Fit notes: the employer's guide
What the two boxes actually mean, who can sign one, and the question employers ask most - what happens when you simply can't do what it suggests.
A fit note says one of two things: "not fit for work", or "may be fit for work" with suggestions. You are not obliged to accommodate the suggestions - but if you can't, the note is treated as "not fit for work" and the person stays off. Fit notes are needed from the 8th calendar day of absence, can be issued digitally without a signature, and come from a wider range of healthcare professionals than most employers realise.
What is a fit note?
A fit note - formally a Statement of Fitness for Work - is the medical evidence for a sickness absence lasting more than 7 calendar days. Before that point, employees self-certify; a fit note is only required from day 8, and the days are counted in calendar days including weekends and non-working days.
Who can issue a fit note?
Not just GPs. Since 2022 the following can all issue fit notes, and since the same year notes can be issued and sent digitally without a handwritten signature:
- Doctors (GPs and hospital doctors)
- Nurses
- Occupational therapists
- Pharmacists
- Physiotherapists
An employer refusing a digital fit note, or one issued by a physiotherapist rather than a GP, is refusing valid evidence. gov.uk publishes the fit note guidance for employers and healthcare professionals.
What do the two options actually mean?
| The note says | What it means | What you do |
|---|---|---|
| Not fit for work | unable to work at all for the stated period | record the absence, pay SSP/company sick pay, keep in touch |
| May be fit for work | could work with support - the professional ticks what would help | discuss it; accommodate if you reasonably can |
What are the four suggestions on a fit note?
- A phased return to work - building hours back up over a few weeks.
- Altered hours - different start and finish times, fewer hours, or avoiding a commute at peak time.
- Amended duties - dropping the parts of the job the condition makes hard.
- Workplace adaptations - equipment, seating, access, or a quieter space.
These are suggestions, not instructions. If you genuinely can't accommodate them, you don't have to - but then the person is treated as not fit for work, and normal sick pay continues. The one thing you shouldn't do is ignore the note and expect them back unchanged. Where the underlying condition is a disability, the Equality Act's reasonable adjustments duty may go further than the fit note suggests.
Do you need a new fit note if you can't accommodate it?
No. Where a "may be fit for work" note can't be accommodated, employers use the existing note as the evidence for their sick pay procedures - the employee doesn't need to go back to their GP for a fresh one. That saves an appointment nobody needs.
What should employers do when a fit note arrives?
- Talk about it, promptly. A ten-minute call about what's possible beats a fortnight of assumptions on both sides.
- Diarise the end date. An absence running past the note's expiry needs a fresh one - and the day it expires is the day to have already agreed the next step.
- Store it properly. A fit note is health data: keep it on the absence record with restricted access, not in a manager's inbox.
- Plan the return. A phased return works far better when it's written down - see returning after mental-health absence and the return-to-work questions.
- Keep the sick pay right. SSP has been payable from day one since April 2026 - the SSP cost calculator and the changes explained cover it.
And when frequent short absences are the pattern rather than one long note, that's a different conversation - see the Bradford Factor and, importantly, what must be excluded from it.
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Fit notes where they belong
CoDash stores fit notes against the absence record with the expiry date tracked, prompts the return-to-work conversation, and keeps sick pay figures straight.