Sickness absence costs UK employers billions every year. The cost is not just in lost productivity; it is also in the complexity of managing absences fairly and legally. When an employee or worker is absent due to illness, employers need to know what to expect from them, what evidence to ask for, how to support a return, and when absences signal a need for intervention. Getting this right requires understanding fit notes, statutory sick pay, return-to-work procedures, and the legal obligations to workers with long-term or disability-related absences.
Fit notes: what they are and who can issue them
A fit note (formally called a Statement of Fitness for Work) is not a medical certificate that simply states “unfit for work” or “fit for work.” Instead, it is a document issued by a healthcare professional—a doctor, nurse, occupational therapist, pharmacist, or physiotherapist—that assesses whether a person can work and, if so, under what conditions.
After a worker has been absent due to illness for more than seven days, the employer can ask for a fit note from their healthcare provider. The worker can also provide one voluntarily earlier if they choose. A fit note is important because it helps both the employer and the worker understand what, if any, support or adjustments might allow the worker to return or stay at work—such as phased return, modified duties, reduced hours, or workplace adaptations.
The fit note does not require the healthcare professional to provide a diagnosis or detailed medical information. Instead, it focuses on the practical impact of the condition on what the worker can and cannot do at work. This keeps the worker’s privacy intact while giving the employer useful information for decision-making.
Employers cannot dismiss someone simply because they have provided a fit note saying “might be fit for work.” That phrase means the worker might be able to work with the right support or adjustments; the employer should discuss with the worker what might help them return.
Statutory sick pay: rates and eligibility
From April 2025, statutory sick pay (SSP) is £118.75 per week, payable from the fourth day of sickness absence. This will change from 6 April 2026, when SSP will rise to £123.25 per week (or 80 per cent of the worker’s average weekly earnings, whichever is lower) and will be payable from the first full day of absence—a significant change that removes the previous waiting period.
An employee is eligible for SSP if they have worked for the employer for at least two years and earn at least the Lower Earnings Limit (LEL). The LEL is £125 per week in the 2025-26 tax year. SSP is not payable for a period of sickness lasting longer than eight weeks that is not linked to a previous period within the previous 56 days.
Small employers often assume they must pay full normal wages during sickness absence; they do not. They can pay SSP instead. Some employers choose to pay more as part of their terms and conditions, but the legal minimum is SSP (once the threshold is met).
Return-to-work interviews: process and purpose
When a worker returns after sickness absence, employers should have an informal conversation with them, called a return-to-work meeting or interview. It is not a legal requirement, but it is best practice and should be recorded in an absence policy if one exists.
The conversation typically happens on the first day back and covers:
- How the worker is feeling and whether they are ready to return to full duties
- Any ongoing concerns or symptoms that might need support
- Any changes to the workplace or their role while they were away
- Whether fit note recommendations (such as phased return or modified duties) are in place
- Whether any workplace adjustments are needed
The return-to-work interview is not an interrogation or disciplinary meeting; it should be a short, friendly check-in that confirms the worker is ready and flags any support needs. Managers should be clear about confidentiality—the worker does not have to share medical details, and if they do, the employer must keep that information private.
If the fit note recommends a phased return—perhaps two weeks at reduced hours before returning to full-time work—the return-to-work meeting is when to plan and agree that schedule.
Absence triggers: when to review and intervene
There are no statutory rules about when absence must trigger a formal review, but many employers use “trigger points”—thresholds that prompt a conversation or a review of the absence pattern. A common trigger might be three separate absences in a 12-month period, or a certain number of sick days.
One method is the Bradford Factor, which weights the frequency of absences more heavily than duration. For example, two days taken as ten one-day absences scores higher than the same two days taken as a single block. The thinking is that frequent short absences are often harder to manage and may signal a pattern that needs addressing.
If an employer uses trigger points or a formula like the Bradford Factor, it must be clearly set out in the absence policy and agreed with employees or their representatives. Important caution: trigger points should not automatically trigger disciplinary action. They should be a prompt to have a conversation and investigate the real reason for the absences. Some workers have legitimate, chronic conditions; others face caring or transport issues; a few might be taking advantage. A good employer deals with each situation on its merits.
Long-term absence and occupational health
When a worker is absent for several weeks or months, employers often need guidance on what the worker can do, whether they will recover, and what adjustments might help. This is where occupational health services help.
An occupational health professional—usually a nurse or doctor with workplace expertise—can assess how a health condition affects specific work functions and advise on fitness, reasonable adjustments, and when the worker might be ready to return. They can also help identify whether there is a link to disability (see below).
An employer should refer a worker to occupational health with clear information: the job description, details of any fit note, and specific workplace concerns (e.g., high stress, physical demands, specific exposures). The worker has the right to review any report and typically has to consent to the report being shared with the employer.
Occupational health is not about resolving medical conditions; it is about understanding the impact on work and planning a realistic return or adjustment. If a worker is unlikely to recover enough to perform their role, an occupational health assessment can help inform a compassionate redundancy or redeployment discussion.
Disability and reasonable adjustments
If a worker has a disability (a physical or mental condition with a long-term impact on daily life or work), the Equality Act 2010 requires employers to make reasonable adjustments to eliminate or minimize disadvantage. This includes adjustments related to sickness absence.
For example, an employer must make reasonable adjustments for:
- Paid time off for medical appointments or treatment
- A phased return to work after an absence linked to the disability
- Modified duties if the disability affects certain tasks
- Flexible hours if the condition requires management (e.g., regular rest)
- A separate record of disability-related absence (to distinguish it from general sickness)
Recording disability-related absence separately can protect both the employer and the worker. It ensures that disciplinary action for absence is not triggered when the absence is linked to a disability. It also shows the employer is taking the disability seriously and making adjustments.
What is “reasonable” depends on the situation. An adjustment must be practical, affordable, and must not harm the health and safety of others. An employer is not required to redesign a job entirely. But if an adjustment is straightforward and low-cost, the employer should usually make it.
Failure to make a reasonable adjustment is a breach of the Equality Act and can result in a tribunal claim.
Key points
- Fit notes (Statements of Fitness for Work) can be issued by doctors, nurses, occupational therapists, pharmacists, and physiotherapists; they assess capability to work and suggest adjustments, not simply whether someone is fit or unfit
- Statutory sick pay is £118.75 per week in 2025-26 (from day four); from 6 April 2026, it rises to £123.25 per week and is payable from day one
- Return-to-work interviews are informal meetings to welcome the worker back, check readiness, and identify support needs; they are not legal requirements but are best practice
- Absence triggers (such as frequency thresholds or the Bradford Factor) can prompt review and conversation but must not automatically trigger discipline; each absence pattern should be assessed fairly
- For long-term absences, an occupational health referral helps assess fitness, recommend adjustments, and plan a realistic return
- Disability-related absence is protected under the Equality Act; employers must make reasonable adjustments and should record disability-linked absence separately to avoid discrimination
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