Returning to work after sickness absence

Going back after illness, burnout, surgery or a mental health crisis raises practical questions. How many hours will you work? Will you go straight back to nights, a full clinic list or a busy dispensary? Who knows why you were away? Clinical work carries extra weight because patient safety depends on your concentration. A written return plan answers these questions before day one, so you are not negotiating on the shop floor.

How fit notes work

You can self-certify for the first 7 days of sickness, counting non-working days. After 7 days in a row you need a fit note, or other evidence your employer accepts. Since July 2022, doctors, nurses, occupational therapists, pharmacists and physiotherapists can all issue fit notes. Northern Ireland made the same change in 2022.

A fit note says either "not fit for work" or "may be fit for work taking into account the following advice". The second option lists four suggestions: a phased return, altered hours, amended duties and workplace adaptations. The advice is not binding on your employer. If your employer cannot meet the advice, the note counts as "not fit for work" and you stay on sick leave.

Build a written return plan

Ask for a return-to-work meeting before your first shift. Occupational health should advise on fitness and adjustments. Your manager decides how the advice works on the rota. Cover these points:

• Hours. A typical phased return builds up over four to six weeks. Agree the starting hours and each step.
• Duties. Decide what you will leave out at first, such as nights, on-call, lone working, controlled drug checks or a full clinic list.
• Supervision. Name one senior colleague to check in with each shift during the first fortnight.
• Pay. Ask how reduced hours affect pay. Some employers pay full salary during a phased return, others pay only for hours worked, and some let you use annual leave to make up the difference.
• Review dates. Set a review at two weeks and at the end of the phased return.
• Confidentiality. Agree what colleagues will be told and by whom.

Ask for the plan in writing. If the plan stops working, ask for an early review rather than pushing through.

Disability and reasonable adjustments

Under the Equality Act 2010, a physical or mental condition counts as a disability if the condition has a substantial, long-term effect on normal daily activities. Long term usually means 12 months or more. Cancer, HIV and multiple sclerosis count from diagnosis. Where the Act applies, your employer must make reasonable adjustments, such as changed hours, a quieter workstation or a different shift pattern. In Great Britain, Access to Work can fund some support at work. Northern Ireland has a separate Access to Work scheme and separate disability law.

Professional duties and your regulator

Being off sick is not a regulatory matter in itself. The GMC, NMC and GPhC expect you to seek advice and adjust your practice if your health puts patients at risk. Most returns after illness need no contact with the regulator at all. If you are unsure, ask your union or defence body before contacting the regulator yourself. The guide on fear of seeking help covers common worries.

Support organisations for staff returning to work

Pharmacists and trainees can contact Pharmacist Support. Confidential clinical care for eligible staff is available through NHS Practitioner Health.

If the return goes badly

If your employer refuses adjustments or starts a capability process soon after you return, get advice from your union or Acas. Keep copies of fit notes, occupational health reports and the return plan. For problems from 1 October 2026, most employment tribunal claims have a 6-month time limit, minus one day. The tribunal deadlines guide explains the rules. If your mental health worsens, use the urgent support page, NHS 111 or Samaritans on 116 123.

Related guides

Burnout in healthcare · Unmanageable workload · Boundaries at work · Workplace rights and wellbeing