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Please check your employer's sickness policy for information on processes you need to follow when you are absent from work due to sickness. The policy will outline:

  • who you need to notify when you have to take sick leave
  • how to 'self-certify' short-term sickness absence
  • what to do if your absence lasts longer than seven days.

Below we explain how the sickness absence process works, including the questions our members ask us about most often.


You will need to 'self-certify' your absence from work until the seventh calendar day after your sickness absence started. Your employer may have their own self-certification form. If not, you can download one from the HM Revenue and Customs website or use form SP2 from your GP surgery.

If you are off work sick for seven days or less, your employer should not ask for medical evidence that you have been ill. Please see the UK government guidance on taking sick leave for more information. 

Read your employer’s sickness policy so that you are clear about what to do.

For sickness lasting longer than the self-certification period (more than seven days), you will need a fit note. Specified health care professionals can indicate in a fit note whether you are fit for work, or whether you are fit for work if certain changes are made. 

The fit note is classed as advice from your GP about your fitness to work. Your employer can decide whether or not to accept it. However, the RCN generally recommends that GP advice is followed.

If you are unhappy with your employer’s interpretation of the fit note advice, you could return to your health care professional for follow up advice where a new, more explicit note may be issued. In some cases, you may be considered unfit for work until you are fully recovered, or until the recommended changes have been made.

If your health problem is work-related (for example, stress), it is important that the fit note clearly states this to allow you and your employer to try and resolve the problem. If your stress is work-related, for example due to staffing shortages caused by unsustainable pressures at work, it is important to report these concerns as they are a health and safety matter. Further information on this can be found in our health and safety guidance.

Contact us if the matter is not resolved, or if you and your employer cannot agree on the changes that need to be made in order for you to return to work.

You may be anxious about attending meetings with your manager to discuss your sickness absence. However, it is important that you attend meetings where decisions that affect you will be made. Your employer will require key information about your situation and you will have the chance to ask questions.

Make sure that you check your employer’s sickness absence policy. Local policy and practice may allow for meetings to be held outside the workplace (such as your home) if that is easier for you.

Employers normally refer to sickness absence in stages, for example stages 1 – 4 (check your employer's policy for this). Stage 1 is for short term sickness and stages 2-4 for longer term absence (and possibly dismissal). Each stage will probably involve a meeting.

Trigger points and absence targets

Many employers use a trigger system based on the number of days taken or the number of occasions. Other employers use the Bradford system, which uses a formula based on:

  • the number of occasions of sickness absence and
  • the number of days taken as sickness absence.

Employers may use a trigger points system to determine what they consider to be 'problematic absence'. This can be one long period of sickness or a number of shorter-term absences. Whilst this can be useful in ensuring a consistent approach across an organisation, it can be difficult for certain staff, especially staff with disabilities and those working in frontline clinical roles where exposure to injury and illness is higher.

If you have a disability or work in such a role and are told by your employer that any further absence may lead to disciplinary action, this may be unreasonable. Staff with disabilities have additional protection in law. Additionally, the Nursing and Midwifery Council (NMC) Code requires you to ensure your own health and fitness so as not to compromise patient safety.

How to prepare for meetings

Read your employer’s sickness absence policy, so you understand your employer’s process. You and your employer will need to comply with the policy.

Contact us for advice before you attend any sickness meetings. We would advise you to always have RCN support beyond stage 2 meetings.

As part of the meeting process consider this checklist:

  • Before the meeting/s, ask for copies of relevant paperwork (this might include Occupational Health (OH) reports). If this is not possible, and you are only presented with the information in the meeting itself, ask for a short break to read the papers.
  • During the meeting, listen carefully to what your employer says and clarify anything you do not understand.
  • Never make a snap decision in a meeting.
  • Try not to get upset - ask for a break if you need one.
  • If your employer raises a subject or asks a question that you feel unsure about, ask for time to consider the issues, even if it means adjourning the meeting. Ask that proposals are set down in writing and sent to you to give you time to consider and discuss them with your representative and your family.
  • You should receive minutes of the meeting. It is also worth taking your own notes during the meeting.
  • Audio recording of meetings is generally not permitted unless all parties agree to the recording and receive a copy shortly after the meeting.

If you have or believe that you have a disability and your absence is directly attributable to it, then it's possible that some or all of your sick leave could be discounted under your employer's sickness absence policy. Please also see our guide on disability discrimination.

Stage 1 meeting

If you are off sick for a long period (for example, more than a week) or if you have had repeated periods of sickness, you will probably trigger your employer's sickness absence policy and a stage 1 meeting may be called. Try not to be too worried about this meeting. You can use the opportunity to discuss any problems. The meeting should conclude with a clear outcome, for example a time period with a set target for absence.

Although your employer may allow you to be represented by an RCN representative or colleague, there is no legal right to representation at this stage. If it is just a stage 1 meeting with no ongoing issues, you may just wish to take a colleague and take notes. If you are unsure, if the sickness is work related, or if you just feel that you need support, contact us for advice.

Stage 2 meeting

You may trigger stage 2 of the policy if you are off work for a long period as defined in your employer's sickness absence policy, or if you have repeated periods of sickness while on stage 1. 

Your employer may involve your Human Resources (HR) and OH departments (where they exist). Contact us for advice if you reach this stage.

Stage 3/4 meetings

If you have a long period of sickness absence or if there are repeated episodes of sickness absence, a stage 3/4 meeting is likely to be held.

It is very important that you do not go alone to these meetings - contact us for further advice. At this stage the employer has to consider all options available to them. These can include redeployment options, but also potentially dismissal and/or ill health retirement.

At all stages, read and follow your employer’s sickness policy.

If you are absent from work due to sickness you will probably be entitled to:

  • statutory sick pay - paid by your employer but claimed back from the government, or
  • contractual sick pay - paid by your employer as part of your contract.

Statutory Sick Pay (SSP)

You are not entitled to SSP for the first three working days of your sickness absence, but if you are eligible, you will receive it from the fourth day for up to 28 weeks. SSP is paid by your employer.

Find out more about your eligibility for SSP and how to claim at Also, see the section below on Work related injury or disease.

Contractual sick pay

If you work under an NHS Agenda for Change contract, your entitlements to sick pay are given in section 14 of the NHS Terms and Conditions of Service Handbook.

If you work outside of the NHS, your sick pay entitlements will be detailed in your contract of employment. If you do not have a copy of your contract, speak to your manager and request a signed copy.

In all instances, keep your own record of the dates of your sickness absence and check your entitlement to sick pay against these dates. Also, see the section below on Work-related injury or disease.

Agency workers' rights to sick pay

After 12 weeks in the same job, the Agency Workers Regulations 2010 entitle agency workers to the same basic conditions of employment as permanent employees (such as pay). However, the regulations do not include rights to contractual sick pay. As an agency worker, you may be entitled to SSP if you satisfy the eligibility criteria.

Find out more about SSP, and how to claim, at  

Read more about agency worker rights at ACAS

You should also check your agency terms and conditions. Our financial wellbeing guide for self employed and agency workers also provides additional guidance on support that may be available to you. 

Financial problems

We can provide benefit checks, debt advice and counselling, and information about these can be found on our member support pages.  Please contact us if you need support.

NHS injury allowance 

As well as receiving sick pay, you may be entitled to claim NHS injury allowance if you believe your injury or illness to be work related. NHS injury allowance can be used to top up your sick pay, or your earnings (if you are on a phased return). The allowance applies to NHS employees covered by the NHS terms and conditions of service handbook and other staff who may no longer be working for the NHS but may have the injury allowance included within their employment contracts. For full details of how and when you may be able to claim this, please see our guidance on NHS injury allowance

Industrial Injuries Disablement Benefit

Please see our guidance for further information. 

If you are unwell during your pregnancy, you should follow your employer’s usual sickness reporting procedures.

Your employer must record any pregnancy-related sickness absence separately from other sick leave. Pregnancy-related sickness absence must not be used as a reason for disciplinary action, dismissal or redundancy.

You have the same rights to paid sick leave as any other employee. 

If you are off sick with a pregnancy-related illness in the last four weeks before your expected week of childbirth, your employer can ask you to start your maternity leave.

Read more about sickness during pregnancy in our having a family toolkit.

For some, going through the menopause can be uneventful, but for many it can be a very difficult experience. The menopause is very individual, but common symptoms can include:

  • poor concentration
  • hot flushes
  • tiredness
  • poor memory/memory loss
  • night sweats
  • insomnia
  • exhaustion
  • anxiety and depression because of sudden changes in hormone levels and emotional outbursts.

Lack of concentration and forgetfulness can lead to poor work performance, difficulties in making decisions and decreased confidence. This can be a vicious circle that is difficult to break without the right support.

If there are performance issues at work or if you go on sick leave due to menopausal symptoms, your employer has clear duties under the Equality Act 2010 not to discriminate against you.  Employers risk facing claims for sex, disability and age discrimination if they fail to properly support their female employees during this difficult time. The Equality and Human Rights Commission has produced guidance for employers about Menopause in the workplace.

Our position statement, Menopause and you at work, provides information and resources relating to how menopause may affect you at work.

Contact us if you feel you are not having the right support or if you feel discriminated against.

Employers should:

  • raise awareness of the menopause
  • take medical information into account in capability situations where menopausal ill-health is raised by the employee
  • ensure that any menopause-related sickness absence is counted as an ongoing health issue instead of a series of short-term absences
  • be accommodating to the flexible working requests that will help manage symptoms
  • assess the physical working environment (for example, the use of fans)
  • ensure that rest break and toilet facilities are readily available, along with access to cold drinking water
  • seek support of occupational health where necessary.

There are a number of practical steps that an employer can take to support staff in alleviating the symptoms of the menopause. The RCN guide The menopause and work: guidance for RCN representatives has a helpful table with examples of common symptoms, the relationship with work and suggested adjustments. 

It is important to contact us if your employer is not being supportive in this area as it could be a discrimination issue. 

Further information

The British Menopause Society
The menopause and work: guidance for RCN representatives
Capability and performance

The RCN has a peer support service for those experiencing the menopause. This group puts members in touch with each other by email.

It is possible for an employee who has two contracts with the same or different employers to be incapable of work under one contract but capable of working under the other. If you have more than one contract with the same employer (or with different employers trading in association), and your earnings are aggregated for NI contributions purposes, you must be incapable of work under all contracts before you can be entitled to SSP.

We advise that you only work for one employer while off sick from the other if both employers agree. It may be a disciplinary breach to be working for one employer without the other employer's permission. Read your employers' sickness policies to be sure of your position.

Occupational health referrals

Occupational health (OH) may become involved in sickness absence management at the request of your manager to look at ways in which you can be supported at work. This is usually a formal process, aimed at identifying what support may be necessary to help manage your sickness absence levels. OH services will assess your condition in conjunction with your working environment. They may seek reports and further information from your GP, consultant or other health care professional, and will ask for your written permission to do this. OH will then make recommendations to your manager as to how the sickness should be handled. This may involve reasonable adjustments or redeployment - please see our Health Ability Passport Guidance for more information. 

OH is not there to force you, or put undue pressure on you, to return to work before you are well enough to do so. They are there to provide advice about your fitness for work, and your manager should consider this advice in conjunction with GP fit notes and reports from relevant health care professionals.

You may be able to self-refer to your employer’s OH service to explore what support might be available to you. Some OH services may be able to offer fast track services such as physiotherapy or counselling, depending on your needs. Check your employer’s sickness absence policy for more detail on when OH may be consulted or how you can access services yourself.

Refusal to consent to an occupational health medical report

If you refuse to provide medical evidence, or undergo an independent medical examination, you may be told in writing that a decision will be taken on the basis of the information available and whether this could result in dismissal. If you are considering refusal, please always seek further advice from us.

Access to Work

Access to Work is a government initiative that can potentially fund adjustments if you have a physical or mental health condition. It involves a workplace assessment and reimbursement for agreed equipment/alterations to your employer.

Read more about Access to Work.

Sometimes your employer may seek further medical information. However, under the Access to Medical Reports Act 1988:

  • additional information cannot be accessed without your knowledge and consent
  • you have the right to decline to give consent for a report to be written
  • you have the right to see the report before it is supplied and to ask for any part that you think is incorrect to be amended.

As an employee, you also have various statutory rights under the Medical Reports Act 1988 and current data protection legislation.

If you are likely to be on long term sick leave, your employer is expected to maintain contact with you on a regular basis. If it is not mentioned in your local policy, then there are no specific rules about this.

Your employer should use tact and common sense. Contact with you should be brief, unintrusive and limited to your wellbeing, the workplace support available and your likely return to work date (if known).

Phased return

Returning to work can seem daunting after a period of absence, but a structured phased return may help.

Take advice from your occupational health department (if you have one) and read your employer's policy on sickness and phased return. If you don't have a local policy, coming back on reduced hours will be done by agreement, which you should have in writing. The RCN can support you to negotiate a suitable phased return to work agreement.

NHS employees and managers can use an online toolkit on the NHS Employer website, which includes information on phased return.

There is no right to full pay during a phased return (unless stated in your policy), however it is recommended. In some cases, annual leave hours can be used, but many employers offer paid leave in the form of further sick pay or special leave.

If there are issues with your return, discuss them with your manager/HR and contact us if you need support.

Employer refuses your return

If your employer refuses to let you return to work even though your GP has signed you as fit, and your employer fails to pay you your normal working pay, then this could amount to a breach of contract and/or an unlawful deduction of salary. Check your contract and contact us for advice.

If you are refused permission to return to work on the basis of a health and safety issue, this would be 'medical suspension'. Your employer's policy should determine how this is managed. If you are medically suspended, this should be on full pay.

Please see the section on Fit notes above if your employer is unable or refuses to make adjustments as outlined on a fit note, or by occupational health.

Longer-term sickness and accrual of annual leave

The European Court of Justice (ECJ) ruled that an employee should be able to accrue their statutory annual leave if they were unable to take those holidays due to ill health.

Statutory leave is different to contractual leave. Everyone is entitled to a certain amount of statutory leave but a contract of employment normally exceeds this minimum amount. For details on statutory annual leave see or

The Healy case confirmed that the amount of leave that can be carried forward is limited to 20 days (for a full time worker) rather than 28 days. This is covered by section 13 of the Working Time Regulations.

If your employer refuses to either pay or carry over your statutory annual leave because of sickness, this may be unlawful. You should contact us for support. If your contract is terminated and you have been unable to take your holidays due to ill health, you have a right to be paid for your statutory annual leave.

Sickness while on annual leave

Most employers will allow staff to claim back their annual leave if they are sick while on holiday. To clarify your position, check your contract and local policies.

If you become unwell while on holiday, take the following steps:

  • obtain a sick note from a medical practitioner (in English if possible)
  • follow your employer's policy and inform your employer as soon as you can (i.e. while you are on holiday rather than when you return)
  • on your return to the UK, visit your GP immediately for an updated certificate.

If your employer refuses to reimburse your annual leave or refuses to accept your overseas sick note, please contact us for support as this could be an unlawful deduction of wages.

Taking annual leave while on sick leave

Whether you can go on holiday while on sick leave will depend on various things, including:

  • the reason for the sickness
  • whether the GP has recommended the trip for recuperation or convalescence
  • whether the holiday had been pre-booked and paid for
  • whether it would be deemed reasonable considering all of the circumstances.

It would be reasonable to secure the agreement of your employer before going on an overseas holiday. Failure to reach any agreement and deciding to take a holiday could possibly lead to disciplinary action and/or deduction of sick pay.

If you are off work sick for more than 4 weeks this is likely to be considered as long term sickness absence. Both you and your employer should continue to follow the sickness absence policy.

  • If you are fit to return in the near future, this should be closely monitored and arrangements to return to work should be made. OH should be involved. In the case of disability, reasonable adjustments should be made to support your return to work. Please see our Health Ability Passport Guidance for more information. 
  • If you are fit to return to work but not to your current role, alternative employment should be considered. Retraining or an induction should also be arranged.
  • If there are no suitable alternative roles available and medical opinion confirms that you are unable to return to work, then your employer may be entitled to terminate your employment on the grounds of incapacity due to ill health.

If you are rethinking your career due to a long-term illness or disability, see our guidance in Managing your career around ill health or disability.

If you are on long term sick leave it is important that you contact us for local support. Some employees feel pressured to resign, but you should not resign without first taking advice. Resigning may remove your entitlement to notice pay and compromise ill health retirement benefits. If you have been off sick with work-related stress, for example due to unsustainable pressures at work due to staffing shortages, please contact us.

Some policies may state that redeployment will happen after a prescribed length of sickness absence; others will require medical advice about the best time to consider long term options.

Your employer is not under any legal obligation to create a new job for you. However, they should assist you in identifying already vacant posts in the organisation that may be appropriate now or once reasonable adjustments have been made (which may include some degree of retraining). Many people feel frustrated and let down by the lack of actual support they receive from their employer, for example, their employer only sends notice of a vacancy but offers no further support, or the employee has to compete with other candidates.

Most employers will set time limits for the consideration of redeployment, usually one to three months. They are not obliged to keep you employed until a suitable vacancy occurs, as, even if you are not receiving any sick pay, there are costs and implications for an employer maintaining your employment.

You are not obligated to take a redeployed position but must consider carefully the implications of turning an opportunity down. You may find it easier to think of redeployment as stepping stone, rather than a permanent change. Many members report that it is easier to move to a more preferable job once they are back at work than to hold out for a better offer, run out of time and risk dismissal.

When discussing alternative employment, prepare yourself before the meeting. Consider if it's realistic for you to return to your original job. If not, think carefully about your experience and expertise and how else they may be used. Be ready to 'make a case' for yourself, covering what you can do and what you can offer. Sell yourself. Try to be positive. There are many opportunities in nursing that are ideal for people living with injuries and/or disabilities.

In instances of suspected drug or alcohol abuse, you may be referred for special treatment and professional counselling.

If your employer has a policy on drug and alcohol abuse, it may state that you are expected to comply with treatment and counselling offered; and that if treatment and counselling does not resolve the issue, you may be disciplined. If you are asked to attend a disciplinary hearing as a result of your drug or alcohol abuse, contact us.

Read more about disciplinary hearings.

It is advisable for you to book annual leave to attend a job interview. If this is not possible then discuss the matter with your GP, and then your employer. You are signed off as unfit for work so your employer could potentially take action against you if you attend an interview while signed off sick. 

Dismissal may affect those on long-term sick leave or for those who have frequent periods of sickness absence. Your employer should follow a fair procedure before deciding to dismiss you. Some employees who are dismissed because of ill health have the right to rely on the unfair dismissal provisions of the Employment Rights Act 1996.

If you have been in regular contact with your employer and there seems little chance of you being able to return to the role that you were employed to do (or any other suitable role), then your employer may be justified in terminating your contract. In some very limited cases of serious illness causing long-term sickness absence, your employer may argue that the contract has been frustrated, which means that it has come to an end without the need for a dismissal and instead by operation of law.

It is important that you have RCN support at an early stage if you think that your absence will be long term. Please contact us for advice.

Before dismissing an employee due to ill health, employers should follow certain principles:

  • They are expected to follow a fair procedure before deciding to dismiss.
  • They must take appropriate and sensible steps to inform themselves of your true medical position.
  • They should consider the opinion of an independent medical adviser if you ask them to.
  • When deciding that you cannot continue in your original job because of ill health, your employer must go on to consider suitable alternative work which may be of a different band/grade (not necessarily lower).
  • Consideration must be given to the provisions of equality legislation, such as the Equality Act 2010, when deciding whether or not to dismiss. In general, the legislation will not affect the dismissal of an employee who is incapable of carrying out his or her job and has been absent for a long time. However, if it was reasonable for the employer to make an adjustment and they did not do so (for example, change a disabled employee’s working hours or duties so as to enable him or her to return to work) then a dismissal may be unfair and discriminatory.

If you are having to rethink your career due to a long-term illness or disability, see our guidance in Managing your career around ill health or disability.


An employee whose contract is terminated while on long-term sick leave and who has exhausted all entitlement to sick pay will be entitled to full pay for the statutory minimum notice period. This is unless their contractual notice exceeds the statutory minimum notice by at least one week.

Section 86 of the Employment Rights Act 1996 sets out the statutory minimum notice periods. These are:

  • one week where the employee has at least a month’s but less than two years’ continuous service, and
  • one week for each year of continuous service, up to a maximum of 12 weeks, where the employee has at least two years’ service.

As an example: where the contractual notice period is one month, but the employee being dismissed while on long-term sick leave has over seven years’ service, their statutory notice entitlement will be seven weeks, so this will be payable at the full rate (1 x 7=7).

However, where the contractual notice period is one month and the employee has three and a half years’ service, his or her statutory notice entitlement will be three weeks (1 x 3 =3). In this case, the contractual notice period exceeds the statutory notice by at least one week, and there will be no statutory obligation for it to be paid at the full rate.

Employers sometimes treat an employee applying for ill health retirement as either an act of resignation (in which case no notice is payable if sick pay has run out) or class it as a termination of contract by mutual consent.

Certain state benefits paid to you as a direct result of an accident can be reclaimed by the Department for Work and Pensions (DWP) if you later recover damages as a result of a personal injury claim. Some employment contracts may contain clauses requiring employees to recover any contractual sick pay paid as a result of an accident, as part of a personal injury claim. It is sensible to check your contract of employment carefully or to discuss the position with your employer before your claim is settled.

Read our guide on accidents at work and personal injury.

If you are concerned about or are facing dismissal due to ill health, please contact us.

Being off sick can be a lonely experience. Our Peer Support group brings together members affected by physical or psychological injury, ill health or disability, whether work-related or not.

Please see our Health Ability Passport guidance for information about reasonable adjustments for staff with health or disability issue needs at work.

If you have been invited to a sickness meeting, and were in the correct category of membership when your sickness absences started, please complete this form for further support.


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Page last updated - 09/07/2024