Managing Employee Sickness Absence: UK Employer's Guide

Sickness absence costs UK businesses billions each year, yet many small employers have no formal process for managing it. Without clear policies and consistent procedures, short-term absence drifts upward, long-term cases become unmanageable, and the line between genuine illness and capability issues blurs.

This guide covers the legal framework, practical processes, and common pitfalls every UK employer needs to understand.

Statutory Sick Pay (SSP): the legal minimum

SSP is the minimum amount you must pay employees who are off sick and meet the qualifying conditions. It is paid by the employer — HMRC does not reimburse you (the previous rebate scheme ended in 2014).

SSP rates and qualifying conditions for 2025/26

Who qualifies for SSP

An employee qualifies for SSP if they:

• Are an employee (not self-employed)
• Earn at least £123 per week on average (the Lower Earnings Limit)
• Have been off sick for at least 4 consecutive days (including non-working days)
• Have notified you of their absence within your required timeframe (or within 7 days if you have no specific requirement)

When SSP does not apply

You do not have to pay SSP if the employee:

• Earns below the Lower Earnings Limit
• Has already received 28 weeks of SSP in the current period of incapacity
• Is within the first disqualifying period after receiving certain benefits
• Is in legal custody
• Is outside the EU and not paying UK NI contributions

In these cases, provide the employee with form SSP1 so they can claim Employment and Support Allowance (ESA) from the Department for Work and Pensions.

Contractual sick pay

Many employers offer contractual sick pay (also called company sick pay or occupational sick pay) that is more generous than SSP. A typical scheme might offer:

• Full pay for a set number of weeks, then half pay, then SSP only
• More generous terms for longer-serving employees
• No waiting days (pay from day one of absence)

Your sick pay scheme should be clearly set out in the employment contract or staff handbook. Make sure employees understand whether contractual sick pay includes SSP or is paid on top of it.

Fit notes (formerly sick notes)

Since July 2022, fit notes can be issued by doctors, nurses, occupational therapists, pharmacists, and physiotherapists — not just GPs. The fit note system was renamed from "sick note" to "fit note" to shift the focus from what employees cannot do to what they may be able to do.

When a fit note is needed

• Days 1-7 of absence: Employees can self-certify. You can require them to complete a self-certification form, but you cannot demand a fit note
• Day 8 onwards: You can require a fit note from a medical professional. The employee is responsible for obtaining this

Understanding fit note options

A fit note will state either:

• Not fit for work: The employee should not work at all during the stated period
• May be fit for work: The employee could return to work if certain adjustments are made

If a fit note says "may be fit for work," the practitioner will tick one or more of these options:

• Phased return to work
• Altered hours
• Amended duties
• Workplace adaptations

Short-term absence management

Short-term absence — the odd day or few days off here and there — is the most common type and the hardest to manage consistently. The key is having a clear process that applies to everyone.

Notification requirements

Set out in your policy:

• Who the employee should contact (their line manager, not a colleague or text message to the team)
• When they should call (before their start time on the first day)
• What information they should provide (nature of illness, expected return date)
• How often they should update you for ongoing absence

Return-to-work interviews

Conduct a brief return-to-work interview after every period of absence. This is the single most effective tool for managing short-term absence. The interview should:

• Welcome the employee back
• Check they are fit to return and ask if any support is needed
• Update them on anything they missed
• Record the reason for absence and the dates
• Where appropriate, discuss any patterns of absence

Keep the tone supportive, not interrogative. The purpose is to show that absence is noticed and monitored, and to identify any underlying issues early.

Trigger points

Many employers use trigger points to identify when absence levels become a concern. Common examples:

• Three separate periods of absence in a rolling 12-month period
• A total of 8 or more days absent in a rolling 12-month period
• Any pattern suggesting non-genuine absence (such as frequent Mondays or Fridays off)

When a trigger is hit, hold a formal absence review meeting. This is not disciplinary — it is a conversation about the employee's absence record, any underlying causes, and what support can be offered.

Long-term absence management

Long-term absence (typically defined as four or more consecutive weeks, though definitions vary) requires a different approach. The focus shifts from monitoring patterns to supporting recovery and planning for the employee's return or, ultimately, managing their exit if return is not possible.

Keeping in touch

Maintain regular, reasonable contact with the employee throughout their absence. Agree the frequency and method of contact at the start (for example, a phone call every two weeks). The purpose is to:

• Show the employee they are valued and not forgotten
• Get updates on their recovery and likely return date
• Discuss any support you can offer
• Keep them informed of relevant workplace changes

Do not pressure the employee to return before they are ready, but equally do not lose contact for months on end.

Occupational health referrals

For long-term absence or complex cases, refer the employee to occupational health (OH). An OH assessment can provide:

• An independent medical opinion on the employee's condition and prognosis
• Recommendations for workplace adjustments that could facilitate a return
• An estimated timeline for recovery
• Guidance on whether the condition may amount to a disability under the Equality Act 2010

You need the employee's consent for an OH referral. If they refuse, you may need to make decisions based on the information available.

The Equality Act 2010 and disability

A long-term health condition may amount to a disability under the Equality Act if it has a substantial and long-term adverse effect on the employee's ability to carry out normal day-to-day activities. "Long-term" means it has lasted or is likely to last 12 months or more.

If the condition is a disability, you have a duty to make reasonable adjustments. These might include:

• Adjusting work patterns or hours
• Reallocating some duties
• Providing additional equipment
• Allowing phased return
• Moving the employee to a more suitable role if one is available

Dismissal on grounds of capability (ill health)

Dismissal due to long-term sickness is potentially fair as a "capability" dismissal under the Employment Rights Act 1996, but only if you follow a fair process.

Before dismissing, you should demonstrate that you have:

1. Obtained up-to-date medical evidence (through OH or with the employee's consent)
2. Explored all reasonable adjustments and alternative roles
3. Kept the employee informed and consulted with them at each stage
4. Given reasonable time for recovery
5. Held a formal meeting to explain that you are considering dismissal, and allowed the employee to be accompanied
6. Considered the employee's representations before making a final decision
7. Offered a right of appeal

There is no fixed period after which dismissal becomes automatic. The reasonableness depends on the circumstances — the nature of the illness, the size of the business, the need to fill the role, and the impact on colleagues.

Frequently asked questions

Next steps

Key takeaways

Effective sickness absence management combines clear policies, consistent processes, and genuine support for employees. Pay SSP correctly from day four, use return-to-work interviews for every absence, and manage long-term cases with medical evidence, reasonable adjustments, and fair procedures.

For related guidance, see our holiday entitlement guide for how leave accrues during sickness, and use our Payroll Tax Calculator to calculate SSP and payroll deductions correctly.