What is a fit note? A plain-English guide to the form and what it means

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A fit note is the official name for what most people still call a sick note: a statement from a healthcare professional, formally titled the Statement of Fitness for Work, which records that your health is affecting your ability to work and gives advice to you and your employer about it. You need one if you are off work ill for more than seven days in a row, and it can say either that you are "not fit for work" or that you "may be fit for work" with support from your employer.

This piece explains the document itself: where it came from, what it actually says, what it looks like, and what it is used for, including when the reason is your mental health. It deliberately stays on the document, because the surrounding stages have their own guides. If you are further along and thinking about going back gradually, how a phased return to work actually works covers that stage in full. Everything here is drawn from NHS and GOV.UK guidance, with the mental health side drawn from the NHS and Mind, and the parts about pay and your rights belong with ACAS or Citizens Advice rather than a health guide like this one.

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Is a fit note the same as a sick note?

Yes, they are the same document, and "sick note" is simply the older name that has stuck in everyday use. The fit note was introduced in 2010 to replace the sick note, and GOV.UK still describes it as "commonly known as the fit note", with the old name in brackets on most official pages.

The change of name was not cosmetic. The old sick note was essentially a yes or no on whether you could work, while the fit note is built around advice: it records how your health is affecting what you can do, and it can suggest ways for you to stay in or return to work rather than simply signing you off. That is why a healthcare professional cannot actually issue a fit note saying you are "fit for work". If you are fit for work, you do not need the document at all, and GOV.UK is explicit that the note only exists for situations where your health is affecting your fitness for work.

One boundary worth knowing about is that a fit note can only be issued for medical problems. GOV.UK is clear that a healthcare professional cannot give you one for non-medical difficulties, such as problems at home, although they may be able to point you towards other sources of support. Mental health conditions are medical, which matters for the section further down.

What does a fit note actually say?

A fit note says one of two things: that you are "not fit for work", or that you "may be fit for work" with support from your employer. It also states the period it covers, and it can include practical advice about what would help.

If the note says you "may be fit for work", the healthcare professional can use tick boxes on the form to suggest the kind of support that might help, and GOV.UK lists the four options: a phased return to work, altered hours, amended duties, or workplace adaptations such as working from home. There is also a comments box where they can add more detailed advice about how your condition affects what you can do.

Two things follow from that, and both are easy to miss. First, the suggestions are advice, not instructions. GOV.UK says the options are not binding on you, and they exist to give you and your employer something concrete to discuss. Second, if your employer cannot put the suggested support in place, both the NHS and GOV.UK say the note is then treated as though it says you are "not fit for work", and you do not need to go back for a new one.

The note also does not lock you in until its end date. The NHS says you should go back to work as soon as you feel able to, with your employer's agreement, and that this can be before the fit note runs out. You do not need to see a healthcare professional again just to return.

What does a fit note look like?

A modern fit note may not look like the paper certificate people picture. GOV.UK explains that fit notes can be handwritten or computer-generated, and can be printed or shared with you digitally, because a 2022 change replaced the ink signature with the printed name and profession of the issuer. A valid fit note must include the issuer's name, their profession and the address of the medical practice, and if the name is missing it is not valid and could be rejected.

Since that same 2022 change, it is also no longer only doctors who can issue one. The NHS lists the healthcare professionals who can provide fit notes as doctors, nurses, occupational therapists, pharmacists and physiotherapists, and the assessment behind the note can happen face to face, by video or phone, or through a written report from another healthcare professional, so you will not always need an in-person appointment.

The fit note belongs to you. GOV.UK says your employer can take a copy for their records, but you keep the original. On length, the period a note covers is down to the healthcare professional's clinical judgement, although in the first six months of a condition a single fit note can cover a maximum of three months at a time.

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Do fit notes cover mental health?

Yes. A fit note is issued for health conditions that affect your fitness for work, and mental health sits inside that in exactly the same way as physical health, so stress, anxiety and low mood are all reasons a fit note can be issued. GOV.UK's own guidance for patients includes a mental health case study, and Mind describes how sustained or unmanaged stress can affect your emotions, your body and your behaviour, which is exactly the territory a fit note conversation is there for.

If that is the situation you are in, the document is usually the smallest part of it. The fuller guide to getting a sick note for work for your mental health walks through self-certification, the appointment itself and what happens next, and how long you can be signed off with stress covers the longer-term picture. Support while you are off does not have to mean committing to a full course of therapy either. Wobble's therapists work to the Wobble response framework, a structured framework built for short, practical, single-response support, and when Wobble was tested with real people, 96% said they felt better after a single video. It is built to be low-friction and low-cost, one clear step at a time, which tends to suit exactly the weeks a fit note covers.

What a fit note is used for

Beyond telling your employer you are off sick, the fit note is a piece of evidence. The NHS says you can use it to support a claim for statutory sick pay or benefits, and GOV.UK explains that a note assessing you as not fit for work is evidence an employer can accept for statutory sick pay eligibility.

That is where a health guide has to hand over, because how much you are actually paid while off, for how long, and what happens with your job are not medical questions and the fit note does not decide them. For sick pay, your rights while off, and returning to work, ACAS (acas.org.uk) and Citizens Advice (citizensadvice.org.uk) are the right places to go, GOV.UK sets out the statutory position, and if a dispute arises about statutory sick pay it can be raised with HMRC. Getting that information early usually removes a layer of worry on its own.

When to see your GP

If the reason you are reading about fit notes is your mental health, the document is a good prompt for a conversation you may have been putting off. Book a GP appointment if you have felt low, anxious or unable to cope most days for a few weeks or more, if work has become something you dread rather than something that is occasionally hard, if it is affecting your sleep or relationships, or if you are leaning on alcohol or other substances to get through. You do not need to have decided whether you want time off before you go, and you do not need to be at breaking point for the appointment to be reasonable.

In England you can also refer yourself to NHS Talking Therapies at nhs.uk/talk without going through your GP, though waits vary widely. In Scotland, Wales and Northern Ireland the GP route is the standard one. For urgent mental health support, NHS 111 has a 24/7 mental health option, Samaritans (116 123) are free to call day or night, and Shout (text 85258) is there if calling feels like too much.

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Quick summary

A fit note is the official name for the sick note: a Statement of Fitness for Work from a healthcare professional, needed once you have been off ill for more than seven days in a row, and issued only when your health is affecting your fitness for work. It says either "not fit for work" or "may be fit for work" with support, can suggest a phased return, altered hours, amended duties or workplace adaptations, and those suggestions are advice rather than instructions. Since 2022 it can be issued digitally without an ink signature by doctors, nurses, occupational therapists, pharmacists and physiotherapists, there is no charge once you have been off more than seven days, and you keep the original while your employer takes a copy. Mental health counts in exactly the same way as physical health. The note itself does not decide pay or rights, so take those questions to ACAS, Citizens Advice and GOV.UK, and take the health side to your GP.

For the mental health journey around the document, see getting a sick note for work. For the stage after, see how a phased return to work actually works.

Sources and further reading

• GOV.UK: The fit note, guidance for patients and employees (gov.uk)
• GOV.UK: Taking sick leave (gov.uk)
• NHS: Getting a fit note (nhs.uk)
• NHS Talking Therapies self-referral (England): nhs.uk/talk
• Mind: Stress (mind.org.uk)
• ACAS: acas.org.uk
• Citizens Advice: citizensadvice.org.uk
• Samaritans: 116 123 (samaritans.org)
• Shout: text 85258 (giveusashout.org)

This article is for information only and does not replace advice from a qualified medical professional. If your mental health is affecting your daily life, please speak to your GP or contact NHS 111. If you are in crisis, please call 999 or go to A&E.