Reasoning GP · Fit notes and work

Fit notes and work, beyond the signature

A request for a sick note is rarely only about paperwork. It can open onto low mood, a struggling employee, a workplace problem or a health condition that needs a plan. This page covers how the domains apply, a structure, pitfalls and cases.

Last checked: October 2026

The fit note in brief

The fit note records advice about a person's fitness for work following an assessment. It is not a certificate of illness for a particular job, and it can say that someone may be fit for work with some help, such as reduced hours, amended duties or a phased return. People do not need a fit note for the first 7 days of sickness; they can self-certify for that period. Doctors, and registered nurses, occupational therapists, pharmacists and physiotherapists, can issue fit notes. GOV.UK has the fit note guidance for healthcare professionals.

In an SCA case, the form itself is rarely the point. What examiners can see is whether you assess the person properly, think about the right length and type of advice, and help them toward work where that is good for their health.

How the RCGP domains apply

Data gathering and diagnosis

Find out what the job involves, what the person cannot do at the moment, and why they are asking now. Screen for mood, alcohol and risk when the story suggests it. Ask about the workplace: conflict, stress, support.

Clinical management and medical complexity

Decide whether a fit note is appropriate, for how long, and whether “may be fit for work” with adjustments fits better. Manage the underlying problem and plan review before the note runs out.

Relating to others

Respect that work matters to people for money, identity and routine. Be honest if you cannot agree to what was asked, and explain why. Negotiate a plan you both can live with.

These summaries are ours. The domain names are the RCGP's; read its own descriptors on the marking and results page and in the SCA consultation toolkit. See how the SCA is marked for the grades and pass mark.

A practical structure

  1. Open, and do not start with the form. “Tell me what’s been happening.” Let the story come first.
  2. Understand the work. What do they do, what are the hours, what has been hard? Is there a problem at work itself?
  3. Assess the health problem. History, red flags, mood and risk where relevant. The fit note follows the assessment, not the other way round.
  4. Discuss options. Not fit for work, may be fit with adjustments, or no note needed. Explain what each means for them.
  5. Agree the plan. Length, review date, treatment, and what they will talk to their employer about.
  6. Safety-net. Especially where mood is low or symptoms could worsen.

Common pitfalls

  • Signing without assessing. A fit note is advice after an assessment. Treating it as an admin task can miss depression, risk or a serious diagnosis.
  • Refusing without exploring. A flat no to a long note, with no alternative, is not negotiation. Find out what is behind the request.
  • Forgetting the “may be fit” option. Adjusted duties or a phased return can be the best plan for both health and income.
  • Writing very long notes for uncertain conditions. A shorter note with a planned review keeps the conversation going.
  • Getting drawn into employment disputes. Stay with health advice and signpost to occupational health or employment advice where appropriate.

Natural phrases

  • “Before we get to the note, tell me what’s been going on.”
  • “What does a normal day at work involve for you?”
  • “Is there anything about work itself that’s making this harder?”
  • “There’s an option where I say you may be fit for some work, with changes like shorter hours. Would that help?”
  • “Let’s do two weeks and talk again before it runs out, rather than three months now.”

Practice cases about fit notes and work

These cases involve a fit note request, a return to work, or a patient whose work is part of the problem or the plan.

Each case page shows the candidate brief you would read in the 3-minute window. The learning points sit behind a spoiler, so read the brief, practise, then look. The full case, with the role-player script and examiner checkpoints, is in The Hot Seat.

How to practise

Read a case brief, set a 12-minute timer and run it with a partner, the AI patient or out loud on your own. The Hot Seat holds the full case bank with a scorecard for each case. The Consultation Conversation Lab drills the Relating to others skills (cues, ideas and concerns, shared plans), and Worked Example Consultations show what a passing consultation sounds like from start to finish. The Fit Note (Med3) helper covers the wording for the comments box if you want to check the detail. Then put a few of these cases into your next mock exam.

Start free

Five sample Hot Seat cases, the full SCA Guide and one free run of the AI Patient Simulator are open to everyone, with no card needed. The whole SCA suite (all 359 cases, the AI mock circuit, group mocks and the Resit Clinic) is in the Gold plan.

Try the free Hot Seat casesRead the free SCA GuideSee plans and pricing
Free means free: no card and no countdown. Paid plans can be cancelled or paused at any time.

Frequently asked questions

Do I have to give a fit note if the patient asks?
No. A fit note records your advice after an assessment of fitness for work. If you do not think one is appropriate, or not for as long as requested, explain why and offer an alternative such as a shorter note with review or 'may be fit for work' with adjustments.
When does someone need a fit note?
Not for the first 7 days of sickness; people can self-certify for that period. After that, a fit note can be issued following an assessment. Check the current GOV.UK guidance for healthcare professionals.
Who can issue a fit note?
Doctors, and registered nurses, occupational therapists, pharmacists and physiotherapists. The GOV.UK guidance recommends completing the fit note training first.
What does 'may be fit for work' mean?
It means the person could do some work with support, such as a phased return, altered hours, amended duties or workplace adaptations. The employer decides whether they can provide it.
What is the SCA really testing in a sick-note case?
Usually the assessment underneath: low mood, risk, a workplace problem or a condition that needs management. The note is the start of the conversation, not the end.

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gpreasoning.uk is not affiliated with or endorsed by the RCGP. The SCA is run by the Royal College of General Practitioners; for anything official (dates, fees, rules, results) always check the RCGP SCA pages. Our cases are original teaching material written for practice: they are not exam recalls and do not predict what you will meet on the day.