Every employee gets ill. That part is simple. What gets complicated is the paperwork.
Do you need a doctor’s note on day two or day eight? Can your employer reject a fit note? What happens if you can’t get a GP appointment in time? And what exactly changed when the UK scrapped the old sick note system?
Most employees and employers get at least one of these wrong.
What This Covers:
- The difference between self-certification and fit notes
- Who can legally issue a fit note (it’s not just GPs anymore)
- What employers can and cannot demand from you
- Statutory Sick Pay rules and the 2026 changes coming
- How digital documentation is reshaping workplace absence
1. Sick Notes Don’t Exist Anymore (Legally Speaking)
The term “sick note” has no legal status in UK employment law. What people call a sick note is officially the Statement of Fitness for Work — commonly known as the fit note or Med3 form.
order-form-med3-med10-for-healthcare-professionals
This isn’t just a name change. The shift matters.
The old sick note said one thing: You’re too ill to work. Stay home.
The fit note says two things:
- “Not fit for work” — You cannot work at all during this period
- “May be fit for work” — You could work with adjustments
Those adjustments might include:
| Adjustment Type | Example |
| Phased return | Gradually increasing hours over several weeks |
| Altered duties | Switching to less physical tasks during recovery |
| Amended hours | Working mornings only, avoiding late shifts |
| Workplace adaptations | Ergonomic equipment, working from home |
Important: Employers are encouraged to consider these recommendations but are not legally required to implement them. However, if an employer cannot offer the suggested adjustments, the fit note must be treated as though it says “not fit for work.”
The fit note system was introduced in April 2010 to shift the conversation from “are you sick?” to “what can you still do?” — a meaningful distinction for both employers managing absences and employees wanting to return sooner.
2. Self-Certification: The First 7 Days
For short-term illness, the system is straightforward.
The rule: Employees do not need a fit note for the first 7 calendar days of illness. This includes weekends and bank holidays — not just working days.
During this period:
- You self-certify by informing your employer you’re unwell
- Your employer may ask you to complete a self-certification form (often called an SC2 form)
- No doctor’s appointment is needed
- No medical evidence is required
What employers can do:
- Ask you to confirm your illness in writing when you return
- Require you to follow their internal sickness reporting procedure
- Record the absence for attendance management purposes
What employers cannot do:
- Demand a fit note or doctor’s letter for absences of 7 days or less
- If they want medical evidence during this period, they can request it — but the healthcare professional may charge a fee, and the employer should cover that cost
After day 7: If you’re still unwell, you need a fit note. Your employer can legally require one before continuing to pay Statutory Sick Pay.
3. Who Can Issue a Fit Note (It Changed in 2022)
Before July 2022, only doctors could sign fit notes. That created a bottleneck. GP appointments were scarce, and employees who couldn’t get seen in time risked losing sick pay.
Since 1 July 2022, these healthcare professionals can legally certify fit notes:
- Doctors (GPs and hospital doctors)
- Nurses
- Occupational therapists
- Pharmacists
- Physiotherapists
Key detail: The professional must conduct a proper assessment of your fitness for work. A fit note should only be issued following a full clinical evaluation — not a quick phone call without context.
What about private doctors?
Private practitioners and private hospitals can produce medical certificates or Allied Healthcare Professionals Work Reports. These may be accepted by your employer as medical evidence, but acceptance is at the employer’s discretion. Most employers prefer NHS-issued fit notes.
Hospital discharge: If you’re admitted to hospital, the healthcare professional responsible for your discharge should issue the fit note before you leave — you shouldn’t be redirected to your GP purely for certification purposes.
4. What Fit Notes Actually Contain
A fit note is not a detailed medical file. It’s a structured form with limited information — deliberately.
The fit note includes:
- Whether you’re “not fit for work” or “may be fit for work”
- The period the advice covers (start and end dates)
- Comments on functional effects of your condition
- Recommendations for workplace adjustments (if applicable)
What the fit note does NOT include:
- A requirement to state a specific diagnosis
- Detailed medical history
- Information about medication or treatment plans
This is intentional. The fit note focuses on capability rather than condition, limiting personal medical information disclosed to the employer. Your boss learns what you can and can’t do — not your complete health picture.
5. Statutory Sick Pay: Current Rules and What’s Changing
Statutory Sick Pay (SSP) is the legal minimum employers must pay during qualifying sickness absence. It’s governed by the Employment Rights Act 1996 and the Statutory Sick Pay (General) Regulations 1982.
Current Rules (2025/26)
| Element | Current Rule |
| Weekly rate | £118.75 (from April 2025) |
| Waiting days | First 3 qualifying days unpaid |
| Earnings threshold | Must earn at least £125/week (Lower Earnings Limit) |
| Maximum duration | Up to 28 weeks |
| Who pays | Employer (cannot reclaim from HMRC) |
How SSP is calculated: The weekly rate is divided by the number of qualifying days (days you normally work). If you work 5 days per week, your daily SSP rate is £23.75.
Linked periods: If you have two periods of sickness within 56 days of each other, they’re linked — meaning you don’t serve new waiting days for the second absence.
What’s Changing from April 2026
The Employment Rights Act 2025 introduces significant SSP reforms:
| Change | Current | From April 2026 |
| Waiting days | 3 days unpaid | SSP from day 1 |
| Earnings threshold | Must earn £125+/week | Removed — all employees eligible |
| Rate for lower earners | Flat rate only | 80% of weekly earnings OR flat rate (whichever is lower) |
What this means practically:
- 1.3 million more workers will become eligible for SSP
- Short-term absences (1-3 days) will now trigger SSP payments for the first time
- Part-time and lower-paid staff gain access to sick pay previously unavailable to them
- Employers face increased costs, particularly for businesses with high short-term absence rates
6. Can Your Employer Challenge a Fit Note?
Yes — but with limits.
What employers can do:
- Request that you undertake further assessment by a medical professional
- Seek their own occupational health opinion
- Discontinue discretionary (company) sick pay if they doubt the validity
What employers cannot do:
- Force you to provide medical evidence beyond the fit note
- Ignore a valid fit note and demand you return to work
- Withhold SSP without providing written reasons
If SSP is withheld: You’re entitled to a written statement explaining why. You can take that statement to HMRC to seek a determination of your SSP entitlement.
“Not fit for work” doesn’t mean “not fit to talk”
This catches many employees off guard. A fit note stating you’re unfit for work doesn’t mean your employer cannot contact you. Employers can — and often should — maintain reasonable contact during absence to discuss return-to-work plans, provided it doesn’t damage your health.
7. Documentation for Modern Workplaces
The traditional model assumed everyone worked in an office with a GP down the road. That’s not today’s reality.
Remote workers may live far from their registered GP practice. Gig economy workers may not have consistent employment relationships. Shift workers struggle to book appointments during surgery hours.
Modern healthcare is adapting. Digital fit notes became standard when the NHS went digital in April 2022, eliminating paper Med3 forms. Fit notes can now be issued electronically and sent directly to patients.
Beyond NHS services, digital healthcare platforms like TrustMedical’s doctors note for work service offer documentation support for employees who need medical evidence without the delays of traditional GP booking systems. These services can be particularly useful for minor illnesses, follow-up documentation, and situations where GP availability creates unnecessary gaps in the evidence chain.
What employers should accept:
- Electronic fit notes (legally equivalent to paper versions since 2022)
- Digital copies provided by the employee
- Allied Healthcare Professionals Work Reports from qualified practitioners
What employers should verify:
- The fit note covers the correct dates
- The issuing professional is qualified to certify
- Any adjustment recommendations are considered and responded to
8. Employer Obligations: Getting It Right
Managing sickness absence isn’t just about collecting paperwork. Employers have legal responsibilities.
Must do:
- Pay SSP at the correct rate to eligible employees
- Accept valid fit notes from any of the five qualifying professions
- Consider workplace adjustments recommended on the fit note
- Keep accurate absence and payment records
- Have a clear sickness and absence policy in employment contracts or staff handbooks
- Update payroll systems each April to reflect new SSP rates
Must not:
- Demand a fit note for absences of 7 days or less
- Dismiss an employee solely for taking legitimate sick leave (without following proper procedures)
- Treat sickness absence related to disability less favourably (Equality Act 2010 obligations)
Best practice:
- Conduct return-to-work interviews after every absence
- Train managers on absence management procedures
- Maintain consistent trigger thresholds for attendance management
- Keep communication open during longer absences
Final Word
UK workplace documentation is more structured than most employees realise and more regulated than many employers follow.
The essentials:
- Self-certify for 7 days or less — no fit note needed
- Fit notes from 5 professions are now legally valid, not just GPs
- SSP pays £118.75/week from April 2025, with major reforms coming April 2026
- Employers can question a fit note but cannot override it without medical evidence
- Digital documentation is now standard — paper-only processes are outdated
- Fit notes focus on capability, not diagnosis — protecting employee privacy
Get the documentation right and sickness absence becomes manageable. Get it wrong and you’re looking at disputes, withheld pay, and potential tribunal claims.
Neither employees nor employers can afford to wing it.
References
- NHS England, “Getting a Fit Note” — nhs.uk/nhs-services/gps/getting-a-fit-note/
- GOV.UK, “The Fit Note: Guidance for Patients and Employees” — gov.uk/government/publications/the-fit-note-a-guide-for-patients-and-employees
- GOV.UK, “Taking Sick Leave” — gov.uk/taking-sick-leave
- Acas, “Statutory Sick Pay” — acas.org.uk/checking-sick-pay/statutory-sick-pay-ssp
- Employment Rights Act 1996
- Statutory Sick Pay (General) Regulations 1982
- Social Security (Medical Evidence) Regulations 1976
- Employment Rights Act 2025, Statutory Sick Pay Factsheet — assets.publishing.service.gov.uk
- CIPD HR-Inform, “Sick Leave and Pay” — hr-inform.co.uk/employment_law/sick-leave-and-pay