The Fit Note 


A revised sick note system was introduced in April 2010, known as the Statement of Fitness for Work or “Fit Note”. The Fit Note is used to prove entitlement to SSP (and occupational sick pay, subject to the employer’s own rules). A paper copy of the Fit Note is issued by the GP and handed to the employer by the worker. A GP can supply a Fit Note after a face-to-face consultation, or less usually, a telephone consultation, or after reading a written report from another health professional. A Return to Work Plan issued by the Fit for Work Service (see below) can be accepted by the employer as proof of entitlement to SSP. 


Most GP surgeries use an electronic version of the Fit Note which the GP prints off the computer like a prescription and hands to the employee to be delivered to the employer in the usual way. The Fit Note is not emailed by the GP to the employer. 


DWP guidance for employers on using the Fit Note, Getting the most out of the fit note, reminds employers that Fit Notes cannot be issued for the first seven days, during which employees must be allowed to self-certify, and that any employer who wants medical evidence covering the first seven days of sickness absence must arrange and pay for this themselves. 


Employers are only allowed to demand medical evidence of sickness for the first seven days if they pay contractual sick pay that exceeds SSP.


The purpose of the Fit Note 


The Fit Note allows the GP, following discussions with the patient, to suggest a return to work based on one of four possible options:


• a phased return;


• altered hours;


• amended duties; and


• workplace adaptations. 


There is space on the Fit Note for the GP to provide more information on the condition and its effect on the member’s work. There is no “Fit for Work” option on the Fit Note. This is because once a worker is fully fit for work, the GP will simply not issue a new certificate. 


Sometimes, an employee’s GP agrees that they are fit to return but the employer insists on extra medical checks. The employee should be paid their normal wages while these extra checks are being carried out, unless a clear written term in the employment contract allows the employer to pay something less than normal wages. This is because there is an implied term in every employment contract that an employee who is ready, willing and able to work must be paid their normal wages (Beveridge v KLM UK [2000] IRLR 765). Withholding wages without a clear written term would be an unlawful deduction of wages (see Chapter 4), and a fundamental breach of the employment contract (see Chapter 3).


The Fit Note guidance for employers says that once a GP has confirmed a worker’s fitness to return, any extra medical evidence of fitness must be organised and paid for by the employer, either through a private arrangement with a GP or by engaging an occupational health specialist. “Once your employee’s doctor 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”, the guidance states. 


The guidance lists examples of possible changes to discuss with the employee. The employer is not obliged to accept the advice on a Fit Note, but if an employer decides not to follow GP advice or follows it inadequately, the Fit Note should be treated as if the GP has advised that the employee is not fit for work. The DWP guidance is clear: “if you can’t agree to any changes, you should treat the Fit Note as if it says that your employee is not fit for work”. 


The employer should carry out a revised health and safety risk assessment of any changes or adaptations needed to implement the recommendations on the Fit Note, to ensure new risks are not introduced. 


The Fit Note procedure does not affect an employer’s statutory duty under the Equality Act 2010 to make reasonable adjustments for a disabled employee (see Chapter 7).