Sick Notes

Issuing of Sick Papers

Sick papers are to be issued only for the purposes of claiming incapacity benefit or sick pay, either directly from your employer or from the government.

Please note that sick papers are considered as legal documents, which means they can only be provided if there are sufficient clinical grounds to warrant issuing a sick paper. If such clinical grounds do not exist, a sick paper will not be issued.

For the first sick paper you must be seen by a GP to  allow for appropriate examination and management of the relevant condition as well as recording this information in the medical notes. Subsequent requests for extensions of sick notes can then be made by phoning the surgery. However, if it has been a long time since the original sick paper was given, the doctor may request you make a further appointment in the surgery to be re-assessed.

Please note that emergency appointments will not be given for the purpose of requesting a sick note.

Sick Papers for School, Court or Probation Hearings

Sick papers will not be issued to cover absence from school time/exams or court/probation hearings. A private sick note may be given to cover such situations at the doctor’s discretion at the cost of £30 Doctors issuing sick notes to defendants in criminal proceedings might be called to court to justify their statements and defend the provision of such a sick note.

Please note that courts are not absolutely bound by medical certificates and may exercise disregard a certificate it finds unsatisfactory.1 Sick notes may be found unsatisfactory if:

  • The certificate indicates a defendant is unfit for work (as opposed to unfit to attend court)
  • Where the nature of the ailment does not prevent defendant from attending court (e.g. broken arm)
  • When the defendant is certified as suffering form anxiety, stress or depression and there is no indication of recovery within a realistic timeframe

Multiple Occupations

If you have more than one employer, the need for issuing a sick paper should be based on your usual occupation. Only one sick paper will be issued, which you should give to your main employer. They (or you) should photocopy this and give it to your subsequent employer(s) as needed.

Sick Papers for those under Hospital Care

Hospitals should provide sick notes for in-patients and out-patients unfit for work. Guidance states that the responsibility for issuing such sick notes rests with the doctor “who assumes clinical responsibility for treating the incapacitating condition”.2 However,  hospital staff(doctors) must issue sick papers, as it is no longer the responsibility of a  General Practitioner.

Unfortunately GP’s are not best placed to issue such papers since they are often not experienced in treating those conditions or knowledgeable on typical sick leave duration for such conditions. Often such information is not provided in clinical letters from the hospital, so please do not be offended  when asked to contact hospital for issuing of sick papers.

Recommended Sickness Absence

The following are maximum times of sickness absence recommended for uncomplicated procedures. Patients in lighter sedentary roles will often return to work earlier. They are all evidence based recovery times.

Duration Operation / Procedure
< 1 week Vasectomy, pilonidal sinus (assuming time off for dressings), laparoscopy and sterilisation, haemorrhoidal banding, colposcopy, D&C, ERCP, TOP, cystoscopy, arthroscopy* (without proceed)
4 weeks Cataract, appendix, hernia, angiography or angioplasty
5 weeks Cholecystectomy
6 weeks Haemorrhoidectomy, mastectomy, turp, myocardial infarction (without LVF or post treatment angina)
7 weeks Benign hysterectomy
12 weeks Valve replacement, laparotomy, fem pop bypass
26 weeks Hip or knee replacement
Lifelong Retinal detachment

Changes to Sick Note Certification

As of the 1st April 2010 the Government has implemented new legislation regarding sick note certification. These changes better reflect that fact that work has many health benefits and that much sickness absence is due to conditions that could often be accommodated at work with appropriate adjustments, adaptations or support.

Please see below for the main changes:

Patients must self-certify for the first seven days of illness

We will not issue a sick paper until a patient has been absent from work for more than 7 calendar days

May be fit for work

A new option has been added to the Med 3 statement titled “may be fit for work”. This box is ticked when it is the doctor’s opinion that a patient is fit to attend their usual place of work, but may require some modification to their usual working practice to allow them to keep working.

This might include one of the four options provided (phased return to work, altered hours, amended duties or workplace adaptations), but there is space for the doctor to write their own recommendations. This advice is not binding on the employer, but you should seek to make alterations where practical and appropriate.

If it is not possible to provide such assistance to your employee, then the sick note stands as if the doctor has ticked the box “is not fit for work”. No further sick paper is required and no further sick paper will be issued (until the time of the next paper).

Patients are no longer signed off or signed ‘fit for work’

It is a common myth that patients need to be signed fit for work though this was often done at the doctors indulgence. As such, the option titled ‘need not refrain from work’ has been removed from the new fit note. Therefore, once the period detailed on the sick note has passed, the patient is automatically deemed fit to return to work, unless a further sick note is issued. No ‘signing off’ paper will be provided.

Removal of Med 5 Statements

The Med 5 (pink) statement has been removed from service. This is normally used to backdate a sick paper when necessary. This function has been merged into the new ‘fit note’ and therefore is no longer required. Please note that sick notes can only legally be backdated for a maximum period of 4 weeks and only if there is sufficient clinical evidence to support this.

References and Further Information


  1. R. v Ealing Magistrates Court Ex p. Burgess (2001) 165 J.P. 82
  2. IB204 – A Guide for Registered Medical Practitioners (Aug, 2004)

Further information regarding can be obtained from the website for Department for Work and Pensions ( Two documents explaining the changes include: