Sick note for stress: how to get one and what it means

If stress is making you unable to work, a doctor can sign you off in exactly the same way as they would for a physical illness. But people worry about asking, whether they will be believed, what the note will say, and whether their employer will find out more than they want them to.

Here is how it actually works.

Will a doctor give you a sick note for stress?

Yes, where it is clinically appropriate. Stress and related conditions such as anxiety and low mood are recognised reasons to be unfit for work, and doctors issue fit notes for them routinely. Mental health is not treated as a lesser category than physical health for this purpose.

What a doctor will not do is issue a note without an assessment. They are making a clinical judgement that you are not fit to work, and putting their name and GMC number on it. That means a conversation about how you are, how long it has been going on, how it is affecting you day to day, and what is going on at work. It is not a test to pass – it is the consultation that makes the note worth something.

You do not need one for the first week

For the first 7 calendar days of any absence you self-certify: you tell your employer you are unwell and confirm the dates in writing. No doctor, no appointment, no charge, and your employer cannot insist on a note during that week.

Those 7 days include weekends and bank holidays. If you stop work on a Thursday, self-certification covers you to the following Wednesday.

A lot of people try to get a GP appointment on day one when they do not need to. Use the week, and if you are still unwell as it runs out, that is the point to arrange a note. Our free self-certification letter generator will produce one for you in about a minute.

What the note actually says

A fit note – formally a Statement of Fitness for Work – records that a healthcare professional has assessed you, gives a reason, and states either that you are not fit for work, or that you may be fit for work with adjustments. It covers a stated period, and it is signed with the doctor’s name and GMC number.

The reason field is where people worry. It cannot be left blank, but it does not have to be detailed. Depending on what the doctor has assessed it might say “stress”, “work-related stress”, “anxiety”, “low mood”, or a more specific condition. What it will not contain is a transcript of your consultation, your symptoms in detail, or anything about your treatment.

If the wording concerns you, say so during the consultation. Doctors are used to this question, and the note only needs to say enough to explain why you are unfit for work.

“Not fit for work” or “may be fit for work”

These are the two options on the note, and the second one matters more for stress than most people realise.

“May be fit for work” means the doctor thinks you could work if certain things changed – reduced hours, different duties, a phased return, or an adjustment to the workplace. For stress, that is often the more useful option, because the thing making work impossible is sometimes the workload or a specific situation rather than the job itself.

It is advice rather than an instruction. If your employer cannot accommodate what the doctor suggests, the note is treated as though it said “not fit for work” and you stay off. In practice most employers would rather have you back on adjusted terms than not at all. Build a phased return plan if that is the route you are heading down.

How long does a sick note for stress last?

It is a clinical judgement, not a fixed period. A first note for stress is commonly two weeks, sometimes four. There is no legal maximum.

Two practical limits are worth knowing. In the first six months of a condition, an individual fit note can normally cover up to three months at a time. After the condition has lasted more than six months, a single note can cover a longer period where that is clinically appropriate.

If you need longer than the note covers, you need another one – which brings us to extensions.

Extending a sick note

Notes are extended routinely. It usually means another appointment, because the doctor is certifying a new period and needs to know how you are now rather than how you were a fortnight ago. Some practices will do this by phone.

Arrange it before the current note expires if you can. A gap between notes is a gap in your evidence, and it can hold up sick pay – your employer needs continuous certification to keep paying for a long absence.

If you are better sooner than the note says, you can return before it expires. The note is a medical opinion about a period, not a prohibition on working, and going back early is a decision for you and your employer.

Who can issue a fit note?

Since 2022, fit notes can be issued by GPs, nurses, occupational therapists, pharmacists and physiotherapists – not only doctors. They no longer need a wet signature, which is why a digital note emailed to you is perfectly valid.

For stress specifically, most people go to their GP, because it usually involves a broader conversation about how you are and what might help.

Confidentiality: what your employer sees

Your employer sees the fit note. They do not see your medical records, your consultation, or anything you discussed with the doctor beyond what is written on the note.

They also cannot contact your GP for more information without your consent, and you can refuse. If they want a fuller picture they would normally arrange an occupational health assessment – and even then, you see the report and the employer receives an opinion on your fitness and what adjustments would help, not your clinical details.

Health information is special category data under UK GDPR. Your employer should collect only what is genuinely needed to manage your absence and pay you correctly, store it securely, and limit access to people who need it.

Getting a note when you cannot get an appointment

The practical problem is often not whether you can get a note, but when. A two-week wait for a GP appointment is no use when your self-certification runs out on day 8, and chasing an appointment while you are already struggling is its own stress.

Health Works issues fit notes the same day, after a short video consultation with a GMC-registered doctor. It is a real consultation – the doctor speaks to you before anything is issued – and the note carries their name and GMC number. Get a fit note online.

If you need more than a note

A fit note buys you time, and time helps. But if stress is affecting you badly, it is worth talking to your GP about what else might help, whether that is talking therapy, a referral, or something else. Self-referral to NHS talking therapies is available in England without going through a GP.

If you are struggling to cope, Samaritans are free and available 24 hours a day on 116 123. For urgent medical help, call NHS 111.

Related reading

If you are already signed off, signed off work with stress: your rights and what happens next covers pay, employer contact, dismissal protections and returning to work.