What a fit note is
A fit note — formally the Statement of Fitness for Work on form Med 3 — is the NHS-issued document that says you are either "not fit for work" or "may be fit for work" with adjustments. It replaced the old "sick note" in 2010. It is the evidence employers and DWP need to pay Statutory Sick Pay (SSP) beyond the first 7 days, to underwrite company sick pay, and to support Universal Credit limited-capability-for-work assessments.
A fit note is not a diagnosis. It does not name your condition unless you want it to (the clinician may write a brief description). It states the clinician's professional assessment of your fitness for work and an end date.
Who can issue one
Since 1 July 2022 the law lets five registered professions issue fit notes — not just GPs:
- Registered doctors (GPs, hospital doctors, A&E)
- Registered nurses
- Occupational therapists
- Pharmacists
- Physiotherapists
It does not have to be your registered GP. A hospital discharge fit note from the ward team is valid. A fit note from a community mental health nurse you have just seen is valid. This matters when your GP practice is hard to get into.
The 7-day self-certification rule
For the first 7 calendar days of any sickness absence (including non-working days) you self-certify. Your employer either gives you form SC2 or accepts their own equivalent. No clinician sees you. This rule applies whether you are off for a one-off bug or the start of something longer.
From day 8 onwards you need a fit note to keep getting SSP. If you are paid company sick pay above SSP, your contract will usually require a fit note from day 8 too.
How to request one
You do not need an in-person GP appointment. Use the channel your practice prefers: online consultation form (eConsult, AccuRx, NHS App), phone request to reception, or a written message via the NHS App. State clearly:
- You need a Med 3 fit note from day 8 onwards
- The condition (or symptoms) and how long you have been off
- How long you reasonably expect to be unable to work
- Your employer's email address if your practice can send direct
Most practices issue digitally now. Renewal works the same way — request before the current note expires, do not let it lapse.
'May be fit for work' explained
The fit note has two tick boxes: "not fit for work" or "may be fit for work" with suggested adjustments. The clinician picks one. "May be fit for work" is not a judgement that you are well — it means the clinician thinks you could work with one or more of: a phased return, altered hours, amended duties, workplace adaptations.
Your employer must consider those suggestions but is not obliged to provide them. If they cannot or will not, the fit note is then treated as "not fit for work" and you stay on SSP. You do not need a new fit note for that.
If your GP refuses
A clinician who has assessed you can decline to issue a fit note only on professional grounds — for example, they do not believe the evidence supports it. They cannot refuse because "we don't do those" or "we only see you in person". If you are stuck:
- Ask any of the five professions above — a hospital team, a community pharmacist, your physio if you are under one
- Ask reception for the practice's complaints procedure and the ICB's contact for primary care complaints — see our formal complaint guide
- Self-certify days 1–7 buys you time
- If a GP has refused because they do not believe you are unwell, get a second opinion within the practice or via Right to Choose — see how to request a second opinion
Frequently asked questions
›How long can a fit note be self-certified for?
The first 7 calendar days of any sickness absence can be self-certified using form SC2 — you do not need a fit note from a clinician. From day 8 onwards a fit note is required for SSP.
›Who can issue a UK fit note?
Since July 2022 fit notes can be issued by registered doctors (GPs and hospital), nurses, occupational therapists, pharmacists and physiotherapists. It does not have to be your registered GP.
›Do I need to be seen in person?
No. Fit notes can be issued after a remote consultation — phone, video or based on a written report. You do not need an in-person appointment.
›Is a fit note free?
Yes for NHS fit notes covering the first 7 days of absence onwards. Your GP cannot charge for the standard Med 3 fit note used to support an SSP claim.
›What if my GP refuses to issue a fit note?
You can request one from any registered healthcare professional listed above, including those at your hospital team. If you have been seen and assessed and a clinician unreasonably refuses, you can complain to the practice manager and the ICB.
›What does 'may be fit for work' mean?
It means the clinician thinks you could work with adjustments — amended hours, lighter duties, phased return, workplace adaptations. Your employer is not obliged to accept, but if they cannot accommodate, the fit note is treated as 'not fit for work'.