five category healthcare professional definition (legislation.gov.uk: S.R. 2022 No. 182). The change widened who may issue a fit note rather than replacing doctors, so a doctor's certificate remains just as valid as it always was. Whoever issues it, the healthcare professional needs to assess the employee's fitness for work before giving a fit note (gov.uk: taking sick leave).

What a fit note does and does not require of your employer

A fit note will say one of two things: that you are not fit for work, or that you may be fit for work, usually with some suggested support such as amended duties, reduced hours, or a phased return (acas.org.uk: if a fit note says might be fit for work).

A "may be fit for work" note is advice for your employer to consider, not a binding instruction. Acas's own guidance is direct on this: "the employer should carefully consider any fit note recommendations," and "if it's not possible for the employer to do anything that's recommended, the employee will become not fit for work." The one exception is where a recommendation would count as a reasonable adjustment for a disabled employee under the Equality Act 2010 (the Disability Discrimination Act 1995 in Northern Ireland), which the employer is legally required to put in place regardless of the fit note. Outside that, your employer can decide the suggested adjustments are not workable in your role, in which case you remain off sick as though the note said not fit for work.

A fit note is not itself about money. It says nothing about pay. Whether you are paid while off sick, and how much, depends on Statutory Sick Pay and any contractual sick pay your employer offers on top of it. For the current SSP rate, the qualifying conditions, and how long it runs, see statutory sick pay and the SSP calculator. For wider employer duties around sickness, see the UK employment law hub.

Frequently Asked Questions

How many days can I be off sick before I need a fit note?

More than 7 days in a row, including weekends and bank holidays. For 7 days or less, you self certify, with no fit note or other medical evidence required.

Can a nurse or pharmacist sign me off sick, or does it have to be a doctor?

Since 1 July 2022, a fit note can be issued by a registered nurse, occupational therapist, physiotherapist or pharmacist, as well as a doctor. Northern Ireland made the identical change on the same date.

Does my employer have to follow the recommendations on my fit note?

Not automatically. A fit note that says you may be fit for work with support is advice your employer must consider, but it is only legally binding where a recommendation counts as a reasonable adjustment for a disabled employee. If the employer cannot accommodate a suggestion, you are treated as not fit for work.

Does a fit note affect how much sick pay I get?

A fit note is about fitness for work, not pay. Your pay while off sick is governed separately by Statutory Sick Pay and any contractual sick pay scheme, not by the wording of the fit note itself.

Can I get a fit note online or does it have to be signed on paper?

Fit notes no longer need to be signed in ink on paper. A separate change from 6 April 2022, made in both Great Britain and Northern Ireland, removed the requirement for an ink signature, so a healthcare professional can issue and sign one electronically.