Last reviewed: May 2026
Key facts:- The NHS fit note (formally a Statement of Fitness for Work) is the standard medical evidence for sickness absences beyond seven days.
- Fit notes can be issued by GPs, hospital doctors, registered nurses, pharmacists, occupational therapists and physiotherapists.
- Self-certification covers the first seven days of any absence, so a fit note is only needed from day eight onwards.
UK Employment Rights Hub › Sick Note How To Get
A sick note (formally a Statement of Fitness for Work, or fit note) is the medical evidence that supports a period of sickness absence beyond seven days. It is issued by a registered healthcare professional and shows whether the patient is not fit for work or may be fit for work with adjustments. This guide explains how to get a fit note from the NHS, which professionals can issue one, and how self-certification covers shorter absences.
The Fit Note - What It Is
The fit note is a formal document issued under the Social Security (Medical Evidence) Regulations 1976. It replaced the older Med 3 sick note in 2010. It is the standard evidence used by employers for Statutory Sick Pay and contractual sick pay.
The note records the period of incapacity, the medical assessment, and the professional view of whether the patient is not fit for work or may be fit for work with adjustments. The may-be-fit option lets the doctor suggest reasonable adjustments such as reduced hours, amended duties or workplace changes.
Fit notes can be issued for up to three months at a time. Repeated fit notes can extend the period of absence. The patient is responsible for getting a fresh fit note before the existing one expires if absence continues.
Who Can Issue a Fit Note
Since July 2022, fit notes can be issued by GPs, hospital doctors, registered nurses, pharmacists, occupational therapists and physiotherapists. This widening of the issuing professions was intended to reduce pressure on GP surgeries.
Each profession can issue fit notes within their scope of practice. A community pharmacist might issue a fit note for a respiratory condition; a physiotherapist might issue one for a musculoskeletal injury. The relevant healthcare professional decides whether they are the right person to assess and certify.
Private healthcare professionals can also issue fit notes provided they are registered with the relevant UK professional body and are competent to make the assessment. Private fit notes have the same legal status as NHS fit notes.
How to Get a Fit Note from a GP
Most fit notes are issued by GPs. The patient books an appointment, either by phone, online through the GP website or the NHS app, or in person at the surgery. The GP assesses the patient and decides whether to issue a fit note.
Many GP surgeries can issue fit notes after a telephone consultation, particularly where the condition is straightforward and the GP has the records to support the assessment. Some surgeries operate an online fit note service through their NHS-approved patient portal.
For ongoing or repeat fit notes, some surgeries offer follow-up appointments by phone. The patient explains how the condition is progressing and the GP decides whether to extend or change the certification.
Hospital, Pharmacy and Allied Health Professional Routes
Hospital doctors can issue fit notes during inpatient care or in outpatient clinics. This is particularly common after surgery or for patients managing chronic conditions through hospital specialists. The hospital fit note covers the period until the next review.
Pharmacists who have completed the relevant training can issue fit notes for conditions within their scope. The pharmacist consultation room offers a quick alternative to a GP appointment for straightforward cases. NHS England has rolled this out through the Pharmacy First scheme.
Occupational therapists and physiotherapists can issue fit notes for musculoskeletal conditions and rehabilitation. NHS physiotherapy services often handle straightforward back pain and joint conditions where a fit note is the appropriate output.
Self-Certification for the First Seven Days
For the first seven days of any sickness absence, the worker can self-certify. A fit note is not required. The worker completes form SC2 or the equivalent internal employer form, declaring the period of absence and the nature of the illness.
Self-certification covers Statutory Sick Pay for the first seven days. After day seven, a fit note is required to continue the SSP payment. Employers cannot demand a fit note for shorter absences and cannot withhold SSP on the basis that the worker did not visit a GP.
Some workplaces have shorter self-certification windows for repeated short absences, particularly where the employer suspects pattern absence. These shorter windows must be reasonable and applied consistently to avoid discrimination claims under the Equality Act 2010.
Practical Issues Around Sick Notes
Phone or video appointments are acceptable. The fit note can be issued after a telephone or video consultation, provided the healthcare professional can make a proper assessment. NHS England guidance specifically allows remote consultations for fit notes, particularly for ongoing conditions where the patient is already known to the surgery.
Repeat fit notes. For longer-term conditions, repeat fit notes can be issued by phone consultation. The patient should book the follow-up before the existing fit note expires. Where the GP has access to the patient records, the follow-up can be a brief phone call confirming the condition is unchanged.
Private fit notes. Private GPs can issue fit notes with the same legal effect as NHS notes. Private notes can be useful where NHS appointment delays are causing problems. The notes must be issued by a registered healthcare professional.
Self-employed and sick. Self-employed people who do not work for an employer do not need a fit note for SSP (which they cannot claim anyway). They may need one for evidence supporting an income protection insurance claim or for ESA / Universal Credit applications.
Where to Get Free Independent Help
Acas (the Advisory, Conciliation and Arbitration Service) is the statutory body that provides free guidance to workers and employers on workplace issues including how to get a sick note. The Acas helpline is the first port of call for many employment law questions. Acas also runs early conciliation before Employment Tribunal claims.
Citizens Advice and law centres provide free initial advice on how to get a sick note. Some law centres have specialist employment law advisers and can represent claimants at Employment Tribunal hearings free of charge. The Law Centres Network website at lawcentres.org.uk lists centres by location.
Trade unions provide free legal advice and representation to members on how to get a sick note. Even where the worker is not currently a union member, joining a union before issues arise gives access to professional advice if problems develop later. The TUC website at tuc.org.uk identifies relevant unions.
The Employment Tribunal handles workplace disputes that cannot be resolved through Acas. The tribunal is a no-cost jurisdiction (no fees to issue claims at the time of writing) and is designed to be accessible to litigants in person. The gov.uk employment tribunal pages explain the process.
For specific protected groups, dedicated organisations provide tailored support. The Equality Advisory Support Service helps with discrimination claims under the Equality Act 2010. Maternity Action specialises in pregnancy and maternity rights at work. Working Families is a charity supporting families with workplace flexibility issues.
Where the issue involves workplace health and safety, the Health and Safety Executive (HSE) is the enforcement body. HSE accepts reports from workers concerned about unsafe practices and can investigate. Reports are confidential to the extent practicable. The HSE website at hse.gov.uk explains how to raise a concern.
Putting It All Together
The rules above set out the legal framework, the practical steps and the support routes available. Where the situation is straightforward, the gov.uk pages and the official tools should be enough to act on. Where the situation is more complex, the free advice services listed in the previous section can usually clarify the position and identify the right next step. Many issues that look intractable at first turn out to be resolvable once the right service is engaged.
Keeping written records of communications and decisions throughout is good practice. Where a decision needs to be challenged later - through an internal complaint, an ombudsman, a tribunal or a court - the quality of the contemporaneous record often decides the outcome. Dates, names, reference numbers and copies of correspondence are the building blocks of any later dispute. The gov.uk advice pages and the relevant ombudsman or tribunal websites all set out the evidence they consider when reviewing decisions, and gathering that evidence from the start is one of the most effective protections available.
Frequently Asked Questions
Do I need a sick note for the first week off?
No. Self-certification covers the first seven days of any sickness absence. A fit note is only required from day eight onwards.
Can a pharmacist give me a sick note?
Yes. Since July 2022 pharmacists with appropriate training can issue fit notes for conditions within their scope of practice. The pharmacy consultation room is a quick alternative to a GP appointment.
How long can a fit note last?
Up to three months in a single fit note. Longer absences require repeat fit notes. The first fit note in a six-month period can only cover the first three months.
Can I get a fit note over the phone?
Yes. GPs and other healthcare professionals can issue fit notes after a telephone or video consultation, provided they can make a proper assessment of the condition.
What if the GP refuses to give me a fit note?
The GP must use their clinical judgment. If you disagree, you can ask another GP at the same surgery or seek a second opinion. The fit note cannot be issued purely on the patient request without a clinical assessment.
Does my employer get a copy of my fit note?
Yes. The fit note is given to the patient to pass to the employer. The patient keeps a copy for their own records. The employer needs the fit note to process SSP and contractual sick pay.
Can I get a backdated fit note?
Yes. The fit note can be backdated to the start of the absence based on the patient account and any available medical evidence. Most fit notes start from the date of consultation but can be retrospective where appropriate.
How do I get a fit note out of hours?
NHS 111 can refer to an out-of-hours GP service that can issue fit notes for urgent cases. Most non-urgent fit notes wait until normal GP hours.
Do private doctors issue fit notes?
Yes. Private GPs and consultants can issue fit notes with the same legal status as NHS fit notes, provided they are registered with the relevant UK professional body.
Can a nurse practitioner give me a fit note?
Yes. Since 2022, fit notes can be issued by GPs, hospital doctors, registered nurses, pharmacists, occupational therapists and physiotherapists.
How We Verified This
Information is taken from the Social Security (Medical Evidence) Regulations 1976 on legislation.gov.uk, the gov.uk fit note guidance, the NHS England Fit Note webpages, and the Department for Work and Pensions and Department of Health joint guidance. Self-certification details are referenced from the HMRC SSP employer guidance.