Should ‘fit notes’ replace ‘sick notes’?

Should ‘fit notes’ replace ‘sick notes’?

Absenteeism is an ongoing issue in workplaces across Canada – and in the face of a medical certificate, there’s not much employers can say or do. However, the rise of graded sickness absence certificates, or ‘fit notes’, in the UK and Europe may be about to hit our shores.

In the case of prolonged illness, or a complex mental health issue, employees may be off from work for months at a time. Fit notes are aimed at addressing what somebody can do, instead of solely focusing on what they can’t do.

Toronto employment lawyer Stuart Ducoffe says his firm has a set form for doctors to fill out including questions about return to work dates, accommodation options and whether employees could manage modified hours or duties.

Norway has been a frontrunner in the use of graded sickness absence. Professor Arnstein Mykletun says despite the widespread agreement that health works on a continuum spanning ‘well’ to ‘ill’, feeling unwell and being absent from work shouldn’t be viewed in black and white terms. “Very rarely would I say I feel 100% - why then should sickness be a case of either [present or absent]?” Mykletun says.

Mykletun was instrumental in the move untaken by the Norwegian Institute of Public Health to shift the practice away from workers being simply present or absent. In use for nearly 10 years, graded sickness absence certificates must be filled out by GPs, and issued to employers. The initiative to increase the use of graded sickness absence has seen a dramatic drop in sickness absence, Mykltun said.

Making the switch – UK case study

The fit note can still be used as evidence for why an employee cannot work due to illness or an injury. In the UK, many employers do not require a fit note as evidence until after the seventh calendar day of sickness. If the doctor has recommended that an employee 'may be fit for work', employees can still apply to remain absent.

The requirements for the payment of sick pay did not change – and if a doctor recommends that an employee 'may be fit for work', and the employer and employee agree that the worker should remain off work, statutory sick pay will be still be paid.

When the doctor provides a fit note they will advise the employee on one of two options. Either the worker will be 'not fit for work' or 'may be fit for work'.

Not fit for work

The doctor will choose this option when they believe that the employee’s health condition will prevent them from working for a stated period of time.

May be fit for work

The doctor will choose this option when they believe that the employee may be able to return to work while they recover with assistance from the employer – for example, changed hours or alternate duties/tasks.

The doctor may include some comments which will help employers understand how they are affected by the employee’s health condition. If appropriate, they may also suggest one or more common ways for employers to aid the return to work.

This could include:


  • Phased return to work – where employee’s may benefit from a gradual increase in work duties or working hours, for example after an operation or after injury

  • Altered hours – allowing the flexibility to start or leave later, for example to avoid the struggle of travelling in rush hour
  • Amended duties to take into account the employee’s condition. Eg, removing heavy lifting
  • Changes to the workplace to take into account the employee’s condition. Eg, allowing the employee to work on the ground floor if they have problems going up and down stairs