DEFINITIVE GUIDE

Sick notes explained

Sick notes – also known as fit notes, doctor’s notes, and med3s – can be complicated to navigate.

They are especially challenging if you have been fortunate enough to never need one.

Get a sick note today - find your nearest clinic and see a doctor in minutes.

Written by Dr Zubair Ahmed and Jenny Huelin. Last reviewed on 01/03/2019. Next review date 01/03/2022.

Fast facts

How does a sick note work?

A sick note (also known as a ‘Fit Note’ or a ‘Statement of Fitness for Work’) is a certificate issued by a doctor. It is used to notify an employer, teacher or person in charge that an absence was due to health problems. Sick notes can say ‘fit for some work’ or ‘not fit for work’.

Can a doctor refuse to give a sick note?

Sick notes are discretionary. A doctor can refuse to give you a sick note if they feel you are fit to work. It helps to document when your symptoms started, what symptoms you have had, and how severe they have been to give the doctor a clear and accurate picture of your health condition.

CHAPTER ONE

How to get a sick note

At times, it can feel like you have to jump through hoops to get a sick note. This is often made worse when you are feeling unwell. Our definitive guide makes it easy to get a sick note from a GP.

Sick notes are issued by doctors; from NHS GPs and hospital doctors to private doctors and online doctors. There are different costs, processes and timelines associated with each option. We can help with:

Where to get a sick note? And what is the best option for you?

Who can issue a sick note?

You can get a sick note from:

  • your local NHS GP
  • your hospital doctor if you are receiving inpatient treatment
  • some walk in centres (most do not offer this)
  • a private doctor

Your employer can also ask for a self certified sick note when you return to work after being absent. Learn more about self sick notes.

How to get a sick note from the doctor?

Getting a sick note:

  1. Schedule a doctor appointment
  2. The doctor may examine you to assess your condition
  3. The doctor will decide if you are fit to work or not
  4. The doctor will write a sick note if they deem you are fit for some work or not fit for work
  5. Present the sick note to your employer

A written report from another healthcare professional can support your case to get a sick note. Examples include a hospital discharge summary or notes from a consultation with another GP.

How much does a sick note cost?

NHS sick notes are free if you have been off sick from work for more than 7 days. Your NHS GP may charge you for a private medical certificate if you have been off sick for 7 days or less. Most private doctors charge additional fees to issue sick notes.

Sick notes from private doctors can cost £39 to £60 depending on the provider.

How to get a private sick note?

You may consider a private sick note if you have been off work for less than 7 days or need a sick note at short notice. Many online doctor services offer same day private sick notes. In many cases, you do not need to see a doctor in person to get a sick note.

Medicspot doctors can speak with you today and email you a sick note at no additional cost. Learn how Medicspot can help you.

Can a doctor backdate a sick note?

Doctors can legally backdate sick notes. However, some doctors prefer to only issue sick notes providing they can assess your current illness. Some providers like Bupa do not provide sick notes for a retrospective illness. Medicspot doctors can provide backdated sick notes if there is sufficient evidence to support the retrospective condition.

CHAPTER TWO

When to get a sick note

You may have heard of the 7 day rule for sick notes: if you have been sick for 7 days or less, you may have to pay your NHS GP surgery for a sick note; if you have been sick for more than 7 days then you are eligible for a free sick note. You can complete a self certificate form for the first 7 days, however some employers and Universities require a doctor’s note.

Your employer or academic institution may require a sick note by a certain date. If this is the case, you may want to explore getting a sick note from a private GP. We can help with:

When do you need a sick note for work? And how do you calculate the number of days you have been off sick?

When do you need a sick note?

Sick notes are generally used to show your employer that you are unwell and need time off work. They can also be used to advise your employer that you need a change in your work hours or duties. Other organisations such as colleges and Universities may also ask for a sick note, particularly if you perform poorly or miss an exam due to being unwell.

Fit notes are designed to prevent people from taking time off work or school when they are not actually sick.

Important

Do not attempt to get a sick note from a doctor if you are not actually sick. Lying about being sick may have severe consequences including disciplinary action.

More than 7 days off sick

Employers will usually ask for a sick note if you have been sick for more than 7 days in a row (including non-working days). You can get a sick note from your local GP or hospital doctor. NHS sick notes are free if provided after 7 days of consecutive sick days.

7 days or less off sick

Employers do not usually ask for a medical sick note if you have been sick for 7 days or less. Some employers may require you to complete a self certification sick note to confirm that you have been ill. You can complete a self certified sick note yourself.

Time off without a doctor’s note

The number of days sick you can have off sick before you need a doctor's note is usually dependent on your employer’s absence policy. You may also find relevant details in your employment contract. As a rule of thumb, employers normally ask for a sick note after you have been ill for more than 7 days.

Counting sick days

NHS sick notes are free if you have been sick for more than 7 days. During your appointment, the doctor will ask how many days you have been sick. When counting the number of days you have been sick, make sure to include weekends and bank holidays.

CHAPTER THREE

What sick notes can and cannot help with

More than 500,000 people are off sick from work every 28 months for anxiety and stress-related conditions. Sick notes are not restricted to physical conditions like a bad back. They also encompass mental health issues that prevent you from being fit for work.

You may require time off work for emergency situations. There are many scenarios that are not health related but still require a leave of absence. We can help with:

What conditions can you get a sick note for? And what is compassionate leave?

Can you get a sick note for bereavement?

You cannot get a sick note for bereavement. However, depending on your employer’s policy, you may be entitled to take compassionate leave. The UK government says “as an employee you are allowed time off to deal with an emergency involving a dependent.” A dependent is someone who depends on you for care. This includes your:

  • children
  • grandchildren
  • spouse
  • partner
  • parents

This leave does not apply if you knew about the situation beforehand (i.e. a pre-planned medical appointment). In some cases, you may be eligible for unpaid parental leave instead.

Bereavement time off work rights

You can get a leave of absence from work for a death in the family if it involves a dependent. There is no limit on the amount of time you can take off as long as it is considered ‘reasonable’. If you need to take compassionate leave, make sure to:

  1. Notify your employer as soon as possible if you need time off
  2. Check your contract or company policy to find out if your leave will be paid or unpaid
  3. In the absence of such a policy, talk with your line manager to see if they will grant paid compassionate leave
Important

Paid leave is at the discretion of your company.

Can you get a sick note for migraines?

You can get a sick note for short term health conditions like migraines or the flu. However, you are usually not required to get a sick note from a doctor if you are sick for 7 days or less. Migraines usually last between 4 to 72 hours and the flu is at its most contagious during the first 5 days of the infection.

Can you get a sick note for mental health issues?

You can get a sick note for mental health issues like depression, work related stress, and anxiety. The NHS introduced the Five Year Forward View for Mental Health in 2016 to reduce the long term impact for people experiencing mental health problems. There are resources available to support people with mental health and reintegration in the workplace.

Does my child need a sick note for school?

If your child has been off sick from school for 7 days or less, they do not require a sick note from a doctor. Instead, a note from you (as the parent or guardian) should be sufficient confirmation that your child’s absence was due to sickness.

CHAPTER FOUR

When to return to work

Sick notes can be used for shorter term illness or injury to long term health conditions. You may feel better and fit for work earlier than the date stated on your sick note. If this is the case, you can usually return to work earlier than the given date on your fit note, provided your employer is in agreement with this.

It can be difficult understanding the difference between ‘fit for work’ and ‘fit for some work’. This guide will explain what this means for you. We can help with:

How to find out when your sick note runs out? And when can you return to work?

Sick note dates explained

Box 2 shows when your sick note runs out. This is the period of time that your sick note is applicable for. Your sick note is no longer valid on any date after the end date. The start date, Box 3, is often the same as Box 1, the date of assessment, but can also be before the assessment date if the doctor has written a backdated sick note.

Fit note return to work date

Your doctor will say on your sick note a date for you to go back to work. Sometimes, your GP may recommend that they need to see you again before you go back to work. If your condition is not serious, you may discuss with your employer about returning to work before your sick note end date.

Can you return to work before your sick note ends?

In many cases, you are able to return to work before your sick note ends. You do not need to be fully fit to return to work. With your employer’s consent, you can go back to work before your sick note ends.

This may happen if you have recovered from injury or illness faster than anticipated or if your employer makes adjustments to support your early return to work.

Sometimes, you cannot return to work early because:

  • your doctor advised that you stay off work for the full duration of the sick note
  • your employer cannot make the required workplace adjustments
  • your employer does not consent to you returning to work earlier than the expiry date on your sick note

Do you need a fit note to return to work?

You do not need to be signed ‘fit’ by your doctor to return to work. However, in some cases you may not be able to return to work until:

  • you show your employer medical evidence that you are fit for work. If your employer stipulates this then they should help you arrange this privately with a GP.
  • you meet special requirements. Your employer will tell you if you need to meet any requirements before returning to work.

This is common if you drive a large goods vehicle (like a lorry) or a passenger carrying vehicle (like a bus). The Driver and Vehicle Licensing Agency (DVLA) has rules about driving with a health condition or disability.

‘Fit for some work’ explained

The doctor may think you are fit for work if certain criteria are met. They may suggest changes to your routine so you can still perform some elements of your job. Discuss these changes with your employer to see if you can return to work. If your employer cannot accommodate these changes, your sick note is considered to say unfit for work.

Possible changes may include:

  • temporarily working different hours
  • temporarily working different roles
  • receiving support in your job (like no heavy lifting with back pain)
  • returning to work on reduced hours or as part of a phased return to work
CHAPTER FIVE

Sick note rules and pay

Sick note rules can vary based on the absence policy of your employer or academic institution. It is a common misconception that employees are entitled to full sick pay when they are not fit for work due to illness or injury.

Occupational Sick Pay is a discretionary benefit provided by employers. Government programs like Statutory Sick Pay and Agricultural Sick Pay are mandatory for employers if you are eligible. We can help with:

What is Occupational Sick Pay? Will you receive Statutory Sick Pay?

Do you get paid with a sick note?

Occupational Sick Pay (OSP) is up to the discretion of your employer. You can find out whether or not you will receive full sick pay in the terms of your contract. If your employer does provide OSP, they may require you to give them a sick note if you have been sick for more than 7 days in a row (including non-working days).

What is Statutory Sick Pay?

Statutory Sick Pay (SSP) is a UK program that provides financial support if you are not fit for work due to illness or injury. SSP applies if you have been sick for at least 4 consecutive days (including non-working days) and lasts for a maximum of 28 weeks.

How much is Statutory Sick Pay?

The level of Statutory Sick Pay (SSP) for 2018/19 is £92.05 per week (rising to £94.25 on 6 April 2019), equivalent to £18.41 per working day. SSP will be paid the same way that you normally receive pay (like weekly or monthly). Tax and National Insurance will be deducted from your SSP. If you have multiple jobs you can get SSP from each employer.

Tip

There are different rules for agricultural workers receiving sick pay.

Do you qualify for Statutory Sick Pay?

Statutory Sick Pay (SSP) requirements:

  • you need to have completed some work for your employer
  • you need to be classified as an employee (agency workers are also entitled to SSP)
  • you need to earn at least £116 per week on average
  • you need to have been ill for 4 or more days in a row

You will not qualify for SSP if:

  • you are receiving Statutory Maternity Pay
  • you have had a continuous series of ‘linked’ periods of sickness for more than 3 years
Tip

Each ‘linked’ period of sickness must be 4 days or longer and 8 weeks or less apart from one another.

How to claim Statutory Sick Pay?

To claim Statutory Sick Pay (SSP) you need to tell your employer before their deadline. If they do not have a deadline, you need to tell them within 7 days of being sick.

You should talk with your employer if you think they wrongly rejected your SSP claim or if you are not receiving the correct amount of SSP. You can also contact the HM Revenue and Customs (HMRC) statutory payment dispute team:

Telephone: 03000 560 630

CHAPTER SIX

Employment and Support Allowance

If you are not entitled to Statutory Sick Pay (SSP) or if your SSP ends, you may be eligible for Universal Credit or Employment and Support Allowance (ESA).

If self-employed or unemployed, sick notes can be used to support benefit claims. You may qualify for ESA if you cannot work because of illness or disability. We can help with:

What is ESA? And how to apply for ESA?

What is Employment and Support Allowance?

ESA is a UK welfare payment made to people who have difficulty finding work due to illness or disability. ESA also provides personalised help so that you can work if you want to. ESA is available to people who are employed, self-employed or unemployed.

There are 3 types of ESA:

  • ‘new style’ ESA
  • contributory ESA
  • income-related ESA

Who can claim Employment and Support Allowance?

You can claim ESA if illness or disability affects your ability to work and you are:

  • under the State Pension age
  • not receiving Statutory Sick Pay
  • not receiving Jobseeker’s Allowance
  • not receiving Statutory Maternity Pay and have not gone back to work

You are entitled to ESA when employed if you:

  • do ‘permitted work’ - you must earn £125.50 or less per week and work less than 16 hours per week
  • do ‘supported permitted work’ - you must earn £125.50 or less per week and either be part of a treatment program or be supervised by someone from a voluntary organisation or local council who arranges work for disabled people

How much is Employment and Support Allowance?

You will usually receive the assessment rate for the first 13 weeks following your claim:

  • up to £57.90 per week (aged under 25)
  • up to £73.10 per week (aged 25 or over)

If you are then entitled to ESA, how much you get will depend on your circumstances (like income) and your type of ESA. ESA will be paid directly into your bank, building society or credit union account.

Tip

Work out how much ESA you will get using a benefits calculator.

How to claim Employment and Support Allowance?

The fastest way to apply for ESA:

  1. Get a sick note from a doctor
  2. Collate the required information*
  3. Call the relevant contact centre (the number to call depends on the type of ESA you are applying for)
  4. Send your sick note online or by post
  5. Complete a Work Capability Assessment (this assessment is different for Northern Ireland)

*To claim ESA, you will need your:

  • National Insurance number
  • sick note
  • GP address and phone number
  • home and mobile phone numbers
  • mortgage or landlord details
  • council tax bill
  • employer address, phone number and dates of employment
  • bank account details
  • details on other money you are getting (like benefits or sick pay)

Does sickness affect Job Seekers Allowance?

Jobseeker’s Allowance (JSA) is a UK welfare payment made to unemployed people who are actively looking for work. If you are sick for a short period of time because of illness or injury, you can still claim JSA if you have either:

  • 2 periods of sickness 14 days or less in any job seeking period
  • a period of sickness up to 13 weeks long (known as Extended Period of Sickness)
Important

An Extended Period of Sickness requires medical evidence (like a fit note) if you have been sick for longer than 2 weeks.

CHAPTER SEVEN

Self certified sick note

A self certification form is used to show to your employer the reason why you were off work sick. It provides evidence to support claims for Occupational Sick Pay or Statutory Sick Pay.

Self certification is only required by some employers when you have been absent from work for 7 days or less. We can help with:

What is self certification? And how do you self certify?

How to self certify sickness?

Some employers may ask for a self certification form to prove that absence from work was due to illness or injury. This can be asked if you have been off sick from work for up to 7 days. If you have been sick for more than 7 days then your employer may ask for medical evidence (like a sick note).

How long can you self certify sickness?

You can self certify yourself sick off work for 7 days or less. Self certification is not required by all employers. Check your company’s absence policy to see whether self certification is applicable for you. If you are unsure what to do, you can call the Fit for Work advice line for free on 0800 032 6235.

Do you get paid for self certified sickness?

Getting full pay for time off sick is up to the discretion of your employer. Your contract or company policy will detail whether or not you will receive paid sick leave. If you are not entitled to Occupational Sick Pay, you should still receive Statutory Sick Pay if you are eligible.

Where can you get a self certification form?

Employers will usually provide their own self sign sick note form. If not, you can use the HM Revenue and Customs template called form SC2. Simply enter your details, print the form and give to your employer.

How to write a self certified sick note?

When you complete a self certification form, make sure to provide as much detail as possible about:

  • why you were absent (illness or injury)
  • the cause of your sickness
  • dates when your sickness started and ended
CHAPTER EIGHT

Fit note resources

Fit notes can be difficult to navigate for both employees and employers. They are designed to support people who are off work sick for more than 7 days so they can receive Occupational Sick Pay (if applicable) or Statutory Sick Pay.

However, almost half of the UK workforce has feigned sickness to take time off work. This may cause an element of mistrust that can cause disputes and affect pay outcomes.

Fit for Work

Fit for Work offers free impartial advice to people looking for help with health and work issues. The service is designed to support those who are off sick from work or have a health condition at work. You can call their helpline on 0800 032 6235.

Acas

Acas helps to prevent and resolve workplace problems by offering training, conciliation and information advice to employers and employees. If you feel you have been unfairly treated for taking time off work for dependents, you can call their helpline on 0300 123 11 00.

Work reintegration

For employees: a return to work plan reduces any feelings of isolation and uncertainty. Fit for Work explains what to include in your plan to help with reintegration in the workplace.

For employers: The Health and Safety Executive (HSE), the regulatory body for workplace health and safety, has a guide on managing sickness absence and helping people get back to work.

Mental health support

Mental health support services in the UK:

  • Anxiety UK - provides support if you have been diagnosed with anxiety or anxiety-based depression
  • Bipolar UK - provides support to people with bipolar, as well as their families and carers
  • CALM (The Campaign Against Living Miserably) - dedicated to preventing male suicide
  • Mental Health Foundation - dedicated to finding and addressing the sources of mental health problems
  • Mind - provides advice and support if you have a mental health problem
  • No Panic - supports people who suffer from panic attacks, phobias and Obsessive Compulsive Disorders (OCD)
  • OCD UK - provides advice and support services to those affected by OCD
  • PAPYRUS - provides confidential suicide advice to young people
  • Rethink Mental Illness - dedicated to improving the quality of life for people affected by mental illness
  • Samaritans - provides confidential support for people experiencing distress or despair
  • SANE - provides support and guidance to anyone affected by mental illness, including families, friends and carers

Employment tribunal

Can your employer override a doctor’s note? Can you be sacked if you have a sick note? These are just two of a number of important questions relating to employment rights and fair treatment. The UK Government has an excellent guide on when and how to make a claim to an employment tribunal.

CHAPTER NINE

Get a sick note with Medicspot

We’re on a mission to make healthcare more accessible and convenient. We have over 100 private doctor clinics across the UK - simply find your nearest one and see a GP today.

Our private doctors can help diagnose your condition, provide expert treatment and write sick notes and referral letters as needed. We can help with:

Where is your nearest clinic? And how can Medicspot help?

How it works

The Medicspot Clinical Station allows doctors to conduct a remote clinical examination to provide a safe, accurate diagnosis. Our doctors can then write sick notes and referral letters as needed.

Find your local clinic.

CHAPTER TEN

About the authors

Dr Zubair Ahmed

Dr Zubair Ahmed is a GP and the Co-founder and CEO of Medicspot. He has been a doctor for 12 years after obtaining his medical degree from the University of Aberdeen, Scotland. He worked across a wide array of specialities including cardiology, accident and emergency, and geriatrics before focusing his energies on becoming a General Practitioner.

Jenny Huelin

Jenny is a Senior Associate at BDB Pitmans LLP. She specialises in and advises on all aspects of employment law. She provides regular and daily advice on contentious and non-contentious employment issues arising before, during and after employment.

Disclaimer

This article is for general information only and should not be used for the diagnosis or treatment of medical conditions. Medic Spot Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. In the event of an emergency, please call 999 for immediate assistance.