From 1st July 2022, fit notes can now be certified and issued by registered nurses, occupational therapists, pharmacists and physiotherapists, in addition to doctors.  In the Government guidance for employers[1], the Department for Work and Pensions (DWP) makes clear that not all individuals within these professions will be suitably experienced and qualified to certify and issue fit notes, so will only do so where they have the relevant training and knowledge to make an assessment of a person’s fitness to work.


The organisations that form the Council for Work and Health include doctors, nurses, occupational therapists and physiotherapists, and other professionals with training and knowledge who can advise on health and work, and who can also advise on training for those now providing fit notes.


Unless they themselves are working in the NHS, doctors, nurses, occupational therapists and physiotherapists working in occupational health will not usually have access to paper or digital versions of the ‘Med3’, which is the form these health professions working in NHS primary care will use, or the F Med 10, which these professionals working in NHS hospitals may now use.  Other forms of medical evidence, including private medical certificates, occupational health reports and an Allied Healthcare Professionals Advisory Fitness for Work Report can be accepted as medical evidence in the same way as a fit note, subject to the employer’s agreement.  DWP go on to advise that in this instance the employer does not need to ask their employee to obtain further fit notes from their GP.


Other aspects of the guidance have not changed, but the following are areas in this guidance where over recent years we have come across some misunderstanding:


  • The employee can come back to work at any time, even if this is before their fit note expires.  They do not need to go back to their healthcare professional first.


  • The fit note belongs to the employee and they should keep the original.  The employer may decide to take a copy for their records (this is usual).


  • People do not need to be signed back to work and there is no option on the fit note to do so.  If the employee’s healthcare professional assesses that they are fit for work, they will not be issued with a fit note.


  • For a limited number of jobs, there are separate procedures to ensure someone is fit to carry out their role.  The HR, occupational health or legal department should know if this applies to the employer’s organisation.


  • If the organisation has a separate policy which requires someone to obtain medical evidence that they are fit for work, this should be arranged through an occupational health specialist[2].


  • The fit note is not binding on the employer. The assessment about whether the employee is not fit for work or may be fit for work (and any other advice in the fit note) is classed as advice, and it is for employers to determine whether or not to accept it.   The employer is within their rights to gather other evidence about their employee’s fitness for work from other healthcare professionals (such as an occupational health professional). The employer can choose to give this other evidence precedence over the advice in the fit note.


  • For complex or possible work related conditions, support from occupational health specialists should be seriously considered.


  • For more information, the employer could consider advice from an occupational health specialist.  The employer can also write to the treating healthcare professional for more information, although they may have to pay for this service and healthcare professionals may not be able to respond immediately.



[1] Guidance for employers on the fit note (updated 1 Jul 2022) at:

[2] Government guidance on the further support provided by occupational health services at: