When employees are not able to attend work due to medical fitness to work issues or health related incapacity they are faced with two options:

  1. Asking their employer if they are able to provide reasonable adjustments to accommodate the health issue, thus enabling the employee to remain in work - in some capacity.
  2. They take a period of sickness away from work.

This article provides a brief explanation of the Fit Note (aka Sick note, or Med 3)

When employees take sick time away from work due to illness, it is important to follow the advice set out by the Department of Work and Pensions outlined in the link below:

Taking Sick Leave

If an employee is off work due to sickness, ill health or injury for more than 7 calendar days (including weekends, bank holidays or days off) an employer will usually ask the employee to gain proof of sickness in terms of provision of a "Fit Note" from their General Practitioner. This enables the company to provide the appropriate sick pay (Statutory Sick Pay - SSP and / or Company sick pay benefit) to be arranged and enables the employer to arrange alternative cover for the period of absence that has been indicated on the fit note.

As well as the General Practitioner, there are other eligible healthcare professionals can provide the fit note Examples of other healthcare professionals. These include:

  • osteopath
  • consultant physiotherapists
  • chiropractors

Employers can ultimately decide on whether the fit note from other healthcare professionals is accepted for the purposes of SSP and can ask their General Practitioner to provide them with a fit note in the event of doubt.

Employers can also ask for an independent fitness to work opinion from specialist occupational healthcare professionals; for example occupational health nurses, doctors or physiotherapists for further health and work advice including opinion on fitness to work.  

Assessment of fitness to work

The information contained within the fit note is classed as advice which is essentially determined by the employer as to whether the advice is accepted. The information provided on the fit note following assessment of the employee`s fitness to work by the General Practitioner. The assessment should include:

  • an assessment of the employee`s functional limitations (e.g. stamina, cognitive abilities, physical capability etc
  • understanding the medical management the employee is currently receiving.
  • an understanding of the work the employee can undertake, bearing in mind whether the work may aggravate the health issue.

Following the medical assessment the General Practitioner offers an opinion on employee eligibility to receive SSP. This is communicated on the "Fit Note" stating either the employee is "not fit for work" or "maybe fit for work".

This means:

Not fit for work - the employee is not fit for work of any kind.

May be fit for work - the employee may be fit for work dependent upon the provision of workplace adjustments by the employer.

When a General Practitioner indicates that an employee 'may be fit for work', they can give general advice on the fit note about how the employer could support the employee. This is achieved using tick boxes which allow the GP to suggest, where appropriate, more common ways in which an employer could support a return to work for an employee. for example:

  • returning to work gradually by starting with part-time hours;
  • working different hours on a temporary basis;
  • performing different duties and tasks; 
  • avoiding certain tasks that may aggravate their health condition.

Space is also provided on the fit note for the General Practitioner to provide advice about the impact of an employee's illness or injury.

NB: if the employer is not able to accommodate the workplace adjustments whilst balancing employee health needs and the needs of business - the "may be fit for work" decision turns into "not fit for work" for the purposes of managing the employee sick pay. 

Employees who recover from their illness or injury before the expected return to work date can return to work at any time before the end date stipulated on the fit note and without seeing their General Practitioner first. It is important to note that the employer must agree this in advance and should ensure that any return to work does not breach their employer liability insurance. In cases such as this, employees should discuss their return to work with their employer in order to establish what adjustments may be possible and should be clear with their employer about what jobs they are realistically capable of undertaking so that the appropriate support can be offered.

For more information on the "Fit Note" please click on the most appropriate link below:

Fit note: guidance for patients and employees from the Department of Work and Pensions

Fit note: guidance for employers and line managers from the Department of Work and Pensions


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