Quick answer: A fit note (the old 'sick note') is advice from a doctor, nurse, occupational therapist, pharmacist or physiotherapist about how your health affects your work. You only need one if you are off sick for more than 7 days in a row. It can say you are not fit for work, or that you may be fit for work with changes such as a phased return, altered hours, amended duties or workplace adaptations.
Checked on 10 October 2026 against GOV.UK: The fit note – guidance for patients and employees and GOV.UK: Statutory Sick Pay. Amounts change, usually each April, so check the official pages.
Arthritis does not always mean you need time off, but flares, flare-related fatigue, surgery or a change in treatment sometimes do. Many people still think a "sick note" simply signs you off. Since 2010 it has been a fit note, and it is designed to help you stay in or get back to work, not only to record that you are off. Used well, it is one of the most useful tools you have for getting the right changes at work.
What a fit note is
The fit note (officially the Statement of Fitness for Work, or Med 3) is advice from a healthcare professional about how your health affects what you can do at work. GOV.UK says it is intended to support you to stay in, or return to, work, and can also be evidence for Statutory Sick Pay and health-related benefits.
It gives one of two outcomes:
- Not fit for work: your health stops you working for a set period.
- May be fit for work: you could work if your employer can make some changes.
A healthcare professional cannot give you a fit note saying you are "fit for work". If you are fit for work, you do not need one.
When you need one, and when you do not
- 7 calendar days or less (including weekends and bank holidays): you do not need a fit note. You can self-certify. Your employer may give you a form, or you can use form SC2.
- More than 7 days in a row: you need a fit note to give your employer.
- Cost: GOV.UK says you will not have to pay for a fit note if you have been ill for more than 7 days. If your employer wants medical evidence for the first 7 days, the healthcare professional may charge, and GOV.UK says the employer should cover this.
Who can issue a fit note
Since July 2022, a doctor, registered nurse, occupational therapist, pharmacist or physiotherapist can issue a fit note in England, Scotland and Wales. Northern Ireland introduced similar rules. The fit note should usually come from the professional responsible for that part of your care, after they have assessed you. It cannot be issued simply on request or over the counter.
For arthritis, that might be your GP, a rheumatology nurse specialist, a hospital doctor after surgery, or a physiotherapist who is treating you. Fit notes can be printed or digital. They must include the issuer's name, profession and practice address.
"May be fit for work": the four tick boxes
For many people with arthritis, "may be fit for work" is the most useful outcome. GOV.UK lists four options on the form:
| Option | What it means | Arthritis examples |
|---|---|---|
| Phased return to work | A gradual increase in duties or hours | Half days for two weeks after joint replacement surgery or a bad flare |
| Altered hours | Changes to the times or length of work | Starting later because of morning stiffness |
| Amended duties | Changing duties to take account of a health condition | No heavy lifting, less standing, avoiding ladders |
| Workplace adaptations | Changing aspects of the workplace | Working from home, a supportive chair, an ergonomic keyboard |
The comments box matters most. GOV.UK says it helps when the professional gives practical information about what you can do, not just a diagnosis. "Rheumatoid arthritis" tells your employer little; "avoid lifting over 5 kg, needs to change position every 30 minutes, would benefit from a later start" gives them something to act on.
These options are advice, not binding instructions. If your employer cannot make the changes, the fit note counts as evidence that you are not fit for work, and you can get sick pay if you qualify.
Getting the most from your fit note appointment
- Prepare a short list of the tasks in your job that your arthritis makes hard, and what would help.
- Ask directly whether you might be fit for some work with changes.
- Ask for practical comments in the comments box.
- Check the dates and whether a review is needed.
- Keep the original. GOV.UK says the fit note belongs to you; your employer can take a copy.
Template: notes to take to your fit note appointment
Copy this into your phone or a notebook and fill it in before you go. It helps the professional give practical advice in the comments box.
- My job: [job title, main tasks, hours, how I get to work]
- What my arthritis is doing now: [e.g. flare in both wrists for 10 days, morning stiffness 2 hours, very tired by mid-afternoon]
- Tasks I cannot do at the moment: [e.g. lifting boxes, typing for more than 15 minutes, standing at the till]
- Tasks I can still do: [e.g. phone work, checking orders, training new staff]
- Changes that would let me keep working: [e.g. later start, working from home, no lifting, more breaks]
- Treatment changes and dates: [e.g. steroid injection on [date], new medicine started [date], surgery booked for [date]]
- Questions: [e.g. how long should the fit note last? Should I be referred to physiotherapy or occupational therapy?]
Common myths about fit notes
| Myth | What GOV.UK says |
|---|---|
| "I have to stay off until my fit note runs out." | You can go back as soon as you feel able, with your employer's agreement. |
| "Only my GP can give me a fit note." | Doctors, registered nurses, occupational therapists, pharmacists and physiotherapists can issue them. |
| "I need a 'fit to work' note to go back." | Fit notes cannot say you are fit for work, and you do not need one to return. |
| "My employer must do what the fit note says." | The advice is not binding. If your employer cannot make the changes, the note counts as evidence you are not fit for work. |
| "The fit note has to be signed in ink." | Current fit notes can be digital and include the issuer's name and profession instead of a signature. |
Talking to your employer about it
GOV.UK suggests discussing the advice with your employer, considering an occupational health assessment, and agreeing regular keep-in-touch meetings. If you count as disabled under the Equality Act 2010, your employer also has a duty to make reasonable adjustments. Our workplace adjustment letter templates include a phased return plan you can fill in together, and our working with arthritis toolkit covers your rights step by step.
GOV.UK also says you can go back to work as soon as you feel able, with your employer's agreement, even before your fit note ends. You do not need to see your healthcare professional again first.
Statutory Sick Pay (SSP)
On 10 October 2026, GOV.UK said:
- SSP is £123.25 a week or 80% of your normal weekly earnings, whichever is lower.
- It is paid by your employer for up to 28 weeks, for all the full days you are off sick that you would normally have worked.
- To qualify, you must be an employee, have done some work for your employer, and have been ill for at least one full working day.
- You must usually tell your employer by their deadline, or within 7 days if they have not set one.
- Your contract may give you more through company sick pay.
Linked periods: regular periods of sickness can be "linked" if they each last more than one full working day and are 8 weeks or less apart. This matters if you have frequent flares, because linked periods count towards the 28 weeks. You are no longer eligible if a continuous series of linked periods lasts more than 3 years.
If your employer does not pay SSP you think you are owed, GOV.UK says you can raise a dispute with HMRC.
Fit notes for Universal Credit and ESA
If you claim Universal Credit or New Style ESA because of your health, you need fit notes too. GOV.UK says you must get one if your condition affects your capability to work for more than 7 days, and keep getting them until you have been sent your Work Capability Assessment decision. When SSP ends, your employer should give you form SSP1, which supports a benefit claim. See our ESA and Universal Credit guide.
Fit notes around surgery
If you are having a joint replacement or other surgery, ask the hospital team about a fit note before you are discharged. GOV.UK says the professional responsible for your discharge should usually issue it, rather than sending you to someone else just for the fit note. Recovery times vary a lot depending on the operation and the kind of work you do, so ask your surgical team and physiotherapist what to expect, and plan a phased return with your employer.
If you are self-employed
Statutory Sick Pay is only for employees. If you are self-employed and arthritis stops you working, you may be able to claim New Style ESA if you have paid enough National Insurance contributions, or Universal Credit depending on your income. You will still need fit notes as evidence for those benefits. Access to Work can also help self-employed people with equipment and travel; see our Access to Work guide.
Disability-related absence and absence reviews
Many employers use trigger points, such as a number of absences in a period, to start absence reviews. If your arthritis is a disability, adjusting these triggers, or recording disability-related absence separately, may be a reasonable adjustment. Ask about this early, ideally before you reach a trigger, and keep a record of which absences were arthritis-related. Our guide to your disability rights under the Equality Act explains the law.
Time off for appointments
There is no general legal right to paid time off for medical appointments, but time off for treatment can be a reasonable adjustment if you are disabled. Agree an approach with your manager in advance, especially for regular blood tests, rheumatology reviews, physiotherapy or infusions.
If money is tight while you are off
PIP (Adult Disability Payment in Scotland) is not means-tested and can be claimed whether or not you are working. Universal Credit may top up a low income. Our financial help directory lists other support.
Free, independent advice
Acas gives free advice on sick leave and workplace rights in England, Scotland and Wales. In Northern Ireland, contact the Labour Relations Agency. Citizens Advice, Scope, Disability Rights UK and trade unions can also help. We are not connected to these organisations.
When to get medical help
Contact your GP or rheumatology advice line if a flare is not settling, if you are getting flares more often, or if you are struggling to work despite treatment. Get same-day advice from your GP or NHS 111 if a joint suddenly becomes hot, swollen and very painful, especially with a fever, or if you feel unwell while taking medicines that affect your immune system. Call 999 in an emergency.
Frequently asked questions
Can a physiotherapist give me a fit note?
Yes. Since July 2022, physiotherapists, registered nurses, occupational therapists and pharmacists can issue fit notes as well as doctors, after assessing you. In practice, it is usually the professional responsible for that part of your care.
Do I need a fit note for a short flare?
Not if you are off for 7 calendar days or less, including weekends and bank holidays. You can self-certify.
Can I go back to work before my fit note ends?
Yes. GOV.UK says you can return as soon as you feel able, with your employer's agreement, without seeing your healthcare professional again.
What if my employer cannot make the changes on my fit note?
The fit note then counts as evidence that you are not fit for work, and you can get sick pay if you qualify.
How much is Statutory Sick Pay?
On 10 October 2026, GOV.UK said it was £123.25 a week or 80% of your normal weekly earnings, whichever is lower, for up to 28 weeks.
Do I have to pay for a fit note?
Not if you have been ill for more than 7 days. If your employer asks for evidence for the first 7 days, any fee should be covered by the employer.
Can a fit note say I am fit for work?
No. If you are fit for work, you do not need a fit note.
Sources and further reading
- GOV.UK: The fit note – guidance for patients and employees
- GOV.UK: Statutory Sick Pay
- GOV.UK: Taking sick leave
- GOV.UK: Health conditions, disability and Universal Credit
- GOV.UK: Definition of disability under the Equality Act 2010
- GOV.UK: Personal Independence Payment
- Department of Health (NI): More healthcare professionals can now certify fit notes
Educational information for people in the United Kingdom — not legal, financial or personal medical advice. Benefit rules and rates change, so always check GOV.UK (or mygov.scot / nidirect) and get free advice before you act. Charity no. 1218461. Clinically reviewed by Louis Maxwell (HCPC PH128483). Everyone's situation is different, so always follow the advice of your own GP, pharmacist or rheumatology team. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.
Continue with related help
- Working with arthritis toolkit — rights and adjustments
- Access to Work — workplace grants
- Benefits and financial help directory — money and support
- Disability benefits FAQ — PIP, ADP and related support
- PIP for arthritis — functional evidence tips
- Carer's Allowance — if someone cares for you
- Newly diagnosed — first steps
- Arthritis pain relief — managing symptoms