Fit notes

A quick guide on issuing fit notes to patients who have been off sick, and your ethical obligations.


The current system for issuing fit notes was introduced in 2010, with a change in emphasis from certifying sickness to helping patients stay in work or return to work where possible.

Completing a statement of fitness to work

It's important to understand how to complete a fit note for patients who are, or have been on, sick leave. GPs are contractually required to complete the statement of fitness to work free of charge, when the patient has been off sick for more than seven calendar days.

The legislation was updated in July 2022 to allow a wider range of healthcare professionals to certify fit notes across England, Scotland and Wales. This includes nurses, occupational therapists, pharmacists and physiotherapists.

Telephone consultations are an accepted form of assessment, as well as face-to-face consultations or reports from another doctor or healthcare professional.

When filling out the form, healthcare professionals should do the following.

  • State whether the patient is 'not fit for work' for a stated period of time - or that the patient 'may be fit for work taking account of the following advice...' with the doctor's recommendations.
  • Comment on the effects of the patient's condition in the space provided, or use the tick boxes to indicate that the patient may benefit from additional support (such as changes to their working conditions) to help them return to work. If it's not possible for an employer to provide this support, the form can be taken as a statement that the patient is 'not fit for work' - it's not necessary to fill out a new form.

The statement can be issued for no longer than three months in the first six months of sickness.

Government advice for healthcare professionals issuing fit notes states that "you are not expected to have specialist knowledge of workplaces or occupational health, and you do not need to suggest possible changes to the patient's workplace or job."

Advice given should be on the functional effects of the patient's condition within the limits of your knowledge and expertise - for example, a person with lower back pain might be advised that they 'cannot sit for long periods of time'.

Ethical obligations

When completing forms, doctors should be aware of their ethical obligations - being honest and trustworthy, taking reasonable steps to make sure information is correct and not deliberately leaving out relevant information.

Some doctors will be more confident than others in giving advice on fitness to work, but it's always important to recognise and work within the limits of your competence.

In some cases, you may prefer to recommend that the patient sees an occupational health doctor.

If you're an MDU member and you need more advice about completing statements of fitness to work, contact one of our medico-legal advisers.

This page was correct at publication on 15/06/2022. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.