Compare what 17 UK universities accept as medical evidence for mitigating circumstances, plus deadlines, self-certification and online doctor rules.
Medically reviewed by Dr Sulaiman Shah , MBChB BMedSci, MRCGP — General Practitioner and founder of The GP Clinic. Last reviewed: 17 September 2026
The short answer
In the UK you do not need a sick note for the first 7 calendar days of illness: you can self-certify and give no medical evidence. After 7 days your employer can ask for a fit note from a registered healthcare professional who has assessed you. A fit note does not need to be from a GP, and you can go back to work before it ends.
Key takeaways
The rest of this guide separates nine common myths from what GOV.UK, ACAS and the CQC actually say, and answers two questions many readers ask: whether a private sick note is valid, and what to do when your note runs out.
Reality: an employer must get your permission to ask for a report about your health, and cannot require medical evidence beyond a fit note. For the first 7 days you need no medical evidence at all, according to ACAS. GOV.UK’s guidance for employers says a fit note describes the functional effects of a health condition on your work, and that employers must keep your information confidential. Ask your clinician what wording will go on your note.
Reality: you can return to work at any time, even before your fit note expires, and you do not need to go back to your healthcare professional first. This is in GOV.UK’s guidance for employers. ACAS adds that you should make sure you are well enough, and that your employer should talk to you to check you are not putting your health at risk by returning early.
Reality: since 1 July 2022, registered nurses, occupational therapists, pharmacists and physiotherapists can issue fit notes as well as GPs and hospital doctors. GOV.UK lists them, and the CQC confirms the change. The professional must be registered with their regulator and must assess your fitness for work first.
Reality: what matters is who issued it and whether they assessed you, not whether the service is NHS or private. GOV.UK says a fit note must come from a registered healthcare professional after an assessment. Its guidance does not say employers must accept or reject private notes, so check your employer’s policy. See the full comparison below.
Reality: per GOV.UK, fit notes are free if you have been ill for more than 7 days when you ask for one. For illness of 7 days or less, the professional might charge a fee. A private online service charges for the consultation and assessment.
Reality: not always, but you must be assessed. The CQC says fit notes “cannot be issued on request or through over-the-counter services” and that patients do not always need to see a GP in person, depending on the illness and whether a face-to-face assessment is needed. NHS guidance describes talking to a professional in person or on the phone.
Reality: a fit note is evidence of your absence, not a guarantee against every employment process. Employers should consider the Equality Act when managing sick leave, according to GOV.UK’s guidance for employers, and any decision should follow a fair procedure. For individual advice on dismissal, speak to ACAS or an employment adviser.
Reality: no. GOV.UK states an employer “must get their employee’s permission to ask for a report about their health”, and an employee “cannot be required to provide further medical evidence beyond a fit note.”
Reality: a fit note is based on how a health condition affects your ability to work, whether the condition is physical or mental. The clinician decides whether you are “not fit for work” or “may be fit for work” after assessing you. If you think a mental health condition is affecting your work, a fit note is a legitimate route.
| Myth | Reality | Source |
|---|---|---|
| Employer can demand my diagnosis | Employer must get permission to ask for a health report; no medical evidence needed for 7 days | ACAS, GOV.UK employers |
| I must be fully better to return | You can return before the fit note expires | ACAS, GOV.UK employers |
| Only a GP can issue one | Nurses, pharmacists, physios and OTs can too, since 1 July 2022 | GOV.UK, CQC |
| Private notes are not valid | Depends on who issued it and whether they assessed you; employers’ policies vary | GOV.UK |
| Fit notes always cost money | Free if ill for more than 7 days when you ask; may be charged for 7 days or less | GOV.UK |
| I must see a doctor in person | You must be assessed; not always face to face; not issued on request | CQC |
| A note stops me being fired | It is evidence of absence, not a shield; fair process and the Equality Act apply | GOV.UK employers |
| My employer can contact my doctor | Only with your permission | GOV.UK employers |
| Only for physical illness | Based on how any health condition affects work | GOV.UK employers |
The legal test is who certified you and whether they assessed you, not whether the service is NHS or private. GOV.UK says a fit note must come from a registered healthcare professional who has assessed your fitness for work. It does not say that private notes are invalid, and it does not say employers must accept them.
| NHS fit note | Private fit note | |
|---|---|---|
| Who can issue it | GP, hospital doctor, nurse, pharmacist, physiotherapist or occupational therapist | A registered professional from the same list, after an assessment |
| Cost | Free if you have been ill for more than 7 days when you ask | Usually charged for the consultation and assessment |
| Assessment | Required | Required; the CQC says fit notes cannot be issued on request |
| Speed | Depends on GP availability | Depends on the service |
| Employer acceptance | Normally accepted | Check your employer’s policy; GOV.UK does not require acceptance |
If you are unsure, ask HR which evidence they accept before paying for a private note. If you need one quickly, you can get a sick (fit) note for work online from The GP Clinic (£45) after a consultation with a UK doctor. Confirm with your employer that they accept private notes first.
Return to work on the first working day after the end date on your fit note, unless you have agreed something different with your employer or you have a new note. Check the dates on your note, because it covers a set period.
Since 6 April 2026, Statutory Sick Pay (SSP) is payable from the first day of sickness, and the Lower Earnings Limit has been removed. SSP is the lower of £123.25 a week or 80% of your average weekly earnings, and it is paid to employees, not the self-employed. A fit note is not needed for the first 7 days, so day-one SSP does not change what evidence your employer can ask for.
For the full breakdown of what changed and who qualifies, read our guide to Statutory Sick Pay from Day One (2026) [link once published]. SSP figures come from Payfit’s 2026/27 summary; check GOV.UK for current rates.
Need a fit note after 7 days? Our doctors can assess you online and, if appropriate, issue a sick (fit) note for work. Check your employer accepts private notes first.
All pages were opened and read on 2 November 2026, except GOV.UK’s main SSP page, which could not be fetched.
No. If you are off sick for 7 calendar days or less, including weekends, you do not need a fit note or other medical evidence, according to ACAS. Your employer may ask you to self-certify when you return.
From the 7th day of absence. ACAS says an employer should only ask for a fit note from that day, and you should give it to them on the 7th day.
Not without your permission for a health report. GOV.UK’s guidance for employers says they must get your permission to ask for a report about your health.
GOV.UK says an employee cannot be required to provide further medical evidence beyond a fit note.
Yes. GOV.UK says you can return at any time, even before the fit note expires, without going back to your healthcare professional first.
GPs, hospital doctors, registered nurses, occupational therapists, pharmacists and physiotherapists, after assessing you.
No. The CQC says fit notes cannot be issued on request or through over-the-counter services.
Your clinician thinks you could work with support, such as a phased return, altered hours, amended duties or workplace adaptations. Your employer is not obliged to agree, and if no support is possible you are treated as not fit for work.
It depends on your employer’s policy. GOV.UK requires a registered professional who has assessed you, but does not say whether employers must accept notes from private services.
No. SSP is paid to employees. A fit note may still help with insurance or other claims.
Yes, from 6 April 2026, if you qualify.
