Oct 27, 2026 · Comments ↓

Why so few fit notes say 'may be fit for work'

2.8 million fit notes in three months, and only 7.8% said 'may be fit for work'. The box is there. Using it means trusting your employer with what comes next.

Between April and June this year, GP practices in England issued 2.8 million fit notes. Only 7.8% of them said “may be fit for work”. The other 92% said not fit for work.

Those are NHS England’s own figures, reported by HRreview this week. The middle option lets a GP say you could work with some changes: a phased return, altered hours, amended duties or changes to the workplace. About one note in thirteen gets it.

I think I know one reason why, because I’ve had one of those notes.

And it’s a fit note, by the way. It replaced the sick note in 2010. The old name says you’re either off or on, and the form has had an option in between for sixteen years.

My fit note had the middle box ticked

My GP would happily have signed me off. I said no. I wanted a middle ground, so we went for “may be fit for work”.

That worked for me because I work for myself. I could set the conditions the note asked for. Nobody else had to agree to them, and nobody could say no.

If you’re employed, you can’t do that. Someone else decides whether the changes happen.

The box is advice, and the employer decides

When an employee hands in a “may be fit” note, the government’s guidance for employers says it’s advice, and employers are “not obligated to agree”. If they can’t agree any changes, the same note is used for sick pay, as if it said not fit for work.

Employers do have a legal duty to make reasonable adjustments for disabled workers, and have had one since the 1990s. If they were good at it, we’d have closed the disability employment gap years ago. We haven’t. In April to June 2025, 52.8% of disabled people were in work, compared with 82.5% of non-disabled people. The government’s own figures show the gap has stopped closing over the last five years.

And if someone does go back on fewer hours, the guidance asks employers to “consider whether your employee might be financially disadvantaged”. They may decide to pay for the hours not worked. The guidance doesn’t say they have to.

So look at it from the employee’s side. Ask for “may be fit”, and you’re relying on your employer to read the advice, talk to you, make the changes, and not cut your pay or hold it against you. Take “not fit”, and at least you know where you stand.

It comes down to trust

I think that’s why “not fit for work” gets ticked so much. People don’t trust their employer to do the right thing with the other box.

That isn’t the whole story. Lots of people really aren’t fit to work while they’re unwell, and a not-fit note is often exactly right. The figures can’t tell us how many of those notes could have said “may be fit” with the right support, and they count notes, not people. HRreview makes both points.

But when the middle option gets used 7.8% of the time, what makes it feel so risky to ask for? If you’re on an insecure contract, or you’ve watched colleagues treated as disposable, you’re not going to hand over a note asking for changes and hope for the best. And adjustments at work already depend too much on having the right paperwork in the first place.

What would make people ask for the middle box

Treat a “may be fit” note as the start of a conversation. That’s what the guidance says it’s for. Ask the person what would help, because the guidance also says the employee is “best placed to determine how their symptoms affect their ability to perform certain tasks”.
Don’t cut pay for a phased return. If someone comes back on fewer hours because their GP advised it, topping up their pay is a choice employers can make.
Don’t count it against them. If coming back on adjusted duties still feeds an absence trigger or a capability process, people will learn to stay off.
Let people see it working. People believe what they’ve watched happen to colleagues, not what the policy says.

And why wait for a fit note before changing the work? If work is making someone unwell, employers should act before anyone needs signing off. The national plan for health at work is mostly about getting people back, not stopping them becoming unwell in the first place.

The middle box has been on the form since 2010. People will use it when they trust what their employer does with it.

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