More healthcare professionals given powers to certify fit notes

From 1 July 2022, legislation is changing which will allow more healthcare professionals to certify fit notes to patients.

Currently only doctors can legally certify fit notes.  DWP are now changing the legislation which will allow a further four professions to do this.  These professions are nurses, occupational therapists, physiotherapists, and pharmacists.

Not everybody working within these professions should issue fit notes.  Professionals should be working in a suitable environment and have the necessary skills and training to have work and health conversations with patients.  This task needs to be within their professional ‘scope of practice’, therefore new guidance and training has been developed which will help professionals to identify if this task is suitable for them.

This legislation change applies across England, Scotland, and Wales.

This change follows legislation changes in April which removed the need for fit notes to be signed in ink.  This change made it possible for doctors to certify fit notes digitally and also for patients to receive their fit note via digital channels (where GP IT systems support this).

For more information, please see the following press release .


Further to the legislation change on 1 July 2022 which allowed more healthcare professionals to certify fit notes to patients, guidance and training is now available to support the new rules.

Employers and healthcare professionals should read the guidance that provides a summary of the knowledge, skills, and experience that healthcare professionals eligible to sign fit notes are expected to have before undertaking this task.

This guidance has been developed to provide advice to doctors, nurses, occupational therapists, pharmacists, physiotherapists and their employers about certifying fit notes.  The guidance is designed to provide a summary of the knowledge, skills, experience and training these healthcare professionals (HCPs) are expected to have before certifying fit notes.

It includes broad principles applicable across all those involved in certifying fit notes, with chapters covering:

  • Eligible HCPs - the experience and competence required for individuals to certify fit notes;
  • Employer - the responsibilities and duties of those employing HCPs enabled to certify fit notes; and
  • Governance - the relevant governance considerations including professional regulation and codes of practice.

The guidance sits alongside two other key resources:

It is important that individuals and employers consider the above resources, alongside this guidance, to understand:

  • who should undertake fit note certification;
  • how to practically certify a fit note;
  • what fit note certification entails.

Healthcare professionals eligible to certify fit notes should complete the e-learning training programme which is freely accessible here.

Completing Fit Notes

The LMC has recently received several enquiries regarding when Fit Notes can be completed, especially whether a Fit note can or should be completed before another Fit Note has expired.

Government guidance on completing Fit Notes explains that the fit note is used to advise employers, employees, and DWP about a person’s fitness to work on the date that you have assessed them.  Thus, if this assessment occurs before the date a previous note expires then you can and should complete the note on the day of the assessment.

Your options when assessing a patient for fitness to work

  • Do not give Med 3 as patient fit for work
  • Do not give Med3 as patient not fit for work but will be within 7 days
  • Give Med 3 stating not fit for work until a specified date
  • Give Med 3 stating may be fit for work considering further advice about: phased return to work, amended duties, amended hours, or workplace amendments.

The final option gives you the flexibility to make comment about why a Fit Note may be issued prior to previous note expiring.  For instance a previous note may expire on 30th May, you asses the patient on 23rd May and feel the patient can return to work so you can issue a Med 3 stating “You may be fit for work taking into account the following advice” tick the “phased return to work” box, and add a comment “can return to work from 24th May”.

The comments section is also helpful, as you can use this to request DWP assess a person’s long term need for Fit Notes.  If you believe a person will not be able to work long-term, tick the “you are not fit for work” box, and put in the comments section “unlikely to be able to work long-term, please assess”.

First Published
16 June 2022
Updated On
6 May 2024
Due to be Reviewed
8 July 2026
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