Long-term sick: your rights, your pay and your job

A short absence is straightforward. A long one is not: the fit notes keep coming, the sick pay changes, meetings start appearing in your inbox, and at some point the question of whether you still have a job stops feeling theoretical.

This covers what actually happens when sickness absence becomes long term – what you are entitled to, what your employer can and cannot do, and what the realistic paths back look like.

When does absence become long term?

There is no legal definition. Most UK employers treat absence of more than four weeks as long term, and that is the point at which their absence policy usually changes gear – occupational health may be raised, review meetings begin, and the conversation shifts from “get well soon” to “what is the plan”.

Nothing automatic happens at four weeks. It is a convention, not a rule, and your employer’s own policy may use a different threshold. It is worth asking to see it.

Fit notes: keeping the evidence continuous

You need a fit note covering every day of absence from day 8 onwards. The first 7 calendar days are self-certified, and after that the certification has to be unbroken.

Two limits shape how this works in practice. In the first six months of a condition, an individual fit note can normally cover a maximum of three months at a time. Once the condition has lasted longer than six months, a single note can cover a longer period where that is clinically appropriate – which means fewer appointments once you are past that point.

Arrange each extension before the current note expires. A gap in certification is a gap in your evidence, and it is one of the few ways to lose sick pay you were otherwise entitled to. If getting an appointment in time is the obstacle, a fit note can be issued online after a video consultation.

Sick pay: what you get, and when it stops

Statutory Sick Pay is paid from your first day of sickness – the three unpaid waiting days were abolished in April 2026 – at the lower of £123.25 a week or 80% of your average weekly earnings. It is paid through payroll for the days you would normally have worked, and it is taxed like wages.

The number that matters for a long absence is 28 weeks. That is the maximum SSP is payable for one period of sickness. Separate absences less than 8 weeks apart are treated as linked, and count towards the same 28-week total.

Work out what you are owed, and find out roughly when your 28 weeks would run out – it is worth knowing that date well before you reach it.

If your employer pays more

Many employers run their own occupational or contractual sick pay scheme: full pay for a period, then half pay, then dropping to SSP. The pattern varies enormously, and the difference over a long absence is the difference between manageable and frightening. Check your contract or staff handbook now rather than when the money changes.

What happens after 28 weeks

When SSP ends, your employer must give you form SSP1. That form is what you use to claim Employment and Support Allowance or Universal Credit, so do not file it in a drawer – it is the handover document between employer sick pay and the benefits system.

Being past 28 weeks does not mean you must return to work or resign. It means your employer is no longer required to pay you sick pay. Your employment continues unless it is formally ended.

Occupational health: accept it

At some point in a long absence your employer will probably suggest an occupational health assessment. People often assume it is a step towards dismissal. Usually it is the opposite.

Occupational health gives an independent clinical opinion on what you are able to do, what adjustments would help, and a realistic view on timescales. It frequently unlocks adjustments a line manager would not have offered on their own, and it gives your employer something concrete to act on rather than guesswork.

You can decline, but declining rarely helps. Without a clinical opinion your employer is left making decisions on incomplete information, and that tends to go worse rather than better. What you should know: you can request to see the report before it goes to your employer, the employer receives an opinion on fitness and adjustments rather than your medical details, and you can ask for factual inaccuracies to be corrected.

Reasonable adjustments and the Equality Act

If your condition counts as a disability under the Equality Act, your employer has a legal duty to make reasonable adjustments. A condition qualifies if it has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities, with long-term generally meaning it has lasted or is likely to last 12 months or more.

Long-term sickness often crosses that threshold even where nobody has used the word “disability”. It applies to mental health conditions as much as physical ones.

Where the duty applies, adjustments might include reduced or altered hours, changed duties, a different location or working from home, equipment, more frequent breaks, or raising your absence trigger points so the absence is not counted against you in the usual way. The duty is to consider what is reasonable, not to grant everything requested – but a refusal to consider adjustments at all is where employers get into difficulty.

Meetings, contact and what is reasonable

Your employer is entitled to keep in touch, to ask for medical evidence, and to hold absence review meetings. That is normal management of a long absence, not harassment.

What is reasonable: agreed contact at a sensible frequency, meetings arranged with notice, and somewhere practical – by phone, at home, or on neutral ground if coming into the workplace would be difficult. You can ask to be accompanied at a formal meeting, and you can ask for adjustments to how meetings happen if your condition makes them hard.

What is not: daily calls, pressure to return before you are fit, being asked to do work while signed off, or formal meetings sprung on you without notice.

Can you be dismissed while on long-term sick leave?

Yes, and pretending otherwise would not help you. Capability dismissal on the grounds of ill health is lawful in principle. What makes it fair or unfair is the process.

For a dismissal to be fair, an employer would normally be expected to have consulted you properly, obtained up-to-date medical evidence, considered whether adjustments would enable a return, considered alternative roles, and taken a reasonable view of how long they can hold the position open. The longer your service and the larger the employer, the more is expected of them.

They cannot simply run out of patience. And if your condition amounts to a disability, dismissing without properly considering reasonable adjustments can amount to discrimination as well as unfair dismissal.

If you are facing a capability process, this is the point to get advice – Acas offer free guidance, and if you are a union member your rep can support you through it.

Holiday keeps accruing

A detail people miss: statutory holiday continues to build up while you are off sick, including on long-term absence. If you are ill during booked annual leave you can usually ask to reclassify those days as sick leave and take the holiday later.

Holiday can also be useful during a phased return – some people use accrued leave to cover the hours they are not yet working, so their pay stays whole.

Going back

Almost nobody goes from long-term absence to full duties in one step, and no reasonable employer expects it. The usual route back is a fit note marked “may be fit for work” with altered hours or amended duties, followed by a phased return building up over several weeks.

After a long absence the build-up should be gentle – six to eight weeks is common after several months off, starting at around a third to a half of your normal hours. Build a phased return plan to propose, and get whatever is agreed recorded with a review date on your return to work form.

Two things worth raising before you go back: what will be different this time, and what happens if the plan turns out to be too much. Both are reasonable questions, and asking them early is a great deal easier than a second absence.

Where to get help

Acas provide free, impartial advice on absence, capability processes and reasonable adjustments. If you are in a union, your representative can support you at meetings. For your health, keep your own GP involved – they are also the person best placed to write the fit notes that support your return, because they know the history.

If you are struggling to cope, Samaritans are free and available 24 hours a day on 116 123.