Work out Statutory Sick Pay
Day-one SSP under the 2026 rules: the lower of £123.25 or 80% of average weekly earnings.
Around 11 million fit notes are issued in England each year, and more than nine in ten of them declare the employee "not fit for work" [1]. The independent Keep Britain Working review put the cost of ill-health to employers at about £85 billion a year, including £10 billion in sick pay [2].
The fit note, formally the Statement of Fitness for Work or Med 3, is the document that sits at the centre of that cost. It is the medical evidence an employer can ask for once sickness absence runs beyond seven days, and it drives what the payroll records as Statutory Sick Pay (SSP) [3]. Yet it is also one of the least understood documents in day-to-day HR and payroll work.
This guide explains what a fit note contains, who can issue one, when an employer can ask for it, what the "may be fit for work" option really means, and how the information flows into the payroll run. It closes with the fit note reforms being piloted in England and what they could change for employers.
Key takeaways
- A fit note can only be requested once an employee has been off sick for more than 7 calendar days in a row, including non-working days.
- Doctors, registered nurses, occupational therapists, pharmacists and physiotherapists have all been able to certify fit notes since 1 July 2022.
- "May be fit for work" advice is not binding: if the employer cannot make the suggested changes, the same fit note becomes evidence that the employee is not fit for work.
- An employer cannot withhold SSP because a fit note arrives late, although it can withhold SSP for days the employee failed to notify.
- SSP is £123.25 a week or 80% of average weekly earnings, whichever is lower, and since 6 April 2026 it is payable from the first day of sickness.
- Four pilots in England are testing a replacement for the fit note built around work and health support plans.
What a fit note is and what it records
A fit note is the statutory medical statement that records how an employee's health condition affects their ability to work. Government guidance describes it as a way to record "the functional effects" of a condition and to prompt a conversation about staying in or returning to work [3]. It replaced the old "sick note" so that the emphasis moved from what the employee cannot do to what they might still be able to do.
The two possible outcomes on the form
Every fit note gives one of two assessments. The healthcare professional either states that the employee is not fit for work, or that the employee may be fit for work taking account of the advice given [4]. There is no third option of "fit for work": if the professional considers the person fit, no fit note is issued at all [3].
The table below summarises the two outcomes and what each one means in practice.
| Assessment | What it means | Employer action | SSP position |
|---|---|---|---|
| Not fit for work | The condition prevents the employee working for the period stated | Keep in touch, plan the return | SSP payable for qualifying days, subject to eligibility |
| May be fit for work | The employee could work with changes such as altered hours or duties | Discuss the advice and decide whether changes are possible | If no changes are made, treated as not fit and SSP continues |
The SSP column reflects the government's employer guidance, which confirms that sick pay can continue where a "may be fit" note cannot be accommodated [3] [5].
The fields an employer should check
The form records the employee's name, the date of assessment, the condition, the assessment outcome, the four "may be fit" tick boxes, a free-text comments box, and the period the note covers [4]. It also shows whether the professional needs to assess the person again at the end of the period, and the issuer's name, profession and address. The government's checklist for employers recommends confirming these details before relying on the note [6].
Since 2022, the ink signature has been replaced by the issuer's printed name and profession, which allows fit notes to be sent digitally. Older ink-signed versions remain valid, but a fit note that carries neither a signature nor the issuer's name "should not be accepted as it may not be genuine" [3].
How long a fit note can last
In the first six months of a health condition, a single fit note can cover a maximum of three months [3]. After that, a longer or indefinite period can be certified where the condition justifies it. A separate hospital form, the Med 10, covers time spent as an in-patient and cannot run beyond 26 weeks.
NHS data shows that long durations are common. In the quarter from April to June 2025, GP practices in England issued 2,625,667 fit notes, and 44.8% of them covered five weeks or longer [7]. For payroll, those long notes are the ones most likely to approach the 28-week SSP limit.
Who can issue a fit note
For most of its history the fit note was a doctor-only document. That changed on 1 July 2022, when legislation extended certification to four further professions [8]. The regulator for allied health professions confirmed the change at the time, noting that it allowed physiotherapists and occupational therapists to certify within their scope of practice [9].
Professions authorised to certify
The following professions can legally sign a fit note, provided they are registered and have assessed the patient.
| Profession | Able to certify since | Typical setting |
|---|---|---|
| Doctor (GP or hospital doctor) | Original fit note | General practice, hospital |
| Registered nurse | 1 July 2022 | General practice, hospital, community |
| Occupational therapist | 1 July 2022 | Hospital, community rehabilitation |
| Pharmacist | 1 July 2022 | General practice, hospital |
| Physiotherapist | 1 July 2022 | Musculoskeletal and rehabilitation services |
The government's employer guide on SSP lists the same professions and confirms that the note "can be printed or digital" [10]. Community pharmacists, however, do not have access to the Med 3 form [3].
Limits on who can sign
The legislation is permissive: it allows these professionals to certify but does not oblige them to. Students on placement and support workers acting under delegation cannot certify, because only registered professionals can [8]. The assessment can take place in person, by video or telephone, or by reviewing a written report from another healthcare professional [3].
Certificates from practitioners outside the authorised list, such as osteopaths or chiropractors, are not fit notes. HMRC guidance says accepting them is at the employer's discretion, and an employer with doubts can still ask for a doctor's fit note [5].
The 7-day rule and self-certification
The single most important timing rule is simple: an employer can only ask for a fit note if the employee has been off sick for more than 7 days in a row, counting non-working days such as weekends and bank holidays [10]. For the first seven calendar days, the employee self-certifies.
How self-certification works
For sickness of seven days or fewer, the employer may accept self-certification verbally, by letter, on HMRC form SC2, or on the employer's own form [5]. Moonworkers has covered the mechanics in its guide to the self-certification sick note. The employee should also notify the absence within the deadline the employer sets, or within 7 days if the employer has not set one [10].
The employer cannot insist that notice is given in person or on a special form [10]. Where an employer does want medical evidence within the first seven days, the healthcare professional may charge a fee, and government guidance says the employer should cover it [3].
Evidence timeline for a typical absence
The table below maps the evidence an employer can expect against the length of a sickness absence.
| Length of absence (calendar days) | Evidence the employer can require | Source of evidence |
|---|---|---|
| 1 to 7 | Self-certification only | Employee (verbal, letter, SC2 or own form) |
| 8 onwards | Fit note or other acceptable medical evidence | Authorised healthcare professional |
| Hospital in-patient stay | Med 10 (up to 26 weeks) | Hospital |
| By agreement | Allied Health Professional Health and Work Report or return-to-work plan | Allied health professional |
The last row reflects the eligibility guidance for SSP, which allows other evidence where the employer agrees [11]. HMRC describes an Allied Health Professional report as "strong evidence of sickness" that is usually acceptable [5].
How the fit note affects Statutory Sick Pay
The fit note is not a payment instruction in itself, but it is the evidence that supports SSP once an absence passes seven days. Every pay decision in a long absence traces back to it, so the payroll team needs to understand where the rules on evidence, timing and withholding sit.
SSP rates and day-one entitlement
SSP is paid at £123.25 a week or 80% of average weekly earnings, whichever is lower, for up to 28 weeks [12]. Following the Statutory Sick Pay reforms that took effect on 6 April 2026, an employee needs to have been ill for at least one full working day to qualify, and there is no longer a minimum earnings condition in the eligibility rules [11]. The government estimates that these reforms put an extra £400 million a year into workers' pockets [1].
The comparison below shows how the reform changed the relationship between the evidence and the first payable day. The background is covered in detail in the Moonworkers guide to sick pay waiting days.
| Rule | Before 6 April 2026 | From 6 April 2026 |
|---|---|---|
| First payable day | Fourth qualifying day | First qualifying day |
| Earnings condition | Average earnings of at least the Lower Earnings Limit | No earnings condition |
| Weekly amount | Flat rate | £123.25 or 80% of average weekly earnings, if lower |
| Fit note required from | Day 8 of absence | Day 8 of absence (unchanged) |
The last row matters for employers: although SSP now starts earlier, the point at which a fit note can be required has not moved [10] [11]. The first week of every absence is therefore paid on self-certified evidence alone.
When SSP can and cannot be withheld
HMRC draws a sharp line between late notification and late evidence. The employer does not have to pay SSP for days the employee was late in reporting sickness, unless there is a good reason for the delay [10]. By contrast, an employer cannot withhold SSP because the employee is late sending a fit note [10].
HMRC's fitness-to-work guidance repeats the point and adds that employers should tell employees in advance what evidence is expected and when [5]. Where an absence lasts longer than the condition would normally justify, the employer can stop SSP, but it must explain its reasons to the employee within 7 days of the decision, and the employee can then ask HMRC for a formal decision [5].
A worked example
Consider a full-time employee who works Monday to Friday and earns an average of £520 a week. 80% of £520 is £416, which is higher than the flat rate, so the weekly SSP is £123.25 [12]. With five qualifying days, the daily rate is £24.65.
The employee falls ill on a Monday and returns on the Wednesday of the second week, so the absence spans ten calendar days and eight qualifying days. The first seven calendar days are self-certified. From day eight, the employer can ask for a fit note, but if the note arrives after payroll cut-off, SSP for those days still has to be paid [10]. Eight qualifying days at £24.65 gives £197.20 of SSP, before any contractual top-up.
A part-time employee earning £120 a week over three days is treated differently. 80% of £120 is £96, which is lower than £123.25, so the weekly SSP is £96, or £32 for each qualifying day [12]. The fit note rules are identical, only the amount changes. The Moonworkers guide to how SSP is calculated works through further variations.
"May be fit for work": the advice employers often misread
The "may be fit for work" option was designed to help people stay in work with temporary support. In practice it is used sparingly: the government notes that more than nine in ten fit notes simply say "not fit for work" [1], and the Keep Britain Working review put the figure at 93% [2]. When the option is used, the employer needs to know what it is, and is not, obliged to do.
The four tick boxes
A "may be fit" note can suggest one or more of four changes, with more detail in the comments box [4]. The table summarises each one and the payroll implications that typically follow.
| Tick box | Example of what it might mean | Payroll implication |
|---|---|---|
| Phased return to work | Starting on a limited number of hours or days a week | Mix of contractual pay for worked time and SSP for sick days |
| Altered hours | Later start, shorter shifts, avoiding nights | Hours or pattern change may alter pay for the period |
| Amended duties | Avoiding lifting or customer-facing work | Usually no pay change unless the role or rate changes |
| Workplace adaptations | Different equipment, working from home | Usually no pay change |
ACAS describes a phased return as coming back for "a limited number of hours or days a week to start with" [13]. HMRC confirms that during a phased return or altered hours, SSP is paid for the sick days as usual, and those days count towards the 28-week maximum [5].
Is the advice binding?
The advice is not binding on the employer. Government guidance states that it is "just advice" and that employers "are not obligated to agree" [3]. ACAS adds that the employer should carefully consider the recommendations, because putting them in place could help the person return to work sooner [13].
There is one important exception. ACAS states that the employer must put the recommendations in place if they amount to reasonable adjustments for a disabled employee [13]. The government's guidance also reminds employers that people with HIV, cancer or multiple sclerosis are treated as disabled under the Equality Act from the day of diagnosis [3].
When no changes can be made
If the employer cannot make any of the suggested changes, the employee is treated as not fit for work, and no new fit note is needed [13]. The same note then serves as evidence for sick pay [3].
HMRC puts it plainly: the employer should accept the current fit note as evidence that the employee is unfit for work "if no changes are made" [5]. Recording the outcome of the discussion in writing gives the payroll team a clear audit trail for why SSP continued.
Handling fit notes in payroll and HR processes
A fit note touches three processes at once: absence management, payroll and data protection. Errors usually arise where these processes do not share the same dates.
Recording the dates correctly
Payroll needs the first day of sickness, the period covered by each fit note, and any return date. Those dates determine the period of incapacity for work, whether a new absence links to a previous one, and when the 28-week limit is reached [11]. Sickness periods link if each lasts at least one full working day and they are 8 weeks or less apart, which the Moonworkers guide to linked periods of sickness explains in detail.
An employee can return before the fit note expires and does not need to see the healthcare professional first [3]. ACAS recommends that the employer talks to the employee first to make sure an early return does not put their health at risk [14]. Payroll should take the actual return date, not the end date printed on the note.
Keeping copies and protecting the data
The employee keeps the original fit note, because it may be needed for benefits or other purposes, and the employer should consider keeping a paper or digital copy [3]. A fit note records a health condition, so access should be limited to those who need it to manage the absence or run payroll.
HMRC does not require employers to keep a specific SSP record, but it expects sickness absence records that would allow it to resolve a dispute [5]. If the employer wants more than the fit note provides, it must get the employee's permission before asking for a report about their health [3].
Automating the evidence trail
For an employer running payroll in-house, the practical risk is a gap between the HR system that stores the fit note and the payroll that pays SSP. Moonworkers' HMRC-recognised payroll software for SMEs calculates SSP from the sickness dates, applies the 80% comparison and tracks linked periods automatically. Platforms that already hold absence data can pass the same dates through the HMRC-recognised payroll API, so the evidence and the pay calculation never drift apart.
Accountants handling sickness for several clients face the same issue at scale. A multi-client payroll dashboard keeps each client's absence periods visible alongside the pay run, which reduces the risk of SSP being paid past a return date or stopped too early.
The future of the fit note
The fit note is under formal review. On 20 May 2026, the government announced that the "broken" fit note system would be overhauled, citing a Call for Evidence in which six in ten employers said the current process was ineffective at supporting employees' work and health needs [1].
The Keep Britain Working review
The independent Keep Britain Working review, led by Sir Charlie Mayfield and first published on 5 November 2025, found that 2.8 million working-age people were economically inactive because of ill-health [2]. It estimated that around 150 million working days are lost to sickness absence each year, and that the fit note in its present form rarely leads to the conversation about adjustments it was designed to prompt [2].
The four pilots in England
From July 2026, four pilots run through NHS WorkWell sites are testing alternatives, with £3 million of funding in the first year and up to 100,000 appointments [1]. The table sets out the two models being tested.
| Pilot area | First fit note issued by GP? | Referral to |
|---|---|---|
| Birmingham and Solihull | Yes, where needed | Mainly non-clinical service |
| Coventry and Warwickshire | Yes | Mixed clinical and non-clinical service |
| Cornwall and the Isles of Scilly | No | Non-clinical service |
| Lancashire and South Cumbria | No | Mixed clinical and non-clinical service |
The government has committed to legislate for further reform once the pilots report [1]. Outside the pilot areas, existing obligations are unchanged: the 7-day rule, the Med 3 form and the SSP evidence rules described in this guide continue to apply [10].
Check SSP against the fit note dates
Once the fit note dates are known, an employer can confirm the SSP due for the absence with the Moonworkers SSP calculator, which applies the 2026-27 weekly rate and the 80% earnings comparison.
Count every calendar day of sickness, including weekends and days off. If the employee is still off, enter today as the last day for the amount due so far.
Statutory Sick Pay due
£0.00
Three quick steps: the absence dates, the working pattern, then the last few payslips. The calculation updates here.
Sick pay handled automatically, from day one
Moonworkers applies the 2026 SSP rules on every payrun: average weekly earnings, the 80% taper, linked absences and the 28-week cap, all itemised on HMRC-compliant payslips.
Conclusion
The fit note sits at a junction between medicine, employment law and payroll. Its clinical content belongs to the healthcare professional, but almost every consequence that follows it, from SSP to phased returns to reasonable adjustments, falls to the employer. The rules that matter most for payroll are few and fixed: no fit note before day eight, no withholding of SSP for late evidence, and a "may be fit" note that becomes a "not fit" note whenever adjustments cannot be made.
What is changing is the surrounding system. With SSP now payable from the first qualifying day and pilots testing work and health plans in place of the traditional note, the direction of travel is towards earlier contact and more structured return-to-work support. Employers whose absence records and payroll already share the same dates will be best placed to adapt when the pilots turn into national rules.
Frequently asked questions
Can an employer ask for a fit note for a 3-day absence?
An employer can only require a fit note once an employee has been off sick for more than 7 days in a row, counting non-working days. For shorter absences, the employee self-certifies, for example on form SC2. If the employer still wants medical evidence for a short absence, the healthcare professional may charge a fee, which government guidance says the employer should pay.
Can an employee go back to work before the fit note ends?
Yes. An employee can return to work at any time, even before the fit note expires, and does not need to see the healthcare professional again first. The employer should talk to the employee to make sure the early return does not put their health at risk, and payroll should use the actual return date to stop SSP.
Does a "may be fit for work" note mean the employee must come back?
No. The note gives advice, and the employer decides whether the suggested changes are possible. If no changes can be made, the employee is treated as not fit for work and the same fit note supports sick pay, without the need for a new one. The exception is where the changes are reasonable adjustments for a disabled employee, which the employer must make.
Can a fit note be issued by a nurse or a physiotherapist?
Yes. Since 1 July 2022, registered nurses, occupational therapists, pharmacists and physiotherapists have been able to certify fit notes alongside doctors. The note shows the issuer's name and profession rather than an ink signature, and it can be provided on paper or digitally. A note that carries neither a signature nor the issuer's name should not be accepted.
