Sickness Certificates

A ‘fit note’ is a legal medical statement which is provided by a clinician following a medical assessment at their discretion.  It considers your illness and its impact on your ability to work. The clinician treating you is best placed to assess your condition. If appropriate, a suitable form of fit note may be issued as part of your treatment plan.

This clinician can be a doctor (specialist or GP), nurse, occupational therapist, pharmacist, or physiotherapist delivering NHS services

Fit notes after hospital care

If you are likely to need a fit note (otherwise known as a sick note or MED 3) when you come out of hospital or following outpatient attendance, please ask the doctor treating you in hospital to provide you with one before you leave.

Mythbusters

• "Consultants and junior doctors don’t write fit notes. Fit notes are a GP’s job” – FALSE
• “The hospital just don’t have any fit note pads” – FALSE
• “The hospital can only issue notes for one or two weeks at the very most” – FALSE
• “The hospital can’t issue you with a fit note if you’ve only been to outpatients” – FALSE
• “The hospital won’t be able to message me with my fit note or send it to me in the post” – FALSE
• “The doctor who is treating you at the time has a statutory obligation to provide you with a fit note if you need one. This includes all hospital doctors” – TRUE
• “The doctor who is treating you should sign you off for the appropriate time period according to the condition you have been treated for” – TRUE
• “Both private and NHS doctors can issue fit notes” – TRUE
• “It is part of the hospital’s contractual duty to issue a fit note when one is required. Failure to do so is breach of the hospital’s contract with the NHS” – TRUE
• “Fit notes can be forward dated” – FALSE. If you have a planned operation or procedure that requires time to recover, on the day of the procedure, the fit note can be issued. This should ideally be done the specialist’s team who you are better able to advise you on the timelines, precautions as well as the recovery period.

Thousands of appointments with GPs are taken up each year by patients requesting fit notes when they could have actually been issued by hospital doctors providing treatment at the time. Please help us to keep our appointments free for patients who have genuine clinical need, rather than for administrative paperwork that could have easily been dealt with by others at the end of your hospital visit. If you have trouble getting a fit note from the hospital, please contact the PALS (Patient Advice Liaison Service) team at the hospital.

For illnesses lasting more than 7 days

If you are off work for more than seven days due to illness, your employer can ask you to give them some form of medical evidence to support payment of SSP (statutory sick pay) or other sickness benefit.

If you are not currently under the care of a Clinician, you will typically need an in-person assessment. If appropriate, a suitable fit note may be issued as part of your treatment plan.

This Clinician can be a doctor (specialist or GP), nurse, occupational therapist, pharmacist, or physiotherapist delivering NHS services. In some cases, a fit note may be issued based on a written report from another Clinician such as a specialist, at the GP’s discretion. However, it’s better to obtain the fit note directly from the team treating you, as they are better equipped to assess and issue it with the necessary details and advice regarding your recovery.

The fit note assessment will consider which daily activities you are able to do, including work (paid or unpaid), studies, caring for others, commuting including travel. If you are unable to perform any form of work, a ‘complete’ or ‘total’  fit note  may be issued for an appropriate period, then reviewed if required. 

It remains the responsibility of and discretion of the clinician treating you if a fit note is issued and any associated stipulations.

A total fit not implies that unable to undertake any forms of work whatsoever. The fit note: guidance for patients and employees.

Optional Occupational Sick Pay Schemes

A number of employers operate occupational sick pay schemes which, while offering employees more benefits than that prescribed under SSP (Statutory Sick Pay) legislation, require more in the way of certification in that they require a Doctor’s certificate for illnesses of less than 7 days’ duration. Since the advent of self-certification for statutory sick pay purposes in 1983, as has been mentioned GPs are not required to issue certificates for periods of sickness of less than 7 days duration. It is clearly not a GP’s role to supervise an employers enhanced occupational sick pay scheme. If employers require additional certification, it is up to them to make their own arrangements, on a private basis, with a Doctor, be it the patient’s own GP or an occupational health Doctor to examine and verify the genuineness of the patient’s illness. For this reason, when GPs are asked to carry out this work and provide a sickness certificate within the first 7 days of illness it is classed as un-commissioned private work and attracts a fee (charged in accordance with national BMA guidance). 

Please note that our members of staff including reception and clinicians have a right to work in a safe environment, without fear of bullying, aggression, intimidation or harassment. The NHS Zero Tolerance Policy applies at all times as such any behaviour deemed in breach of this will not be tolerated. Please refer to Zero Tolerance page for further information.