Fit note or sick note? What the difference is
What a fit note is, who can issue one, how it differs from a private sick note, and which one you need for work, sick pay and benefits.
The short answer. A fit note is the official name for the NHS statement of fitness for work, also called a Med3. Most people still call it a sick note. A private sick note is a certificate from a doctor working outside the NHS: your employer can choose to accept it in the same way as a fit note, but benefit claims need the NHS fit note.
What is a fit note?
A fit note is a form of medical evidence, defined in regulations, that is used for Statutory Sick Pay and for health-related benefits. Its full name is the statement of fitness for work, and it is also known as a Med3.
It gives one of two opinions:
- Not fit for work: you should not work for the period stated.
- May be fit for work: you could do some work with support. The clinician can tick phased return to work, altered hours, amended duties and workplace adaptations, and add comments.
The second option means the form can say what you are able to do, not only what you cannot. DWP calls it an advisory document, and your employer decides whether to accept it. If they cannot make the changes a “may be fit” note suggests, you are treated as not fit for work on the same note.
Private sick note or NHS fit note: side by side
Both are signed medical evidence. They differ in who issues them, what they cost and where they are accepted.
| NHS fit note | Private sick note | |
|---|---|---|
| Who issues it | An eligible healthcare professional: a doctor, registered nurse, occupational therapist, pharmacist or physiotherapist | A doctor working privately, outside the NHS |
| Where you get it | Your GP surgery, a hospital, or another NHS clinician involved in your care | A private clinic or an online doctor service |
| Cost | Free if you have been ill for more than 7 days when you ask. A fee may be charged for 7 days or less | Set by the provider. Ours is £47 |
| Format | Handwritten or computer-generated, printed or digital. Must show the issuer’s name, profession and practice address | Depends on the provider. Ours is a PDF showing the doctor’s name, GMC number, signature and date |
| Accepted for Statutory Sick Pay | Yes. An employer cannot ask for further medical evidence on top of it | If your employer agrees. If they accept it, they do not need to ask for a fit note as well |
| Universal Credit and Employment and Support Allowance (ESA) | Yes. This is the evidence the benefit rules ask for | No. Get an NHS fit note for any benefit claim |
| First week of absence | Not required for the first 7 days, and NHS clinicians may decline to issue one | Available if your employer wants evidence early |
| Advice on adjustments | Can say “may be fit for work” and suggest phased return to work, altered hours, amended duties and workplace adaptations | Depends on the doctor and what your employer asks for |
The one rule to remember. A private certificate is not a fit note and not a Med3. DWP guidance says employers can accept one as medical evidence in the same way as a fit note, subject to their agreement. No employer is obliged to.
Who can issue a fit note?
Until 1 July 2022, only doctors could. Since then the law has also allowed a registered nurse, occupational therapist, pharmacist or physiotherapist to certify fit notes, as long as they are registered with their professional regulator. In practice that means:
- your GP, or another clinician at your surgery
- a hospital doctor, ideally the one responsible for your discharge, rather than sending you back to your GP
- a nurse, physiotherapist or occupational therapist treating you
- a pharmacist working in a GP practice or hospital team
Two limits apply. The law is permissive, so any of these professionals can decline to write one. And pharmacists in high-street community pharmacies do not have access to the NHS fit note form. Midwives are not on the list either.
Is a fit note the same as a sick note?
For the NHS document, yes: the words are interchangeable in conversation. The difference matters when someone offers you a “sick note” that is not from the NHS. GOV.UK says professionals in private practice who are not treating NHS patients may produce other evidence, including private medical certificates, and these are not the Med3 form. DWP describes a private report that contains the information set out in the regulations as “a form to like effect”.
Fit note from a GP
Most fit notes come from GP surgeries. It is free once you have been ill for more than 7 days when you ask, and you may be able to request one through the NHS App if your surgery offers that. The steps for each route, including hospital and private options, are in how to get a sick note.
Fit note online: digital fit notes
Since April 2022, a fit note no longer needs a signature in ink. It can be authorised digitally, sent to you electronically or printed. Whatever the format, it must include the issuer’s name, profession and practice address, and it must be signed or carry their name to be valid.
The assessment does not have to be face to face either. DWP guidance lists video calls, telephone consultations and a written report from another healthcare professional as acceptable. The regulations themselves mention in-person and telephone consultations, so a video assessment rests on the guidance.
An “online fit note” from a private website is a different thing. Unless the clinician is treating you as an NHS patient, what you receive is a private medical certificate. Whether employers accept those is covered in are online sick notes valid.
How long a fit note can last
In the first 6 months of a condition, one fit note can cover up to 3 months. Longer periods become possible after that. The full rules, alongside self-certification and private certificates, are in the sick note rules.
Benefits need a fit note
This is where the two documents part company completely.
- Universal Credit: you need a fit note if your condition affects your capability to work for more than 7 days. You enter its details in your online account, and keep providing new ones until your Work Capability Assessment decision.
- New Style ESA: you need a fit note once you have been unable to work for more than 7 days in a row. You can send it online on GOV.UK, as a digital note or a photo of a printed one, or post it to Freepost DWP ESA 26.
An Allied Health Professional (AHP) Health and Work Report can replace a fit note for your employer if they agree, but not for ESA. A private certificate is not accepted for either benefit.
Fit note changes being tested
On 20 May 2026, DWP and the Department of Health and Social Care announced 4 pilots in England to test a different approach to fit notes, run through NHS WorkWell services. They are pilots only. The legal rules for fit notes have not changed, and the government has said legislation would follow later.
When a private sick note is the better fit
If you are not claiming benefits and your employer accepts doctors’ certificates, a private sick note can be arranged online with no appointment. A GMC-registered UK doctor reviews your answers online and decides whether a note is appropriate. If they decide it would not be, they will say so and refund you in full.
Common questions
Is a fit note the same as a sick note?
In everyday speech, yes: most people call the NHS fit note a sick note. Strictly, “fit note” is the official name for one statutory form, while “sick note” also covers private doctors’ certificates, which are a different document.
What does a fit note say?
One of two things: that you are not fit for work, or that you may be fit for work with some support. A “may be fit” note can suggest changes such as a phased return or different duties.
Can a midwife give me a fit note?
No. The regulations list doctors, registered nurses, occupational therapists, physiotherapists and pharmacists. Midwives are not on that list, although a midwife’s written report can inform a fit note issued by someone who is.
Can I get a fit note online?
You can get an NHS fit note after a phone or video consultation, and it can be sent to you digitally. Private online services issue private medical certificates, which are not fit notes, though your employer may accept one.
Does a fit note need a wet signature?
No. Since April 2022 a fit note can be authorised digitally. To be valid it must be signed or carry the name of the professional who issued it.
Does my employer have to follow a may be fit note?
No. The advice is not binding. If you and your employer cannot agree on changes, you are treated as not fit for work on the same note, without needing a new one.
Can I use a private sick note for Universal Credit?
No. Universal Credit asks for details from a fit note, and no official source says a private certificate can stand in for one.
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 note for your employer?
A private sick note from a GMC-registered UK doctor, after an online questionnaire. £47. Check your employer accepts private certificates first.
Start your assessmentAssessed by a GMC-registered UK doctor. Full refund if a note cannot be issued on clinical grounds.