This blog was developed from NIG Risk Assist in order to inform employers of the changes to ‘Fit Note’ rules. Use this blog to educate your employees and be mindful of the changes in future.


Who is now legally permitted to certify “fit notes” has changed. They can now be certified by medical professionals other than only doctors. Nurses, occupational therapists, pharmacists, and physiotherapists will all be able to do this as of July 1, 2022.

The new fit note form will be available to healthcare professionals (HCPs) providing NHS services in GP offices, hospitals, and other NHS settings where the change is being implemented. HCPs are frequently at the vanguard of patient care, with careers eager to recognise job and health requirements, receive the proper care, and support and aid patients to manage their conditions and remain in the workforce or return to it quickly.

More experts providing this service should hasten the procedure and aid individuals in returning to or continuing their employment.

The New Adjustments

Fit notes, formerly sick notes, are official declarations by a licenced healthcare expert expressing their professional judgement regarding a person’s ability to perform their job. They may also contain suggestions for how the company could assist the employee, and they can now be supplied in paper or online. The length of the sick leave will determine whether or not a fit note is required.

The Guidance has published important resources outlining general guidelines that are relevant for persons involved in certifying fit notes, such as: –

  • Advice for healthcare professionals and their employers that is not required by law
  • Making the most of the “fit note” involves taking practical steps like having a health and work talk and completing the fit note form
  • A fit note training session for healthcare professionals that helps them get ready to certify fit notes as part of their practise is available online

How do fit notes work?

How do fit notes function?

Once a worker has missed more than seven calendar days of work, HCPs may issue a fit note (the employee self-certifies for the first seven days). A worker may be “fit for work” or “not fit for work,” according to the fit note. An employee’s health will only affect their ability to perform their job duties if the HCP issues a fit note. Employers may be able to make adaptations so that employees may perform some work during their recuperation period, thus their choice will be based on the employee’s overall capacity to work rather than their ability to perform their specific job. The fit note also informs the employer of the completion date of the HCP’s evaluation and whether the employee needs to see them again on expiry of the fit note.

NB. HCPs cannot issue fit notes for non-medical problems (such as home or relationship issues). 

The HCP may check one or more of the following to indicate that the worker would profit from receiving advice from the employer on returning to work:

  • A phased return to work
  • Altered hours
  • Amended duties
  • Workplace adaptations

Employers must make sure that any modifications advised by the HCP are appropriate and won’t endanger the worker.

What is required of an Employer?

If the employee’s fit note indicates that they are “not fit for work,” the employer should take note of when it expires and whether the HCP must visit them before they may resume work. The individual can start working again before the fit note expires, and the HCP does not need to “sign them off” again. The employer should be informed of this. However, if the employer is unsure whether the employee’s early return is suitable (which may occur if they are not being paid), they may recommend that they do so.

The employer might think about getting a medical report from a third party, like an occupational health specialist, if an employee is declared “not fit for work” for a lengthy period of time.

If the note indicates that the employee “may be fit for work,” the employer should talk with the employee about the HCP’s recommendations. These can include, for example, a completely different function during the recovery period, adjusted/part-time hours, working from home, or extra breaks. The employer is required by law to make reasonable adaptations to the working environment to enable the employee’s return to work if their conditions qualify them as disabled under the Equality Act 2010.

The HCP’s recommendations on the fit note are not legally enforceable; rather, they are there to give more details about what the employee can and cannot do.

If the fit note indicates that the employee’s job might be having an adverse effect on their health, this should be examined with the person to find out exactly which components of their job are hurting their health and wellbeing.

The employer should keep in mind that they are free to consult a GP or an expert in occupational health for more information.

Possible Concerns for the Employer

Some companies are worried that employees would manipulate the system as a result of these recent developments by seeking out HCPs who are more likely to write a fit note or by going to any drugstore and easily getting one “over the counter.”

Healthcare practitioners “should assess their scope and practise and ensure they have the required skills, knowledge, and experience before completing health and work talks and making judgments around certifying fit notes,” according to government guidance, which addresses these concerns.

Additionally, in order to avoid employees from receiving a fit note without a professional assessment being done, HCPs are obliged to evaluate a person’s fitness for work prior to providing a fit note.

N.B. In light of these modifications, companies must make sure that their contractual sick pay is not tied to an employee visiting a doctor, as this tactic could lead to issues.

What benefits are there for employers?

The pandemic had a significant impact on doctor visits and the accompanying issuance of fit notes. Additionally, companies have had to be more accommodating when it comes to the documentation needed for any kind of sick absence.

An HCP who is treating the employee and is therefore more likely to be aware of what job their patient is fit to do should provide employers with more accurate and up-to-date information thanks to the change in how fit notes are provided.

It has been demonstrated that returning to work before being fully recovered is not always necessary, and that working can frequently speed up the healing process. The HCP will go over how a worker’s health influences their ability to perform their job duties, taking into account their overall fitness for work as opposed to just their current position.

Instead of just noting the health problem, the HCP can also offer useful suggestions on the fit note. Employers should use this information to help them decide what modifications to make to help employees return to work.

Useful Resources:

See Fit Notes in the HR A-Z Guidance

Further information and guidance can be found in the following:

On the Government website:

Also see the ACAS website regarding fit notes and proof of sickness


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