Last updated: June 2026
If you have been signed off work because of an illness or injury, you may be wondering whether you need an NHS fit note or a private fit note.
The short answer is that both can provide evidence that you are unwell, but they differ in cost, availability, and how they may be used for work and benefit claims.
An NHS fit note is usually free and is commonly used as medical evidence by employers and government departments. A private fit note may be quicker to obtain and can be useful if you are unable to get an NHS appointment, but not all private medical certificates are treated the same way.
There is no legal requirement to obtain a private fit note if you can get an NHS fit note, and one is not automatically “better” than the other.
This guide explains everything you need to know about NHS and private fit notes in the UK.
Key takeaways ✔ NHS fit notes are usually free. ✔ Private fit notes usually involve a fee. ✔ Some private clinicians can issue official Med3 fit notes if they are the healthcare professional responsible for your care and meet the legal requirements for issuing them. ✔ Some private providers issue private medical certificates rather than official Med3 fit notes. These are accepted by most employers for workplace absence, but cannot be used for government benefit claims such as ESA or Universal Credit. ✔ Employers are generally required to accept a valid fit note from any GMC-registered doctor, whether NHS or private. ✔ You can self-certify sickness for the first seven calendar days of absence. |
NHS fit note vs private fit note: quick comparison
Feature | NHS fit note | Private fit note |
Cost | Usually free | Usually paid |
Issued by | NHS healthcare professionals | Private doctors or clinicians |
Waiting times | Depends on appointment availability | Often same-day or next-day |
Format | Official Med3 fit note | Med3 fit note or private medical certificate |
Accepted by employers | Generally yes | Yes, for workplace absence purposes |
Can be used for SSP | Yes | Yes, if accepted by employer as sufficient evidence |
Can be used for ESA / Universal Credit | Yes | No – official NHS Med3 required |
Available online | Yes | Yes |
What is a fit note?
A fit note, officially called a Statement of Fitness for Work (Med3), is a medical certificate explaining how your health condition affects your ability to work. A healthcare professional can state that you are not fit for work, or that you may be fit for work if certain adjustments are made.
Adjustments could include reduced working hours, temporary changes to duties, a phased return to work, or workplace adaptations.
According to data analysed by the BBC, approximately 72% of fit notes issued in 2025 did not specify a reason for sickness absence – they stated fitness status only. Where reasons were recorded, mental health and behavioural disorders were the most frequently cited category.
According to the NHS and GOV.UK, you only need a fit note if you have been off work for more than seven calendar days, including weekends and bank holidays. Read our detailed guide to fit notes in the UK.
Since July 2022, fit notes can be issued by:
- Doctors
- Nurses
- Occupational therapists
- Physiotherapists
- Pharmacists
provided they are treating you and are authorised to issue fit notes. A fit note from any of these professionals carries the same legal weight. Your employer cannot reject a fit note solely because it was issued by a nurse rather than a doctor.
What is an NHS fit note?
An NHS fit note is an official Med3 certificate issued by an NHS healthcare professional responsible for your care.
Key features of an NHS fit note ✅ Usually free of charge. ✅ Official medical evidence for employers. ✅ Can be used to support Statutory Sick Pay (SSP) and government benefit claims (ESA, Universal Credit). ✅ Can recommend workplace adjustments. ✅ Available electronically or on paper. |
You can usually request a fit note through a GP appointment, an online consultation, a telephone appointment, or via a hospital doctor if you are receiving hospital treatment.
What is a private fit note?
A private fit note is a medical certificate issued by a doctor or healthcare professional working outside the NHS. Depending on the provider, this may be an official Med3 fit note, or a private medical certificate or doctor’s letter.
This distinction matters A private medical certificate from a GMC-registered doctor is accepted by most UK employers for workplace absence and SSP purposes. However, it cannot be used for government benefit claims such as Employment and Support Allowance (ESA) or Universal Credit, for which an official NHS Med3 is required. |
Private fit notes are commonly used for:
- Work absences
- Insurance claims
- University or college absences
- Travel cancellations
- Legal and administrative purposes
How much does a private fit note cost?
Unlike NHS fit notes, private fit notes usually involve a fee. Costs vary between providers, but many clinics charge anywhere from around £20 to £70 or more, depending on the clinic, the type of consultation, whether the certificate is included in the consultation fee, and the type of medical evidence requested.
Some providers charge separately for a fit note, a medical letter, insurance certificates, or travel cancellation certificates. It is worth checking costs before booking an appointment.
NHS fit note vs private fit note: key differences
1. Cost
NHS fit notes are generally provided free of charge. However, if your employer requires evidence of sickness during the first seven calendar days of absence, a healthcare professional may charge for providing this documentation, and that cost should generally be paid by your employer. Private fit notes usually require payment.
2. Waiting times
NHS appointments can sometimes take longer to arrange. Private providers often offer same-day or next-day appointments.
3. Flexibility
Private providers may offer appointments during evenings and weekends and can often provide additional documentation.
4. Benefits and government claims
This is the most important practical difference. NHS fit notes are accepted by employers and government departments including the DWP for ESA and Universal Credit claims. Private medical certificates are accepted by most employers for workplace absence and SSP, but cannot be used to support government benefit claims. If you are applying for ESA or Universal Credit, you will need a free NHS Med3 from your registered GP.
5. Employer obligations
Under UK employment law, employers are required to accept a valid fit note from any GMC-registered doctor, whether NHS or private. An employer cannot reject a fit note solely because it was issued privately or by a nurse rather than a doctor. If an employer refuses to accept valid medical evidence, the employee can refer the matter to ACAS or HMRC’s statutory disputes team.
Are private fit notes legally valid?
Yes. Private medical certificates from GMC-registered doctors are valid evidence of illness and must be accepted by employers for workplace absence and SSP purposes. However, there is an important distinction between the two types of private certificate.
Official Med3 fit note from a private doctor
If the private clinician issues an official Statement of Fitness for Work (Med3), it is treated in the same way as an NHS-issued fit note, including for government benefit claims.
Private medical certificate or doctor’s letter
Some private providers issue a private medical certificate rather than an official Med3. These are accepted by most UK employers for absence documentation and SSP purposes. They cannot be used for ESA, Universal Credit, or other DWP benefit claims.
Before paying for a private certificate, check:
- Your employer’s sickness policy.
- Whether your employer requires an official Med3 or will accept a private certificate.
- Exactly what type of certificate the provider issues.
Read our detailed guide on how to recognise a legally valid fit note in the UK.
Can a private GP issue an official fit note?
Yes, in certain circumstances. According to GOV.UK guidance, a doctor outside the NHS may issue an official Med3 fit note if they are the healthcare professional responsible for your care and have assessed your fitness for work.
Can an employer refuse a private fit note?
Employers are generally required to accept a valid fit note from any GMC-registered doctor. An employer cannot reject a fit note solely because it was issued privately. However, an employer may request additional evidence, seek clarification, or refer you to occupational health. This is why it is important to understand your employer’s sickness absence policy before obtaining a private certificate.
Can you use a private fit note for Statutory Sick Pay (SSP)?
Yes, in most cases. A private medical certificate from a GMC-registered doctor is accepted by most employers as sufficient medical evidence for SSP.
SSP rules changed from 6 April 2026 From 6 April 2026, SSP is payable from day one of sickness absence for all eligible employees, following the Employment Rights Act 2025. The three waiting days have been abolished, and the Lower Earnings Limit has been removed, meaning more workers now qualify. The current SSP rate is £123.25 per week, or 80% of average weekly earnings, whichever is lower. |
Some employers may still prefer an official Med3 fit note or request additional evidence. If you are unsure, speak to your HR department or occupational health team. Explore our detailed guide to SSP changes 2026 UK.
Can you use a private fit note for Universal Credit or other benefits?
No. If you are claiming government benefits such as Universal Credit or Employment and Support Allowance (ESA), you will generally need an official NHS Med3 fit note. A private medical certificate or doctor’s letter will not normally be accepted by the DWP for these purposes. Contact the DWP directly to confirm the evidence they require.
Can NHS and private fit notes be issued online?
Yes. Both NHS and private providers can issue fit notes following telephone consultations, video consultations, or face-to-face appointments, if the healthcare professional believes a fit note is medically appropriate. Since the July 2022 reforms, fit notes no longer require an ink signature. Electronic fit notes are valid and are accepted in the same way as paper certificates.
Read our full guide on how to get an online fit note in the UK.
When is an NHS fit note the better option?
An NHS fit note may be the best choice if:
- You need an official Med3 certificate.
- You are claiming ESA, Universal Credit, or other government benefits.
- You are claiming SSP and your employer requires an official Med3.
- You already have access to an NHS appointment.
- Cost is a concern.
Because NHS fit notes are generally free, they remain the most cost-effective option for most people.
When might a private fit note be better?
A private fit note may be useful if:
- You need an appointment urgently.
- You cannot get a timely NHS appointment.
- You need additional medical documentation (insurance, travel, legal).
- You require evening or weekend appointments.
- You only need medical evidence for your employer, not for a government benefit claim.
Do you need a fit note for the first seven days off work?
No. Employees can usually self-certify their sickness for the first seven calendar days of absence. This includes weekends, bank holidays, and days you would not normally work. A fit note is usually only needed once your illness lasts longer than seven calendar days.
Note From 6 April 2026, SSP is payable from day one of absence. This does not change the fit note rules: self-certification still covers the first seven days, and a fit note is required from day eight onwards. |
Learn more about self-certification in the UK.
NHS fit note vs private fit note: which should you choose?
An NHS fit note is usually the best option if you need a free official Med3 certificate, evidence for a government benefit claim (ESA, Universal Credit), or documentation for Statutory Sick Pay where your employer requires an official Med3.
A private fit note may be worth considering if you need faster access to a clinician, a same-day appointment, or additional medical certificates (insurance, travel, legal), and you only need the note for your employer rather than for a government benefit claim.
The most important things are confirming that the certificate you obtain meets your employer’s requirements, checking whether you need an official Med3 or whether a private certificate is acceptable, and ensuring the note is issued following an appropriate medical assessment.
Frequently Asked Questions (FAQs)
Yes. A healthcare professional may issue a fit note following a telephone or video consultation if they have enough information to assess your condition.
Yes. Both NHS and private providers can issue fit notes online following an appropriate assessment.
Yes. Healthcare professionals can sometimes backdate a fit note if they believe you were unfit for work during an earlier period. Here is our detailed guide on backdated fit notes in the UK.
The length of a fit note depends on your medical condition and the clinician’s assessment. Some fit notes are issued for a few days, while others may cover longer periods. Read more about how long a doctor can give a fit note in the UK.
Yes. A fit note is advice, not a binding instruction. You can return to work before the fit note expires if you feel well enough and both you and your employer are satisfied that it is safe and appropriate for you to do so.
⚠️ Disclaimer: This article is for general informational purposes only and does not constitute medical, legal, or academic advice.
