Sickness Absence Management: The UK Employer's Guide

The distinction matters because it decides which process you run.

Short-term absence is a pattern problem. One person off with a stomach bug for two days is not a management issue. The same person off for two days six times in a year is, because the cost is in the disruption rather than the days. Short-term absence is handled through recording, trigger points, return-to-work conversations and, where a genuine pattern of avoidable absence emerges, a formal attendance process.

Long-term absence is a capacity problem. The question is not "why do they keep going off" but "will this person be able to do this job again, and when". That question can only be answered with medical evidence, which means occupational health. Long-term absence is handled as capability, not conduct, and the full process is set out on our long-term sickness absence guide.

There is a third category most absence policies miss entirely: disability-related absence, which can be short-term, long-term or both, and which has to be recorded and treated differently from ordinary sickness. Acas recommends recording disability-related absence separately precisely so that it does not get swept into the same trigger count as everything else. More on that below.

One practical point that catches employers out. An employee who is off sick does not stop accruing holiday, and can take holiday during sickness absence. Employment does not automatically end because sick pay has run out, either. Absence ends when the employee returns, resigns, or is dismissed after a fair process. Nothing happens by itself.

Most UK employers use one of two models, and plenty use both:

• ●Frequency: a set number of separate absence occasions in a rolling period. Three occasions in any rolling twelve months is the most common setting.
• ●Duration: a set number of days lost in a rolling period, commonly eight to ten working days in twelve months, or any single absence of a defined length.

Whatever you pick, four things have to be true for it to survive scrutiny.

1. It is written down and people have seen it. Acas lists a trigger point system as one of the things an absence policy should set out, alongside how to report absence, how to keep in touch, and what people get paid. An unwritten trigger is indistinguishable from a manager's mood.

2. It is applied to everybody the same way. The single most common reason an employer loses an attendance case is that the same trigger was enforced against one person and quietly ignored for another. Tribunals look for the comparison. So do your employees.

3. Hitting it starts a conversation, not a warning. The point of a trigger is to make you look. Sometimes what you find is an underlying condition nobody had mentioned. Sometimes it is caring responsibilities. Sometimes it is a manager. Sometimes it is genuinely unacceptable attendance, and then you follow your attendance procedure properly.

4. Disability-related absence is handled separately. Acas sets out the two accepted mechanisms: "not counting some or all sickness absence related to a disability towards any trigger points", or "increasing the number of absences that will trigger a review". Pick one, write it into the policy, and record disability-related absence separately so you can apply it. Acas also recommends recording pregnancy-related and disability-related absence separately for exactly this reason.

The legal weight behind point four comes from *Griffiths v Secretary of State for Work and Pensions* [2015] EWCA Civ 1265. The Court of Appeal held that an attendance management policy is a provision, criterion or practice for the purposes of the duty to make reasonable adjustments. Elias LJ framed the PCP as "the employee must maintain a certain level of attendance at work in order not to be subject to the risk of disciplinary sanctions", and rejected the argument that applying a policy equally to everybody removes the disadvantage: disabled employees are more likely to breach an attendance requirement, so they are substantially disadvantaged by it. Extending a trigger point *can* be a reasonable adjustment. On the facts of *Griffiths* the particular extension sought was held not to be reasonable, so this is not a rule that disabled employees get unlimited absence. It is a rule that you have to think about it rather than apply the number blind.

Hold them anyway, for every absence, for everybody. They are the highest-value fifteen minutes in absence management, for four reasons: they confirm the person is actually well enough to be back, they surface adjustments early while adjustments are still cheap, they put an accurate reason on the record while it is fresh, and they make the absence policy visible without anybody having to be formal about it.

Acas sets out what to cover: make sure the employee is ready to return, tell them what happened at work while they were off, ask whether they need any support, agree a return plan if one is needed, and agree what they would like colleagues to be told about their absence. That last one matters more than it looks, and it is the one managers skip.

Practical notes on getting them right:

• ●Do it in private and treat it as confidential. You are about to discuss health information, which is special category data. See the data protection section.
• ●Have the absence record in front of you, but do not open with it. "How are you doing" first.
• ●Ask an open question about whether anything at work makes the condition worse. This is where work-related musculoskeletal and stress problems surface, and where you find out you have a job design problem rather than an attendance problem.
• ●Record the reason for absence and any adjustments agreed. Keep it short and factual.
• ●If a trigger point has been hit, say so plainly in the meeting rather than sending a letter a week later.
• ●Do them for senior staff too. Inconsistency here is the easiest disparity for an employee to point at, and the hardest to explain away.

The CIPD's 2025 guidance on short-term absence notes that line managers take primary responsibility for managing short-term absence in 70% of organisations. Those managers are the people holding these conversations. If they have not been trained to hold one, the process does not exist no matter what the policy says.

Self-certification covers the first seven calendar days. If an employee is off for seven calendar days or less, including weekends and bank holidays, they do not need a fit note and you should not ask for one. From the eighth day they should provide one. Acas notes that a healthcare professional might refuse to issue a fit note before the seventh day, and gov.uk confirms that fit notes are free only where the person has been ill for more than seven days.

Five professions can issue one. Since July 2022, fit notes can be issued by doctors, nurses, occupational therapists, pharmacists and physiotherapists (GOV.UK, taking sick leave). Since 2022 they can also be authorised digitally rather than signed in ink, and a digital fit note is legally valid. Refusing an emailed fit note because it has no wet signature is a mistake employers still make.

A fit note says one of two things. Either the employee is "not fit for work", or they "may be fit for work". If it says may be fit, the healthcare professional can suggest a phased return, altered hours, amended duties or workplace adaptations.

Here is the part most employers get wrong. The suggestion on a fit note is advice, not an instruction: gov.uk's employer guidance says plainly that the healthcare professional's advice "is advice, and you are not obligated to agree". But the corollary bites. GOV.UK states that where a fit note says may be fit for work, "the employee must be treated as 'not fit for work' if there's no agreement on these changes". You cannot decline the suggested adjustments and then treat the employee as fit. If you will not make the changes, they are off sick and SSP applies.

Scale. 2,972,596 fit notes were issued by GP practices in England in the quarter to 31 March 2026, and 1,215,820 of them, 40.9%, were for five weeks or longer. Four in ten fit notes are already long-term absence at the point of issue. If you wait until week four to react, you are frequently reacting to something that was signalled in week one.

• ●Absence has reached or is heading past four weeks.
• ●A pattern of short-term absence suggests an underlying condition.
• ●The employee has mentioned a disability, a mental health condition, or a condition that might be either.
• ●You are considering any formal step, including an attendance warning or a capability process.

Acas lists the same use cases: a worker struggling with physical or mental health, identifying the right reasonable adjustments, someone off sick for a long time or returning from sickness absence, and reducing the amount of time people need to take off.

Occupational health is available to small employers. 69% of employers provide occupational health, rising to 86% among those with 250 or more employees (CIPD Health and Wellbeing at Work 2025). The gap is almost entirely SMEs. Acas's advice where a smaller organisation has no occupational health scheme is that the employer should communicate with both the worker and their doctor, and must get permission before contacting the worker's doctor. You do not need a retained provider. Single-case referrals can be bought from an independent occupational health provider.

The referral is only as good as the questions. "Please advise" produces "the employee is currently unfit for work", which you already knew. Ask these, in writing:

1. 1.What is the employee's current functional capability in relation to the specific duties of their role? (Attach the job description.)
2. 2.When, on current evidence, are they likely to be fit to return to their substantive role?
3. 3.Are they fit to return now with adjustments, and if so exactly which adjustments, for how long?
4. 4.Is the condition likely to meet the definition of disability in section 6 of the Equality Act 2010?
5. 5.Would redeployment to a different role be appropriate, and what would it need to look like?
6. 6.Are there any workplace factors making the condition worse?
7. 7.Is further specialist input needed before a decision can reasonably be taken, and if so, over what timescale?
8. 8.Will the condition be permanent or is improvement likely, and over what period?

Question four does not ask occupational health to make a legal ruling. Whether someone is disabled is ultimately for a tribunal, not a clinician. It asks for the clinical facts you need in order to take a view, and it puts on the record that you asked.

Consent, and what the employee can see. An employee does not have to agree to an occupational health assessment, and after the assessment the adviser must ask the worker's permission before sharing it with the employer. Where a doctor carries out the assessment, or where occupational health seeks a report from the employee's own GP or consultant, the Access to Medical Reports Act 1988 applies. Under that Act the employer must notify the individual that it proposes to apply for a report and obtain their consent; the individual may state that they wish to see the report before it is supplied; the practitioner may not supply it until 21 days have elapsed or the individual has responded; and the individual may ask for parts they consider incorrect or misleading to be amended, and may withhold consent to it being supplied at all.

Tell the employee all of this in the referral letter, in plain English, before they sign the consent form. Employers who treat consent as a formality lose the report and the goodwill at the same time.

If the employee refuses. You cannot compel an assessment. Explain in writing what the assessment is for, that without medical evidence you will have to make decisions on the information you hold, and invite them to reconsider. Then make decisions on the information you hold, and record that you offered. A refusal documented properly is a much stronger position than a referral never offered.

It is the leading cause of long-term absence. The CIPD's 2025 survey found mental ill health, mainly depression and anxiety, was the top cause of long-term absence at 41%, ahead of musculoskeletal injuries at 31% and other long-term conditions including cancer at 30%. It is also the second most common cause of short-term absence at 29%, behind minor illness at 78%. ONS puts mental health conditions at 11.5% of all days lost in 2025.

Some of it is caused by work. HSE's 2025 statistics put work-related stress, depression or anxiety at 964,000 workers and 22.1 million lost days in 2024/25, which is 62% of all days lost to work-related illness. The causes workers name are workload, tight deadlines, lack of managerial support, bullying, and organisational change. Where that is the cause, absence management is the wrong tool. Employers have a legal duty to assess the risk of work-related stress under health and safety law, and HSE publishes Management Standards for doing it.

Contact needs designing, not defaulting. Acas's guidance on mental health absence is that "an employer should have appropriate contact with an employee who is off sick because of a mental health problem" and that the employer should agree the purpose, type and level of contact with the employee "to make sure it's useful and not overwhelming". Where the employee finds contact too difficult, Acas suggests asking whether there is someone else they can check in with, such as a family member or close friend. Weekly calls from a line manager is the default that does the most damage.

Three further practical points:

• ●A mental health condition can be a disability under the Equality Act 2010, and frequently is. Depression and anxiety that have lasted or are likely to last twelve months with a substantial adverse effect on day-to-day activities meet the statutory test. Treat the disability question as live from the start rather than waiting for the employee to raise it.
• ●The employee will often not tell you what is wrong, and does not have to. You are entitled to ask for medical evidence. You are not entitled to a diagnosis.
• ●Adjustments for mental health are usually about workload, hours, predictability and supervision rather than equipment, and they are usually cheap. Ask what would help before assuming what would help.

Adjustments that come up repeatedly in sickness absence cases:

• ●A phased return with hours building over an agreed period.
• ●Amended or reduced duties, permanently or temporarily.
• ●Changed hours or start times, including to fit medical appointments or to avoid a commute at peak times.
• ●Working from home, in whole or in part.
• ●Equipment and workstation changes.
• ●Time off for treatment, appointments and rehabilitation, sometimes recorded as disability leave rather than sickness absence.
• ●Adjusting or disapplying absence trigger points, as in *Griffiths*.
• ●Redeployment to a suitable alternative role.

What "reasonable" means depends on the size and resources of the employer, the cost and practicality of the step, and how far it would actually help. A ten-person firm in Bolton is not held to the standard of a national employer. It is held to the standard of a ten-person firm that thought about it.

Two boundaries worth knowing: paying full sick pay for disability-related absence is very rarely a required adjustment (*O'Hanlon*), and there is no duty to create a job that does not exist. Do not charge the employee for adjustments, and pay for time spent at occupational health appointments. Acas warns that if a disabled worker is disadvantaged because the employer will not pay for that time, this could be disability discrimination. Redeployment, trial periods and the case law on transferring a disabled employee without a competitive interview are covered on the long-term sickness absence guide.

Establishing the reason is the easy half. Section 98(4) then asks whether the employer "acted reasonably or unreasonably in treating it as a sufficient reason for dismissing the employee", having regard to the size and administrative resources of the employer, and determined "in accordance with equity and the substantial merits of the case".

Four things have to be in place before a sickness dismissal is reasonable:

1. 1.Adequate, current medical evidence. Not just fit notes. An occupational health or specialist opinion on prognosis, obtained recently enough to still be true.
2. 2.Genuine consideration of adjustments and alternative work, documented, including the ones you rejected and why.
3. 3.Consultation with the employee, at which they have seen the medical evidence and have had a real opportunity to respond.
4. 4.A decision within the range of reasonable responses, meaning you can say how long you waited, why you could not wait longer, and what the effect on the business was.

Acas's own guidance is that an employer "should take steps to avoid dismissing an employee on the grounds of capability" and should look at changes to the role and a phased return first. For a disabled employee, Acas adds that formal procedures "should be a last resort" and that the employer must first have done all they reasonably can to support the person.

One point almost every guide gets wrong. The Acas Code of Practice on Disciplinary and Grievance Procedures does not apply to a genuine ill-health capability dismissal. The Code covers "misconduct and/or poor performance", and in *Holmes v QinetiQ Ltd* [2016] UKEAT/0206/15 the Employment Appeal Tribunal held that it requires some element of culpable conduct (judgment on BAILII; analysis by CMS). What you lose is the 25% uplift, not the claim, and the exception is narrow: allege malingering and the Code applies again.

The right to be accompanied still applies. Section 10 of the Employment Relations Act 1999 gives a worker the right to be accompanied at a "disciplinary hearing", and section 13(4) defines that as a hearing which could result in "the taking of some other action in respect of a worker by his employer". A capability hearing that could end in dismissal qualifies. Offer the companion, in writing, every time.

The full capability process, redeployment, permanent health insurance, ill-health retirement, redundancy during sickness and notice pay are covered on our guide to long-term sickness absence and capability dismissal. If dismissal is already on the table, dismissal on sick leave covers the step you are at.

That means you need a lawful basis and a separate Article 9 condition before you process any of it. Five practical rules:

1. Do not rely on consent. The ICO's position is that consent is generally inappropriate in the employment context because workers cannot freely give it to their employer. Use legitimate interests or legal obligation as the lawful basis, and the employment, social security and social protection condition under Article 9(2)(b).

2. Know the difference between an absence record and a sickness record. The ICO draws a line: a sickness record "contains details of the illness or condition responsible for a worker's absence", while an absence record "may give the reason for absence as 'sickness' or 'accident' but does not include any reference to specific medical conditions". The ICO advises using absence records "where practical" because they are less intrusive. Most line managers do not need the diagnosis. They need to know somebody is off sick.

3. Restrict access. The ICO says organisations "should not make the sickness, injury or absence records of individual workers available to others, unless it is necessary for them to do their jobs". Occupational health reports in particular should not circulate freely. Managers who can see them should be told what they can and cannot do with them.

4. Keep it out of the shared drive. Absence spreadsheets with a "reason" column, visible to a whole department, are one of the most common breaches in small businesses.

5. Retention. Do not keep health data indefinitely. Set a retention period, write it down, and apply it. One factor to feed into that decision: from 1 October 2026 the time limit for bringing most employment tribunal claims doubles from three months to six (Acas, Employment Rights Act 2025), so the window in which you might need absence records to defend a claim has lengthened.

Acas makes the same point from the other direction: when recording medical information you should "be able to give a reason for keeping this information" and "make sure you only share it with relevant people".

1. 1.Record the absence on day one. Log the date, who reported it, how, and the reason given. Since 6 April 2026 the first day carries an SSP liability, so day-one recording is a payroll requirement as well as an HR one.
2. 2.Stay in contact, at an agreed frequency. Agree with the employee how often you will be in touch, by what method, and with whom. Acas's guidance is that contact should be agreed rather than imposed, and that for mental health absence the purpose, type and level of contact should be agreed so it is useful and not overwhelming.
3. 3.Get the fit note from day eight. The first seven calendar days are self-certified. From day eight ask for a fit note. Accept a digitally authorised one. If it says "may be fit for work", discuss the suggested adjustments; if you cannot agree them, the employee is treated as not fit for work.
4. 4.Hold a return-to-work discussion on the first day back. Every absence, every employee, in private. Confirm they are fit to be back, ask whether anything at work makes the condition worse, agree any adjustments, and record the reason for absence.
5. 5.Review against your trigger points monthly. Run the absence report. Exclude or adjust disability-related absence in line with your policy. Where a trigger is hit, that starts a review meeting, not a warning.
6. 6.Refer to occupational health at four weeks, or earlier if the picture is unclear. Send the job description with the referral and ask specific questions about functional capability, timescale, adjustments, disability status and redeployment. Explain the employee's rights under the Access to Medical Reports Act 1988 before they consent.
7. 7.Meet the employee to discuss the report. Share it in advance. Discuss what it says, what it means for their role, and what they think. Offer a companion. Record what was agreed.
8. 8.Make and trial the adjustments. Implement what is reasonable, in writing, with a defined review date. Record any adjustment you decided against and the reason. Review it on the date you set.
9. 9.Hold a formal capability review only when the evidence supports it. Write to the employee setting out the length of absence, the medical evidence, the adjustments tried, the effect on the business, and the fact that dismissal is a possible outcome. Give reasonable notice and the right to be accompanied. Listen to what they say before deciding.
10. 10.Decide, confirm in writing, and offer an appeal. If dismissal is the outcome, confirm the reason as capability, set out the notice position, and offer an appeal to a manager who was not involved in the decision. If it is not the outcome, set the next review date and say so.