Can a doctor refuse a sick note? What the rules say
Why a GP or other healthcare professional can decline to sign you off, what the rules say, and what to do next if it happens to you.
The short answer. Yes. A GP or other healthcare professional can refuse to give you a sick note. The law lets them issue fit notes but does not oblige them to, every note must follow an assessment, and a doctor must not sign anything inaccurate. A fit note is also not required for the first 7 days off, because you can self-certify.
Why a doctor can say no
Three rules sit behind a refusal. First, the law on who can issue fit notes is permissive. GPs, hospital doctors and, since 1 July 2022, registered registered nurse, occupational therapist, pharmacist or physiotherapist can all certify fit notes, but government guidance says none of them is required to.
Second, a fit note must be based on an assessment of your fitness for work. The clinician has to be satisfied, from what you tell them and what they find, that your condition affects your ability to work. A request on its own is not enough.
Third, doctors have a professional duty about what they sign. The General Medical Council’s Good medical practice (paragraph 89) says information a doctor communicates must be accurate, not false or misleading. A doctor who does not believe you are unfit for work cannot write that you are.
Common reasons for a refusal
Most refusals fall into one of these. The right next step depends on which.
| Situation | What the rules say | What you can do |
|---|---|---|
| You have been off for 7 days or fewer | A fit note is not required for the first 7 calendar days, because you can self-certify. The clinician may decline, or may charge | Self-certify with your employer. If your employer still wants medical evidence, government guidance says they should cover any fee |
| The assessment does not show you are unfit for work | Every fit note must follow an assessment of your fitness for work | Ask what the doctor found, and whether a ‘may be fit for work’ note with changes would fit better |
| The reason is not your own medical problem | Fit notes can only be issued for medical problems, not, for example, for caring for a relative | Ask your employer about other kinds of leave |
| You want dates the doctor cannot support | Doctors must make sure what they write is accurate, and cannot give a fit note a future start date | See when a note can cover earlier dates |
Refused in the first week
This is the most common refusal, and it is not a judgement on your illness. You do not need a fit note for the first 7 calendar days off, counting weekends and bank holidays, because you can self-certify. DWP guidance says a fit note is not required for that period, and Acas notes that a healthcare professional might refuse to provide one before day 7. Fit notes are free if you have been ill for more than 7 days when you ask, and a fee may be charged for 7 days or less.
If your employer wants medical evidence in the first week anyway, government guidance says any fee should be covered by the employer. For Statutory Sick Pay, your employer cannot require medical evidence for the first 7 days. The self-certification guide explains what to send instead.
Can a doctor refuse a sick note for mental health?
Yes, but only on the same basis as any other condition. Stress, anxiety and depression are genuine reasons to be unfit for work, and Acas says employers must treat mental and physical health as equally important. If a doctor declines, you can ask them to explain why.
Sometimes the doctor thinks some work, with changes, would help your recovery. A fit note can say you ‘may be fit for work’ and suggest phased return to work, altered hours, amended duties or workplace adaptations. That is not a refusal: if your employer cannot make any of the changes, you are treated as not fit for work on the same note. The mental health sick note page covers how these assessments work.
Need help now? If you have seriously harmed yourself, or you do not feel you can keep yourself safe, call 999 or go to A&E now. For urgent mental health help, call 111 and choose the mental health option. Samaritans are free to call on 116 123, day or night.
What to do if your GP refuses a sick note
- Ask why. Ask what the doctor found and what would change their view. If they think you could work with changes, ask whether a ‘may be fit for work’ note would suit you.
- Self-certify if you can. Within the first 7 days, your own statement is the evidence.
- Tell your employer. Acas advises contacting your employer if your fit note will be delayed, to explain why and when they will get it. Your employer cannot withhold Statutory Sick Pay just because a fit note arrives late.
- Ask for a second opinion. There is no legal right to one, but NHS 111 Wales guidance says a healthcare professional will rarely refuse to refer you. At a practice with several GPs, you can ask to see another one.
- Go back if things change. If your symptoms get worse, a new assessment may reach a different view.
Is a private doctor a way around a refusal?
No, and it should not be treated as one. A private doctor also has to assess you, works to the same GMC standards, and can also decline. What a private doctor offers is access: an assessment without waiting for an appointment, for example when your employer wants a doctor’s note for a short absence your GP will not certify. A private certificate is not an NHS fit note, your employer decides whether to accept it, and it cannot be used for Universal Credit or Employment and Support Allowance (ESA).
Our private sick note is assessed by a GMC-registered UK doctor through an online questionnaire. If the doctor declines on clinical grounds, you get a full refund. For what an employer can and cannot do with a private certificate, see are online sick notes valid, and for the wider rules, the sick note rules.
Common questions
Can a doctor refuse a sick note?
Yes. The law lets doctors and other eligible healthcare professionals issue fit notes but does not require them to, and a note can only follow an assessment that supports it. A doctor who thinks you are fit for work, or fit with some changes, will not write that you are unfit.
Can a doctor refuse a sick note for mental health?
Yes, on the same grounds as any other illness: the assessment has to support it. Mental health problems are genuine reasons to be unfit for work, and Acas says employers must treat mental and physical health as equally important. If the doctor thinks some work would help you, they may suggest a ‘may be fit for work’ note instead.
Can a GP refuse to give you a sick note for the first week?
Yes. A fit note is not required for the first 7 calendar days because you can self-certify, so a GP may decline to issue one, or may charge for it.
What do I do if my GP refuses a sick note?
Ask why, and what the doctor found. If you are still within the first week, self-certify. If you disagree with the assessment, you can ask to see another GP at the practice. Tell your employer if your evidence will be late.
Can I get a sick note from a private doctor if my GP refused?
A private doctor carries out their own assessment and can also decline. They work to the same professional standards, so a private note is not a way around a GP’s clinical decision. If your circumstances have changed, a new assessment may reach a different view.
Can a doctor refuse to backdate a sick note?
Yes. A fit note can include dates before the day it is issued in some situations, but the clinician decides whether the evidence supports them. It cannot have a future start date.
Sources. The legal, pay and clinical facts on this page were checked against these primary sources on 27 October 2026. Rules and rates change, and your employer’s own policy may add to them, so check your contract or HR policy too.
Need a doctor’s assessment without the wait?
A GMC-registered UK doctor reviews an online questionnaire and decides whether a private sick note is appropriate. £47, full refund if they decline on clinical grounds.
Start your assessmentAssessed by a GMC-registered UK doctor. Full refund if a note cannot be issued on clinical grounds.