- A fit note is a healthcare professional's advice about general fitness for work. It is not job-specific, it does not say what changes to make, and it is advice rather than an instruction unless its suggestions are reasonable adjustments for a disabled employee.
- Nobody needs to be signed back to work. An employee can return before a fit note ends without seeing their GP again, and there is no option on the form to do so.
- An occupational health report is commissioned by the employer, built around the specific job and answers the questions you ask, with the employee's consent.
- Since 6 April 2026 statutory sick pay has been payable from the first full day of absence, which raises the cost of leaving a fit note as the only document in the file.
Most absence conversations start with a piece of paper. An employee is off, a fit note arrives, and the manager reads it looking for an answer. When are they back? What can they do? Is a phased return on the cards? The fit note rarely says. That is not a failing of the GP. It is a limit of the document, and understanding that limit is the difference between an absence that drifts and one that is managed. Here is what each document does, what it cannot do, and how the two work together.
What a fit note is
A fit note is the Statement of Fitness for Work, the form a healthcare professional issues when a patient's health affects their ability to work. For the first seven calendar days of absence, including weekends and bank holidays, an employee can self-certify. GOV.UK is explicit that an employer can only ask for a fit note if the employee is off for more than seven days in a row.
Since 1 July 2022 fit notes can be issued by nurses, occupational therapists, pharmacists and physiotherapists as well as doctors, and since April 2022 they no longer need an ink signature, so a printed or digital note is equally valid. The form records either that the patient is not fit for work, or that they may be fit for work with support. Where the healthcare professional ticks "may be fit", the form offers four suggestions. A phased return, altered hours, amended duties, or workplace adaptations.
The fit note is evidence for sick pay purposes, and it is advice. The government's guidance for employers and line managers puts it plainly. Remember that this is advice, and you are not obligated to agree.
A fit note answers the question the GP was asked, which is whether the patient is well enough to work. An occupational health report answers the question the employer has, which is what this person can safely do in this job and what would help.
What a fit note cannot tell you
Three limits matter for managers. First, the assessment is general. The same guidance states that the advice in the fit note is about your employee's fitness for work in general, and not specifically about their current job. The healthcare professional does not need to refer to the job at all. It is advice about the person, not about the post.
Second, the fit note will not tell you what changes need to be made. It may suggest amended duties, but it will rarely say which duties, for how long, or whether the person can safely drive, lift, work alone or work nights. Third, the diagnosis on the form may be deliberately vague. Healthcare professionals are allowed to enter a less precise diagnosis where a specific one might harm the patient's wellbeing or their position with their employer.
If you cannot accommodate the suggestions on a "may be fit" note, the guidance for healthcare professionals is that the fit note is then treated as if it stated that the patient was not fit for work, and it can be used as evidence for sick pay. There is one important exception. Acas points out that where the recommendations amount to reasonable adjustments for a disabled employee, the employer must put them in place. Advice on the fit note is optional; the duty under the Equality Act 2010 is not.
Do you need a fit note to return to work?
No. This is the question managers most often get wrong, sometimes by sending people back to their GP for a note that does not exist. GOV.UK's employer guidance states that people do not need to be signed back to work and there is no option on the fit note to do so. Your employee can return to work at any time, even before their fit note expires, and they do not need to go back to their healthcare professional first. Acas says the same, and adds that the employer should talk with the employee to make sure an early return is not putting their health at risk.
That conversation is the point. An early return is usually good news, but for a safety-critical role, a return after surgery, or a mental health absence, the sensible step is a return-to-work meeting and, where there is any doubt about what the person can safely do, occupational health advice rather than a trip back to the GP.
Good practice
Do not treat the end date on a fit note as a return date. It is the date the advice runs out. Plan the return in the weeks before it, so that the employee comes back to an agreed plan rather than to an empty diary and a fresh fit note.
What an occupational health report is
An occupational health report is the written outcome of an assessment that the employer has commissioned, usually through a management referral. The clinician, an occupational health nurse or physician, receives the referral with the employer's questions, assesses the employee, and writes a report addressed to the manager or HR. The employee sees the report before it is released and the report is only sent with their consent.
Acas describes an occupational health assessment as a useful addition to a fit note or a doctor's medical report because it is more focused on how someone does their job and how the job might affect their health. A good report confirms whether the person is fit for their role, with or without adjustments, sets out what adjustments would help and for how long, gives a realistic view of timescales, advises whether the Equality Act 2010 is likely to apply, and answers the specific questions the employer asked. What it does not contain is the employee's medical history. Medwyn issues reports within 72 hours of the appointment.
The two documents side by side
The fit note is requested by the patient from their own clinician, assesses fitness for work in general, and gives a short piece of advice that the employer can accept or not. It costs the employer nothing and arrives in days, but it answers a narrow question.
The occupational health report is requested by the employer, assesses fitness for a specific job against its actual demands, answers the employer's own questions in writing, and comes from a clinician whose role is to be impartial between employer and employee. It takes a referral, an appointment and consent, and it costs money. In return it gives the manager something to act on.
Neither replaces the other. The fit note is the trigger and the evidence. The report is the plan.
When a fit note is enough, and when it is not
For a short, self-limiting absence with a clear end, the fit note is usually all you need. The employee returns, a return-to-work conversation happens, and the file closes.
An occupational health referral earns its place when the absence looks likely to be prolonged or recurrent, when the fit note suggests amended duties or a phased return and you need to know what that means in practice, when the role is safety-critical, when the employer's duty to consider reasonable adjustments may be engaged, and when the fit note and the employee's own account of what they can do have started to diverge. The government's own employer guidance says occupational health can be very helpful in complex cases and where work may be affecting the employee's health.
Where a fit note and an occupational health report appear to conflict, Acas advises the employer to consider both, talk with the worker and agree the best course of action rather than simply choosing one.
Why this matters more in 2026
Two changes have raised the stakes. Since 6 April 2026, under the Employment Rights Act 2025, statutory sick pay has been payable from the first full day of absence rather than the fourth, and the lower earnings limit has gone, so eligibility no longer depends on earnings. The 2026/27 rate is £123.25 a week or 80% of average weekly earnings, whichever is lower, for up to 28 weeks. Our article on day-one sick pay covers the detail. Absence that is left to drift now costs more from the first day.
At the same time the fit note itself is under review. The government told Parliament in May 2026 that over 11 million fit notes were issued in a year, around 93% of them "not fit for work", and that the system is not working as intended. From July 2026 four areas of England have been piloting alternatives through the NHS WorkWell programme, with new Community Work and Health Teams developing "workability plans" for patients and their employers. The Keep Britain Working review proposes stay-in-work and return-to-work plans agreed between employer, employee and clinician, and its September 2026 update notes that a fit note often becomes the main workplace document even though it cannot, on its own, resolve the demands of a particular job. For now, outside the pilot areas, nothing has changed in law. The direction of travel is towards exactly the kind of work-focused plan that a good occupational health report already provides.
Practical steps for managers
- Read the fit note for what it is, advice about general fitness, and note the end date as a planning date rather than a return date
- Where the note says "may be fit", talk to the employee about the suggestions before deciding whether you can accommodate them
- Check whether the employee is likely to be disabled under the Equality Act, because fit note suggestions that are reasonable adjustments are not optional
- Never send someone back to the GP to be "signed off as fit"; hold a return-to-work conversation instead
- Refer to occupational health as soon as an absence looks prolonged, recurrent or complex, and ask specific, work-focused questions
- Keep the fit note, the report and the return-to-work plan together on file, with review dates
A fit note starts the conversation. An occupational health report gives you the answers you need to finish it. If you are looking at a fit note now and are unsure what it means for a particular role, our team can advise on whether a referral would help and what to ask.
This article is general guidance for employers and is not individual medical or legal advice. If you are unsure how it applies to your organisation, contact our team.
