Sick notes explained: when you need one, and how to get it

Most questions about sick notes come down to three things: when you actually need one, who can issue it, and how long it lasts. Here are the answers, and where a private appointment does and does not help.

The first seven days: you do not need one

For sickness absence of seven calendar days or fewer - including weekends and days you would not have worked - you do not need a note from anyone. You self-certify, usually on your employer's own form or the SC2 form.

Some employers ask for a doctor's note earlier than that anyway. They are entitled to ask, but it is a workplace policy rather than a legal requirement, and NHS practices are not obliged to provide one. That gap is the single most common reason people end up paying for a private appointment.

After seven days: a fit note

Beyond seven days you need what is officially called a Statement of Fitness for Work, and what everyone calls a fit note or a sick note.

Since 2022 these have not been doctors-only. Nurses, pharmacists, physiotherapists and occupational therapists can all issue one, and they can be issued and sent digitally rather than needing a signature on paper.

The bit most people miss: "may be fit for work"

A fit note has two options, and only one of them signs you off entirely. The other says you may be fit for work with support, and lets the clinician suggest:

• a phased return to work
• altered hours
• amended duties
• workplace adaptations

This is often more useful than being signed off, particularly for a long recovery or for mental health, where a gradual return is usually better than a cliff edge. It is worth raising in the appointment rather than waiting to be offered it.

How long can one last?

In the first six months of an illness a fit note can cover up to three months at a time. After that a clinician can issue one for longer. There is no single fixed length - it is a clinical judgement about your condition, and it can be extended.

For a phased return you do not usually need a new note each time your hours change: the original note's recommendations stand for the period it covers.

Can you get one without going in?

Sometimes. A fit note can be issued after a telephone or video consultation where the clinician is satisfied they can make the assessment that way, and there is no legal requirement to be seen in person.

In practice it depends on the situation. A straightforward extension of something already assessed is very different from a first appointment about a new problem, where an examination and a proper history usually matter. Be wary of any service promising a guaranteed note from a form - a fit note is a clinical judgement, and a service that guarantees the outcome before assessing you is not making one.

What it is not

A fit note is not proof you were ill on a particular past day, and it is not a document your employer can insist a doctor writes to order. Clinicians issue one where they believe it is clinically justified, and decline where they do not.

Where we come in

We are a private GP practice in Hull, and people come to us for a fit note in three situations: their employer wants one inside the first week, they cannot get an NHS appointment before the deadline, or they want to talk through a phased return properly rather than be signed off.

A private fit note is issued in the appointment where the doctor judges it appropriate. We usually ask you to come in, because a first appointment about a new problem is better done in person - but a telephone appointment is possible depending on the circumstances, so it is worth asking when you ring.

Call 01482 766555, Monday to Friday, 9am to 5pm.