Understanding NHS sick leave and pay
If you're unwell and can't work, it's important to understand the process for reporting your absence and how you'll be paid. For NHS staff on Agenda for Change (AfC) contracts, you can self-certify for up to seven days of sickness, after which you'll need a formal 'fit note'. Your sick pay entitlement depends on your length of service and is calculated over a rolling 12-month period.
What is self-certification?
Self-certification is the process for reporting short-term sickness without needing to see a doctor. It covers you for the first week of your absence.
Key points to remember:
- The 7-day rule: You can self-certify for up to seven consecutive calendar days. This period includes any days you wouldn't normally be working, such as weekends or rest days.
- Reporting your absence: You must follow your department's local procedure. This usually means phoning your line manager or a designated point of contact as early as possible on the first day you are unwell. An email or text message may not be sufficient.
- The form: When you return to work, you will usually be asked to complete a self-certification form (sometimes called an SC2 form) to formally record the dates and reason for your absence. This is a standard part of the return-to-work process.
Always check your trust's Sickness Absence Policy for the exact procedure you need to follow. These policies are often available on your staff intranet or from your HR department.
When you need a fit note
If your illness continues beyond seven calendar days, you will need to get a Statement of Fitness for Work, commonly known as a 'fit note', to cover your absence.
The fit note is a medical certificate that provides evidence of your fitness for work. You must send it to your manager or HR department as soon as you receive it to ensure your sick pay is processed correctly.
Who can issue a fit note?
Gone are the days when only a GP could sign you off work. The rules have been updated to make it easier to get a fit note from the most appropriate healthcare professional. Today, a fit note can be issued by:
- GPs and hospital doctors
- Registered Nurses
- Pharmacists
- Occupational Therapists
- Physiotherapists
This means if you're receiving treatment from a physiotherapist for a back problem, for example, they can issue your fit note directly without you needing a separate GP appointment.
The 'may be fit for work' option
A fit note doesn't just say you are 'not fit for work'. It can also state that you 'may be fit for work' taking into account certain advice. This is a positive development designed to help you return to work safely and in a way that supports your recovery.
If your clinician selects this option, they will include recommendations for how your employer can support your return. These might include:
- A phased return: Gradually increasing your hours over a set period.
- Altered hours: Temporarily changing your start and finish times to avoid peak travel or to fit around appointments.
- Amended duties: Avoiding specific tasks that could hinder your recovery (e.g., heavy lifting, long periods of standing).
- Workplace adaptations: Changes to your workspace, such as providing a specific type of chair or desk equipment.
If you receive a fit note with this advice, you should discuss it with your manager immediately. Your employer has a duty to consider the recommendations. If they are unable to make the necessary adjustments, you will be treated as if the fit note says 'not fit for work', and you will remain on sick leave.
How your NHS sick pay is calculated
Your entitlement to occupational sick pay is one of the key benefits of working in the NHS. It is governed by Section 14 of the Agenda for Change (AfC) handbook and is based on your length of service. The longer you've worked in the NHS, the more generous the provision.
The entitlements are calculated based on a 'rolling 12-month period'. This means that when you are off sick, your payroll team will look back at the 12 months immediately before your first day of absence and deduct any sick days you've already had from your total entitlement.
| Length of Service | Full Pay Entitlement | Half Pay Entitlement |
|---|---|---|
| During first year (after 4 months' service) | 1 month | 2 months |
| During second year | 2 months | 2 months |
| During third year | 4 months | 4 months |
| During fourth and fifth years | 5 months | 5 months |
| After five years | 6 months | 6 months |
If you have less than four months of service, you are not typically entitled to occupational sick pay, but you may be eligible for Statutory Sick Pay (SSP). Always check the latest rates and rules on the gov.uk website.
A worked example: sick pay in practice
Let's look at a realistic scenario to see how the rolling period works.
Javier is a Band 5 nurse who has been in the NHS for just over three years. His sick pay entitlement is 4 months of full pay and 4 months of half pay.
In January, he was off for one week (7 calendar days) with a nasty chest infection. He self-certified for this absence.
In June of the same year, he unfortunately breaks his ankle and is signed off by his physiotherapist for 6 weeks.
When calculating his pay for the 6-week absence, his payroll department looks back over the preceding 12 months. They see he has already had 7 days of sickness. This is deducted from his entitlement.
His remaining entitlement at the start of his June absence is 4 months of full pay minus 7 days. As his 6-week absence falls well within this remaining period, he will receive his full normal pay for the entire time he is off.
What's included in sick pay?
A common question is whether sick pay only covers basic salary. Under AfC terms, sick pay is calculated based on what you would have been paid if you had been at work. This means it includes more than just your basic pay.
Specifically, your sick pay should include any regularly paid supplements. This is a crucial point. It covers things like:
- Unsocial hours enhancements (for night, weekend, and bank holiday work)
- On-call payments
- Shift payments
Payments for occasional overtime or one-off bank shifts are not usually included. The key word is 'regular'. If you consistently work a rota that includes enhancements, they should be part of your sick pay calculation.
If you believe your sick pay is incorrect, check your payslip carefully and speak to your payroll department or union representative. You can use our NHS Take Home Pay Calculator to get a better understanding of your usual pay breakdown.
Returning to work after sickness
When you are fit to return, you should let your manager know. Most trusts have a formal return-to-work process, which usually involves a short, informal meeting on your first day back.
This isn't something to worry about. The purpose is to:
- Welcome you back to the team.
- Check that you are well enough to be at work.
- Discuss and implement any adjustments recommended on your fit note.
- Update you on any important news or changes that happened while you were away.
- Complete any necessary paperwork, like your self-certification form.
This meeting is a supportive measure to ensure your return to work is smooth and safe. It's your opportunity to raise any concerns you might have about your health and wellbeing in the workplace.
Key takeaways
- You can self-certify for sickness for up to 7 consecutive calendar days.
- For any absence longer than 7 days, you must provide a fit note.
- Fit notes can be issued by a range of healthcare professionals, including nurses, pharmacists, and physiotherapists, not just doctors.
- The 'may be fit for work' option on a fit note allows your employer to make adjustments to help you return safely.
- Your entitlement to occupational sick pay under Agenda for Change increases with your length of service.
- Sick pay is calculated over a rolling 12-month period and includes your basic pay plus any regularly paid enhancements like unsocial hours payments.
- Always follow your local trust's Sickness Absence Policy and keep your manager informed.