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Publication, Part of

Fit Notes Issued by GP Practices, England, December 2023

Official statistics


The outbreak of Coronavirus (COVID-19) in the last quarter of 2019-20 has led to unprecedented changes in the work and behaviour of GP practices and consequently the data in this publication may have been impacted. As such caution should be taken in drawing any conclusions from this data without due consideration of the circumstances both locally and nationally and would recommend that any use of this data is accompanied by an appropriate caveat.

The Statement of Fitness for Work (the Med3 form or 'fit note') was introduced in April 2010 across England, Wales and Scotland. It enables healthcare professionals to give advice to their patients about the impact of their health condition on their fitness for work and is used to provide medical evidence for employers or to support a claim to health-related benefits through the Department for Work and Pensions (DWP).

A fit note is issued after the first seven days of sickness absence (when patients can self-certify) if the healthcare professional assesses that the patient’s health affects their fitness for work. The healthcare professional can decide the patient is 'unfit for work' or 'may be fit for work subject to the following advice...' with accompanying notes on suggested adjustments or adaptations to the job role or workplace.

In 2012, DWP funded a project to provide general practice's with the ability to produce computer-generated fit notes (eMed3) and this included the capability to collect the aggregated data generated.

Fit notes are issued to patients by doctors, nurses, physiotherapists, occupational therapists and pharmacists following an assessment of their fitness for work. While they can be written by hand, most fit notes provided by general practice are now computer-generated.

This quarterly statistical publication is produced by NHS England in collaboration with The Work and Health Unit, jointly sponsored by the Department for Work and Pensions and the Department of Health. It presents data on electronic fit notes issued in general practices in England for a given period.

This is a ‘cumulative’ data collection. Weekly data collected will continue to be added to existing data. All data for all reporting periods is updated in each quarterly publication. From April 2019 all publications will contain data from practices who have TPP as their system supplier (which was not previously available), and accounts for one third of practices in England, consequently publications from this date may not be comparable to previous publications.

All GP practices are mapped using current NHS geographies and recent changes may have resulted in a small number of practices not being mapped historically. These are shown as 'Unallocated' but are included in the England total.

NHS England will publish data on a quarterly basis in October, January, April and July.

Key Facts

Decrease in fit notes

2,776,226 fit notes were issued in Q3 2023-24, a decrease of 36,687 ( 1.3%) compared to Q3 2022-23 (2,812,913).

Average rate per 100,000 patients

The highest commissioning region average rate per 100,000 registered patients for Q3 2023-24 was 3,249 fit notes (North West). The lowest regional rate was 1,793 fit notes (London).

Fit notes for 5 weeks or longer

1,137,414 (41.0%) fit notes were for 5 weeks or longer in Q3 2023-24 compared to 1,141,801 (40.6%) in Q3 2022-23.

Increase in fit note episodes

1,126,877 fit notes episodes took place in Q3 2023-24, an increase of 4,458 ( 0.4%) compared to Q3 2022-23 (1,122,419).

Source: Fit note eMED3 data set, NHS England

Last edited: 11 April 2024 7:18 am