The process of supporting an employee back to work after a period of absence.
Return to work (RTW) is the process of bringing an employee back into their role after a period of absence — most often long-term sickness, but also maternity or paternity leave, or injury. In the UK the process turns on the fit note: an employee off sick for more than 7 days in a row must give their employer one, and it will say either that they are "not fit for work" or that they "may be fit for work", the second of which obliges the employer to discuss the changes that would let them come back.
An employee must give their employer a fit note if they have been ill for more than 7 days in a row and have taken sick leave. The count includes non-working days — weekends and bank holidays — so someone who falls ill on a Friday and is still unwell the following Saturday has passed the threshold even though only four working days were lost. Fit notes are free once the illness has run more than 7 days; a healthcare professional may charge a fee for one requested at 7 days or less.
A fit note says one of two things: the employee is "not fit for work", or they "may be fit for work". The second is the one that changes what the employer has to do. Where a fit note says an employee may be fit for work, the employer should discuss any changes that might help them return — different hours or different tasks, for example. And if there is no agreement on those changes, the employee must be treated as not fit for work.
That last rule is the one most worth knowing, because it runs against the intuition that a "may be fit" note is a clearance to return. It is not. It is an invitation to negotiate adjustments, and a failed negotiation returns the employee to full sick leave rather than to their desk. Employers can take a copy of the fit note; the employee keeps the original.
| Length of absence | What the employee must provide |
|---|---|
| 7 days or less | No fit note. The employer can ask for self-certification on return |
| More than 7 days in a row | A fit note, counting weekends and bank holidays in the 7 days |
If an employee is off work for 7 days or less they do not need to give their employer a fit note or any other proof of sickness from a healthcare professional. When they return, the employer can ask them to confirm they have been off sick, which is called self-certification. How that is done is for the employer and employee to agree — a short form, or an email setting out the dates.
Fit notes do not only come from a GP or hospital doctor. A registered nurse, occupational therapist, pharmacist or physiotherapist can also issue one, and the healthcare professional must assess the employee's fitness for work before doing so. Where an employer agrees, an Allied Health Professional Health and Work Report can be used instead, although that document cannot be used to apply for Employment and Support Allowance.
A phased return — shorter hours or lighter duties, built back up over weeks — is the usual practical answer to a "may be fit for work" note, and for most absences it is a matter for discussion rather than obligation. That changes if the employee is disabled. Employers must make changes to a disabled employee's working conditions, known as reasonable adjustments, and those can include working shorter hours or adapting the equipment they use at work.
An employee off work sick for more than 4 weeks may be considered long-term sick. The label matters less than what tends to follow it: longer absences are where occupational health input, structured phased returns and formal adjustment discussions become the norm rather than the exception. A long-term sick employee remains entitled to annual leave throughout.
Statutory Sick Pay is £123.25 a week or 80% of the employee's average weekly earnings, whichever is lower, paid by the employer for up to 28 weeks. An employee cannot receive less than the statutory amount, though a contractual or occupational sick pay scheme may pay more. This is the floor a return-to-work plan is negotiated against, and it is low enough that the financial pressure to return early is real.
Statutory holiday entitlement builds up while an employee is off work sick, no matter how long they are off, and any statutory entitlement not used because of illness can be carried into the next leave year. If an employee falls ill just before or during a booked holiday, they can take that time as sick leave instead. Employers cannot force employees to take annual leave when they are eligible for sick leave.
The reverse move is also available: an employee can ask to take paid holiday for time they are off sick, which some do when they do not qualify for sick pay. Where holiday is changed to sick leave, the employee is paid Statutory Sick Pay and that counts towards the holiday pay they have received — unless they do not qualify for SSP, or were off sick on occupational sick pay.
RTW stands for return to work: the process of bringing an employee back into their role after a period of absence, most commonly long-term sickness but also maternity or paternity leave or injury. In practice it covers the fit note, any return-to-work discussion, phased return arrangements and any workplace adjustments agreed before the employee comes back.
After more than 7 days in a row of illness during which they have taken sick leave. The 7 days include non-working days such as weekends and bank holidays, so the threshold arrives sooner than a count of working days suggests. For 7 days or less, no fit note is needed and the employer can instead ask for self-certification when the employee returns.
It means the healthcare professional thinks the employee could return if certain changes were made, such as different hours or different tasks. The employer should discuss those changes with them. If there is no agreement on the changes, the employee must be treated as not fit for work — a "may be fit for work" note is not on its own a clearance to return.
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