Long-Term Sickness Absence: UK Small Employer Guide

Introduction: why long-term absence needs a plan, not a panic

When one person in a small team is off sick for weeks, the effect is immediate: work piles up, customers wait, and colleagues pick up extra hours, while the owner wonders what they can legally ask, what they must pay, and when the absence can be brought to a close. Doing nothing is the worst response; rushing into warnings or dismissal without medical evidence is the second worst.

Long-term absence usually means four weeks or more continuously, although there is no single statutory definition. What matters is the process: keep in touch, understand the medical position, support a return wherever possible, and only consider ending employment after a fair capability process. This guide covers that process, including the Statutory Sick Pay (SSP) rules changed on 6 April 2026, fit notes, phased returns and adjustments. It is general guidance, not legal advice.

What counts as long-term absence?

Short absences are normally handled with self-certification and a brief return-to-work chat. Long-term absence is different: it often involves a condition still being investigated or treated, an uncertain return date, or a return needing changes to hours, duties or the workplace. Common causes include mental ill health, musculoskeletal problems, recovery from surgery, and cancer treatment.

Two legal frameworks run through this guide. Under the Equality Act 2010, if a condition amounts to a disability — an impairment with a substantial, long-term adverse effect on day-to-day activities — the employer must consider reasonable adjustments and must not discriminate; no formal diagnosis label is needed. And under unfair dismissal law, capability (ill health) is only a potentially fair reason for dismissal after a fair procedure in which alternatives were genuinely explored.

The first four weeks: get the basics right

Contact should be supportive, agreed and proportionate — not surveillance. Agree who to contact, how often, and how; a short check-in every week or two is usually reasonable, daily calls are not. You need the likely timescale and barriers to returning, not a full medical history. Put the agreement in a short email and adjust it if contact is worsening the employee’s anxiety.

Fit notes follow a clear timetable. For the first seven calendar days, including weekends, the employee can self-certify — you may ask for a form such as HMRC form SC2, but cannot demand a fit note, nor withhold SSP merely because a fit note arrives late. From day eight, you can ask for a fit note (a Statement of Fitness for Work) saying the employee is “not fit for work” or “may be fit for work” subject to adjustments such as a phased return or altered hours. Since July 2022, fit notes can be issued by doctors, registered nurses, occupational therapists, pharmacists and physiotherapists, on paper or digitally, including after a remote consultation — so a policy insisting on “a doctor’s note in person” is stricter than the law requires. Treat a “may be fit” note as the start of a conversation, and record what was discussed.

Pay during absence: SSP after the April 2026 changes

This is where out-of-date guidance causes the most errors, because SSP changed substantially on 6 April 2026 under the Employment Rights Act 2025 — check your contracts, handbook and payroll against the current rules. SSP is now payable from the first full day of absence: the three unpaid waiting days and the lower earnings limit have gone, so employees qualify regardless of earnings, provided they are classed as an employee, have done some work for you, and have been ill for at least one full working day. The 2026/27 rate is £123.25 per week or 80% of average weekly earnings, whichever is lower, for up to 28 weeks on qualifying days (days normally worked). The crossover is £154.06 per week: an employee averaging £120 receives £96 per week, while one averaging £300 receives the flat £123.25.

Payroll must also handle linked periods: separate absences count towards the same 28-week limit if each lasts at least one full working day and they are eight weeks or less apart. When SSP ends, or the employee does not qualify, send form SSP1 promptly so they can claim other benefits. Contractual sick pay sits on top of SSP unless the contract says otherwise. For budgeting, 28 weeks at £123.25 is £3,451 at the flat rate, before contractual sick pay and cover costs.

Keeping the business running

A long absence creates a second problem: who does the work? Options include redistribution, overtime, agency cover, or pausing lower-priority work. Overtime for an extra day a week quickly exceeds £200 a month, and agency cover for a skilled role can cost £150 to £300 per day or more. Be honest about what is temporary — cover must not become permanent unpaid overload — and review it at each absence meeting.

Getting medical evidence

After about four weeks, or sooner if the condition looks long-term, consider an occupational health (OH) referral. With consent, an OH professional can advise on timescales, whether full or modified duties are realistic, what adjustments would help, and whether the condition is likely to count as a disability. A single private OH assessment typically costs from around £375, though prices vary.

You may also, with written consent, ask the GP or consultant for a report. Under the Access to Medical Reports Act 1988, the employee can see it before it is sent and ask for amendments. Keep requests focused: broad diagnosis, prognosis, likely return date, restrictions and suggested adjustments. Never contact a clinician without consent, and never treat refusal alone as a disciplinary matter — warn instead that decisions may be made on the evidence available, and record the refusal.

Reasonable adjustments and the Equality Act

If the condition is, or may be, a disability, you must consider reasonable adjustments — steps removing a disadvantage at work. What is reasonable depends on your size, resources, cost and effectiveness. For a small employer, adjustments are often low-cost: changed hours, a phased return, part-week home working, a different workstation, lighter duties, extra breaks, or a temporary change of role.

Two mistakes are common: applying trigger points rigidly to disability-related absence (consider discounting some or all of it), and demanding a formal diagnosis before offering help. Access to Work may fund assessments, equipment or coaching, with grants of up to £69,260 per year reported for 2026.

Planning the return: phased returns that actually work

A phased return — gradually building hours or duties back up over a defined period — is one of the most effective return-to-work tools and is frequently recommended on fit notes and in OH reports. A typical pattern might be three days a week for two weeks, then four days for two weeks, then full-time, with lighter duties at first; two to six weeks is common. Agree the pattern with the employee, base it on medical advice where available, and write it down with review dates.

Pay during a phased return is a frequent source of dispute, so agree it in advance and in writing. There is no single statutory rule: common approaches are full pay throughout, pay for hours worked topped up with SSP or contractual sick pay, or pay for hours worked only. Check the contract first, and note SSP is not payable on any day the employee works. Hold a return-to-work meeting on or shortly after day one, agree what colleagues will be told (health details stay confidential), and share a brief record with the employee.

When a return is not possible: the capability process

Sometimes, despite support, adjustments and a phased plan, the employee cannot return within a reasonable timescale. Dismissal on capability grounds may then be a lawful last resort — but only after a fair process. ACAS guidance and tribunal practice expect: up-to-date medical evidence, normally including an OH report, on prognosis and whether adjustments or redeployment could work; formal consultation meetings at which the employee can be accompanied and warned in advance that dismissal is possible; genuine consideration of alternatives such as reduced hours or a different role; a reasoned written decision with contractual notice and a right of appeal; and an appeal heard, where possible, by someone uninvolved in the original decision.

Length of service matters: staff with under two years’ service usually cannot claim ordinary unfair dismissal, but discrimination and other automatically unfair claims have no qualifying period, so a sloppy process remains risky. Never dismiss by letter without a meeting, set an arbitrary return deadline without medical backing, or use sickness absence as a shortcut around redundancy or performance. Any negotiated exit needs proper advice and, where appropriate, a settlement agreement.

Records, privacy and a practical checklist

Keep absence records factual, dated and secure: dates, fit notes, meeting notes, OH reports, adjustments agreed and review dates. Health information is special-category data under UK GDPR, so restrict access and do not share details with colleagues. Apply the same process to everyone, and review your written policy: it should cover reporting, fit notes, SSP, keeping-in-touch arrangements, OH referrals, phased returns, trigger points and capability. If it still mentions three waiting days for SSP, it is out of date since April 2026.

Timeline: day one, record the absence and agree contact; day eight, request a fit note; week four, consider OH and review cover; before any return, agree the phased plan and pay in writing; before any capability decision, get up-to-date evidence, consult, consider alternatives, and offer an appeal. The best employers here have the clearest process, not the toughest policy.