How to get a sick note in the UK: every route explained

Getting a sick note is more straightforward than most people expect, and there are more routes to one than most people know about. Since 2022 it is not only GPs who can issue them, you do not always need a face-to-face appointment, and several practices will now issue one from an online request without you setting foot in the surgery.

This covers every route, what each costs, how long each takes, and what to do if you are told no.

First: do you actually need one?

Probably not yet. For the first 7 calendar days of any sickness absence you self-certify – you tell your employer you are unwell and confirm the dates in writing. No clinician is involved and your employer cannot require a doctor’s note during that week.

Those seven days include weekends and bank holidays, so an absence starting on a Thursday is covered to the following Wednesday.

A lot of people ring the surgery on day one. If you are likely to be back within the week, you do not need to. Use our free self-certification letter generator instead, and only arrange a fit note if you are still unwell as day 8 approaches.

The routes at a glance

Route 1: Your NHS GP

The default, and free once you have been off more than seven days. Most practices now offer three ways to ask.

Online request form

Most GP websites have a fit note request form. You complete it with your dates and what is wrong, a clinician reviews it, and they either issue the note or ask you to come in. Many practices have moved to this “total triage” model, where every request is reviewed before an appointment is offered.

The NHS App

You can request a fit note through the NHS App at practices that support it. In the App, go to Appointments, then Request a letter or information, and describe what you need including the dates you have been off. It is an admin request rather than a booking, so you are not taking an appointment slot.

Not every practice has this enabled. If the option is not there, use the surgery’s own online form instead.

Phone or in person

Still works, and it is the right route if you are not online or your request is complicated. Ring during quieter hours if you can – mid-morning to mid-afternoon rather than the 8am rush.

One thing that catches people out

If this is the first time you are asking about this illness and the practice has no record of it, you will usually need to be seen or have a phone consultation before a note is issued. A clinician cannot certify a period they know nothing about. If the surgery already has a record – you have been seen, or there is a hospital letter on file – a note can often be issued without another appointment.

Do not book an emergency or urgent appointment to get a fit note. Practices ask specifically that you do not, and it delays people who need urgent care.

Route 2: Hospital

If you have been treated in hospital, the hospital can issue your fit note. A hospital doctor can provide one covering your admission, and separately a certificate confirming you were an inpatient.

Ask before you are discharged. It saves a GP appointment afterwards, and the ward team has all the information already.

After discharge, your GP can usually issue a note based on your hospital discharge summary without needing to assess you again.

Route 3: Nurses, physiotherapists and others

This is the change most people have missed. Since 1 July 2022, fit notes can be issued by five professions, not just doctors:

• Doctors, including GPs, hospital doctors and A&E
• Registered nurses
• Occupational therapists
• Pharmacists
• Physiotherapists

Fit notes also no longer need a handwritten signature, which is why a digital note emailed to you is perfectly valid.

In practice this matters most if you are already under one of those professionals. If you are seeing a physiotherapist for a back injury, or a community mental health nurse, or an occupational therapist, they can issue the note at your appointment rather than sending you back to your GP.

One clarification, because it causes confusion: the pharmacists who can issue fit notes are those working in GP surgeries, hospitals and clinics – not the counter at your local high street chemist. You cannot walk into a pharmacy and buy a fit note.

Route 4: Private and online services

Private services issue fit notes for a fee, usually same day. The distinction that matters is what you are actually paying for.

Some services work from a questionnaire alone – you complete a form, nobody speaks to you, and a certificate arrives. They are cheap and fast, and employers and HR teams are increasingly sceptical of them.

Others include a consultation with a clinician, by video or phone, before anything is issued. That is a genuine assessment, and the note carries the clinician’s name and registration number, which an employer can check.

A fit note issued after a video consultation is exactly as valid as one issued in a consulting room. What makes a note valid is the assessment behind it, not the room it happened in.

If you are weighing up a private service, three things worth checking before you pay: whether a clinician will actually speak to you, whether the provider is registered with the Care Quality Commission, and whether the issuing clinician’s registration number appears on the note.

What to have ready

Whichever route you use, you will be asked for much the same things:

• The first day of your absence
• Whether you are still off, or the date you returned
• What is wrong, in general terms
• How it is affecting your ability to do your particular job
• Whether anything at work is contributing
• Whether you think adjustments would let you work – reduced hours, different duties, working from home

That last one is worth thinking about beforehand. A fit note has two options: “not fit for work”, or “may be fit for work” with advice. If a change to your hours or duties would let you work, saying so gets you a more useful note.

Can a sick note be backdated?

Yes, within limits – and no, it cannot be future-dated.

A clinician can date a note from an earlier point where that is clinically appropriate, for example from the date of an assessment that has already happened, or from a hospital admission. What they cannot do is certify a long period they know nothing about, because the note is their professional judgement about days they have assessed.

Future-dating is not possible at all. A note cannot certify that you will be unfit next month.

If an absence has already passed and you have no note for it, remember the first seven days are self-certified anyway, so a short absence rarely needs one retrospectively.

What if you are refused?

A clinician can decline to issue a fit note. It is a clinical judgement, and they are putting their registration behind it – which is exactly what makes the note worth something to your employer.

If it happens:

• Ask why. Often it is that they need to assess you first, or that they do not have enough information, rather than a flat refusal.
• Ask what would change it. An examination, a phone consultation, or a report from another clinician may be all that is needed.
• Consider “may be fit for work”. If the clinician thinks you could work with adjustments, that note is still useful – it tells your employer what would help.
• Ask for a second opinion at the same practice if you think the decision was wrong.

What will not work is presenting the same request to a different service and hoping for a different answer. If no clinician thinks you are unfit for work, a certificate saying otherwise would not be worth having.

What it costs

The middle row is the one that surprises people. If your employer wants a note for an absence of seven days or less, that is not something the NHS covers – it is a private certificate and your practice is entitled to charge for it.

Extending a note

Notes are extended routinely and there is no limit on how many you can have. It normally means another consultation, because the clinician is certifying a new period.

Arrange the next one before the current note expires. A gap in certification is a gap in your evidence and it can hold up your sick pay.

In the first six months of a condition, a single note can normally cover up to three months at a time. After six months it can cover longer where clinically appropriate.

If you cannot get an appointment in time

The genuine problem for most people is not whether they can get a fit note, but whether they can get one before day 8. If your surgery cannot see you for a fortnight, self-certification has already run out.

Health Works issues fit notes the same day, after a 5-minute video consultation with a GMC-registered doctor. We are the online letters service of The Blackheath Clinic, a CQC-registered practice, and the issuing doctor’s GMC number appears on every note. Get a fit note online.

If you can wait for your own GP, do – it is free, and they have your history. This is for when you cannot.

Once you have it

• Send it to your employer promptly – by email is fine, and keep a copy.
• Check your sick pay – SSP is paid from day one since April 2026. Work out what you will get.
• Plan the return – if the note says “may be fit for work”, build a phased return plan to propose.
• Expect a return to work conversation on your first day back, usually with a short form to complete.

For the complete rule set, see our guide to sick note rules in the UK.