2023 - Sickness, Fit Notes And The Small Business

Levels of long-term sickness in the UK are at a record high.

In May 2023, the Office of National Statistics (ONS) reported that for every 13 people currently working,1 person is on long-term sickness absence from the workforce. The ONS commented that the underlying causes for the record levels of sickness was a rise in mental health conditions and symptoms of long Covid.

Many Employers struggle with balancing compassion for Employees on sick leave, with addressing the needs of their organisations. Sickness is unavoidable in any operation that involves people, but as much as an Employer may care about the health and welfare of an ailing Employee, the business still needs to run.

The impact of sickness absence is especially felt in small businesses, where there are smaller teams, and Employees may each have multiple responsibilities within their roles. Often, small businesses will suffer the triple whammy of a loss of productivity, a need to find temporary Employees to cover an absence, and the need to provide compensation to the sick Employee (if they are off for more than 3 days where only SSP is payable).

Sickness absence doesn’t exclusively impact productivity, finances and the economy, though.  High rates of sickness absence amongst a workforce can negatively impact the atmosphere and culture within an organisation – especially if it means that remaining Employees feel encumbered by workloads left behind by an absent colleague.

Occasional and sometimes long-term sickness is part-and-parcel of being human. This is why it is vital for Employers to have a robust sickness and absence Policy in place that combines compassion for sick Employees, with concern for the needs of the business, supporting Employees to stay in work, or return to work as soon as practicably possible.

A recent update from the UK Government regarding ‘Fit Notes’ emphasises the need for adjustments and discussion with Employees. This may be of particular interest to small businesses, who are likely in the best position to work closely with Employees, and in much greater need of getting them back into the workplace as quickly and as safely as possible.

Updated Guidance on Fit Notes

On 6 October 2023, the UK Government updated its guidance; ‘Getting the most out of the fit note: Guidance for Employers and Line Managers’.

A Fit Note (or a Med3 form, to give it its formal title) is an official statement from a registered healthcare professional as to an Employee’s fitness for work. If an Employee is absent from work due to sickness for more than 7 calendar days, they are required to obtain a Fit Note in order to claim Statutory Sick Pay (Employees may self-certify any absence that is fewer than 7 days in duration). Fit Notes can be issued for up to 3 months at a time.

The law requires that the healthcare professional issuing the Fit Note conducts an assessment with the Employee/patient, either through a face-to-face meeting, video call, telephone consultation, or through consideration of a written report by another healthcare professional.

In April 2022, the Fit Note was updated to a new format that allowed it to be issued digitally.  This replaced the former version that required an inked signature from a GP. In July 2022, the Fit Note was updated further to allow nurses, occupational therapists, pharmacists and physiotherapists to issue Fit Notes, in addition to GPs.

Notable updates in October 2023 include;

  • Guidance as to what to consider when an Employee presents a Fit Note stating that they ‘may be fit for work’;
  • Recommendations as to discussions with the Employee upon receipt of their Fit Note, should it state that they ‘may be fit for work’; and
  • Recommendations as to maintaining regular contact with the Employee during the period of their Fit Note.

 May Be Fit For Work

A Fit Note will say that an Employee is either ‘Not fit for work’, or ‘May be fit for work’.

A ‘May be fit for work’ Fit Note means that the healthcare professional’s view is that the Employee is not fit for a full return to their work, but that with some adjustments, they may be able to return.

This invites the Employer to discuss any changes and adjustments with the Employee that may assist them in returning to work.

Examples set out by the Government include:

  • A phased return to work, such as a gradual increase in work duties or hours (arrangements regarding pay and SSP will vary in this instance – please contact us if you require further information in this regard);
  • A change to working hours, such as start and end times or the duration of work;
  • A change to the Employee’s duties, to take into account their condition; and
  • Workplace adaptations, such as adjusting environmental aspects through to working from home.

This type of Fit Note may also include medical advice and recommendations from the healthcare professional, as to how the Employee can stay in, or return to work. This advice relates to their fitness for work in general, but is not specific to their role. For this reason, it is recommended that a discussion takes place with the Employee upon receipt of this type of Fit Note.

Discussions with Sick Employees

On receiving a ‘May be fit for work’ Fit Note, it is necessary for the Employer to have a discussion with the Employee, and to agree on any changes, adjustments and workplace modifications that are reasonable to support them in staying in, or returning to work.

Expanding further on the recommendations made by the Government, adaptations an Employer could consider include:

  • Working fewer hours than normal, by way of shorter days or shorter weeks;
  • Working from home for some or all of their contracted hours (where their job allows this);
  • Assigning alternative work that can be done from home, should their normal job be impossible to carry out from home;
  • Taking additional rest breaks or longer rest breaks, or being seated while performing tasks (where health-and-safety appropriate);
  • Undertaking alternative duties that may have a lesser impact on their condition;
  • Reducing their duties until they are able to return to their usual role; and
  • Providing alternative equipment or technology to assist an Employee in working with their condition.

If the Employer feels that they cannot accommodate any of the adjustments needed to help the Employee to continue to work, that Employee must be treated as not fit for work.

Keeping In Touch With Employees On Sick Leave

Employers have a statutory duty to ensure the health, safety and welfare of their Employees, including when they are absent from work through sickness. Even more so, in the case of long-term sickness absence, Employers must take steps to check on the wellbeing of sick Employees; to figure out how to support their recovery and eventual return to work; and to ensure that the business continues to run optimally, in the face of their absence.

Necessary and acceptable reasons for getting in touch with a sick Employee include:

  • Checking on their health and welfare;
  • Determining how long they will be off work, for the purposes of planning cover;
  • Discussing any matters relating to their sickness absence, such as Statutory Sick Pay;
  • Updating them on any changes happening at work in their absence (unless they are off sick due to stress, anxiety etc. see below) ; and
  • Discussing any adjustments that need to be made to support the Employee’s return to work.

Contacting an Employee on sick leave does require particular care, though. There is a balance that needs to be struck between keeping reasonable contact to check on an Employee’s health and welfare and discuss any absence-related operational matters, and contact that may be considered intrusive or excessive by the Employee, potentially further impacting their recovery, especially if the sickness is a result of stress and/or anxiety.

While it is important to maintain the Employer-Employee relationship by supporting the Employee during what may be a difficult time, it does not give the Employer licence to repeatedly or excessively contact Employees while they are on sick leave.


Sickness absence has a significant impact on any business, large or small.  However, when it comes to the updated guidance on Fit Notes, small businesses may find that they have an advantage over larger organisations.  They are more likely to have a good personal knowledge of each of their Employees, including their work styles, personalities and commitments outside of work, and therefore, in following the guidance, be better able to deliver greater compassion, while also getting the very best levels of collaboration from their sick Employees, wherever practicable, reasonable and possible.

Could this be one of the trickiest areas of Employment Law to manage?  Possibly. That’s why we are always here to help. Please do not hesitate to contact us if you need any further advice on this topic.