Patient with doctor

Fit notes

Doctors issue fit notes to provide evidence of advice they have given to patients about their fitness to work.

Fit notes record details of the effects of the patient’s condition so that the patient and employee can consider ways to facilitate a return to work where appropriate.

You must provide a fit note, sometimes referred to as a sick note, after being off sick for more than seven days in a row (including non-working days). Hospital doctors or GPs can complete the fit note.

There are two options: that you are ‘not fit for work’; or that you ‘may be fit for work, taking account of the following advice’.

There are four types of alterations from which the GP/hospital doctor can choose:

There is space on the form for the doctor to provide more information on the condition and how it may affect what the employee can do.

In some cases, there will be nothing to recommend and, as previously, you will go back to work once the GP feels you are ready. If you are fit for work, the GP does not issue a new medical certificate. In such cases, you are deemed fit for work once the existing certificate expires (even if this is during a period of school closure).

The doctor should only recommend a return to work with adjustments if you are not fully recovered, after discussing it with you and making sure you are fully aware of, and happy with, what is being suggested.


Phased return

The doctor is likely to propose a phased return to work where you are suffering from an illness that has left you fatigued, or if you have been away for a long period of time and are not confident about returning full-time. It may also be used if you have an injury where the doctor believes that your strength has to be built up gradually. Often a phased return to work may be proposed along with other changes such as amended duties.

Altered hours

Here the doctor may recommend that the pattern of working hours is changed. This may be recommended if the GP feels, for example, that you may not be able to travel on rush-hour public transport, or need time to build up to a full day’s work.

Amended duties

The GP should recommend amended duties where they believe that you cannot fully fulfil your duties, but may be able to do your job if some duties are temporarily avoided or changed. This could include not attending after school meetings or not undertaking playground duties.

Workplace adaptations

These may be recommended if the GP believes that some physical adaptations are needed to help you return to work. An example of this could be ensuring that you can work on the ground floor of a building if you have trouble with stairs.

In each of these cases, the GP should base the recommendations on what you have told them about the workplace and they should discuss the proposals and the implications fully with you.

If you are disabled and protected by the Equality Act, this procedure does not alter the duty on the employer to make reasonable adjustments regardless of what a GP recommends. If you are disabled within the meaning of the Act, the GP may be able to argue that proposals in a fit note are reasonable adjustments and should be implemented by the employer.

The medical statement is given to you and you should send it to the school. It is good practice for the head teacher to discuss the proposals with you and agree what changes will be made. If there is disagreement, the head teacher may not require you to come back until you feel comfortable with the changes proposed. If it is not possible to implement the recommendations, you should not return to work.

The employer/school management does not have to accept the advice on the medical statement, but if it does not do so the statement should be treated as though the doctor has advised ‘not fit for work’. Some schools may try to argue that you are ready to come back and are no longer signed off. This is not the case and the Government advice on this is clear.


If a school does not take the action recommended by the GP, you should not return to work. Government advice says clearly that if the employer cannot make the changes, the employee should be considered to be unfit for work until they are fully recovered, or the changes are made. Some schools may refuse to make the changes because of cost, or it may be because they do not understand the process.

NEU local officers can play a key role in ensuring that members do not go back until the recommendations on the statement are in place. Where members do go back to work without the recommended changes being made, there is a very good chance that they will have to go off on sick leave again, possibly for even longer.

It may be that you are happy with what a GP recommends, but disagree with how this is interpreted by your employer/school. In cases like this, you may need NEU support in negotiating the full ‘package’ as recommended by the GP. The involvement of occupational health services could also prove beneficial, but you do not have to return to work until you are satisfied that the recommendations have been fully implemented.

In that case, NEU representatives may take steps to encourage the medical experts to reach a compromise that does not at the same time compromise the member’s health and/or safety. There is case law to suggest that an employer may choose to rely on whichever advice they wish when confronted with two conflicting medical opinions of equal value (i.e., where both doctors have expertise in occupational health).

In the first instance, you should go back to your GP and explain that your condition has worsened, even with the changes that were recommended. The GP may either issue a new statement saying you are ‘not fit for work’, or may revise the recommendations on the statement by possibly recommending further changes.

Woman sneezing

Sick leave

Most teachers will at some point need to take sick leave.

Back to top