Private GP letters and fit notes: what a doctor can and cannot write

Written by the AccessGP Team, Clinically reviewed by Dr Zamiel Hussain, Lead GP and Founder of AccessGP

Many people book a GP appointment because they need a letter.

It may be for work, university, travel, insurance, an examination board, a gym membership, an employer, an airline, or another organisation asking for medical evidence.

Sometimes the request is straightforward. Sometimes it is more complicated. A patient may know exactly what they want the letter to say, but a responsible GP can only write what is clinically appropriate, factual and supported by the consultation or available evidence.

The same applies to fit notes, sometimes still called sick notes. A private GP can consider issuing a fit note after an assessment, but it is not simply an administrative form. It has to reflect how a health condition affects someone’s ability to work.

This guide explains what private GP letters and fit notes are, when AccessGP may be able to help, what evidence is useful, and why some requests cannot safely or appropriately be completed.

Why people need private GP letters

Medical letters are often needed when an organisation asks for written evidence from a doctor.

Common reasons include:

• work or HR requests
• university or examination support
• travel or airline documentation
• insurance evidence
• cancellation or refund requests
• confirmation of a medical condition
• support after illness
• private referral letters
• fitness-to-study or fitness-to-work queries
• evidence of symptoms affecting daily life

A GP letter can be helpful because it provides a clear, professional summary of relevant medical information. It can explain what was discussed, what symptoms were reported, what the GP assessed, and what advice or plan was agreed.

However, a GP letter is not a guarantee that the receiving organisation will accept a request. Employers, universities, insurers, airlines and examination boards make their own decisions.

A doctor can provide medical evidence. They cannot control the outcome.

What a private GP can usually write

A GP may be able to write a factual medical letter after a consultation if there is enough information to support it.

Depending on the situation, a letter may confirm:

• the date of consultation
• symptoms reported by the patient
• relevant past medical history
• medication discussed or evidenced
• the GP’s assessment
• advice given
• whether symptoms are likely to affect work, study, travel or daily life
• whether follow-up, tests, referral or treatment were advised
• whether a fit note was issued, if appropriate

The wording should be careful and honest.

For example, if a patient has anxiety symptoms affecting sleep, concentration and work, a GP may be able to write that this was discussed and assessed during the consultation. If the GP has not previously assessed the patient during the period in question, the letter may need to explain that the information is based on a later consultation and the history provided.

That kind of caveat is not unhelpful. It is what makes the letter credible.

What a GP cannot write

A GP cannot simply write whatever a patient asks for.

A doctor cannot usually:

• confirm facts they have not assessed or cannot evidence
• guarantee that someone is fit for every aspect of work, travel or study
• state that an employer, university, airline or insurer must make a particular decision
• retrospectively verify symptoms that were not assessed at the time
• provide an occupational health opinion beyond the GP’s role
• say someone meets a legal definition of disability without proper context
• complete specialist forms that require detailed in-person examination or specialist assessment
• provide misleading wording to support a refund, appeal or claim
• write a letter where the clinical evidence does not support it

This is important for patient safety and professional standards.

A strong GP letter is not one that says the most. It is one that says the right things clearly, accurately and responsibly.

Fit notes: what they are for

A fit note is the official medical statement used when a health condition affects someone’s fitness for work.

In the UK, employees can usually self-certify sickness absence for the first seven calendar days. After that, a fit note may be needed if the person remains unwell or their health affects their ability to work. NHS guidance explains that a fit note may be needed if someone is off sick for more than seven days.

A fit note can say that someone is either:

• not fit for work, or
• may be fit for work with adjustments

The “may be fit for work” option can be useful when someone might manage some work with changes, such as reduced hours, amended duties, working from home, avoiding certain tasks, or a phased return.

The aim of a fit note is not only to sign someone off. It can also support a safe and realistic return to work.

Can a private GP issue a fit note?

Yes, a private GP can consider issuing a fit note, but only after a clinical assessment.

A fit note should reflect the GP’s assessment of how the patient’s health condition affects their fitness for work. It cannot be issued just because an employer has asked for one or because a patient wants time off.

GOV.UK guidance for patients explains that a fit note can be issued after a health and work assessment by a healthcare professional responsible for the patient’s care plan. It also states that a healthcare professional cannot give a fit note for non-medical problems, such as problems at home or relationship trouble at work.

This distinction matters.

Work stress, family pressure or difficult circumstances may contribute to illness, but the fit note needs to relate to a health condition and how that condition affects work.

Common reasons for fit notes

Patients may request fit notes for a range of health problems, including:

• anxiety
• depression
• stress-related illness
• panic symptoms
• bereavement-related symptoms
• musculoskeletal pain
• migraine
• infections
• recovery after surgery or hospital care
• pregnancy-related illness
• flare-ups of long-term conditions
• fatigue or dizziness needing further assessment

The GP will usually ask about symptoms, duration, severity, work role, risk, treatment, support, and whether adjustments might help.

Can a fit note be backdated?

Sometimes, but this needs care.

A fit note can sometimes cover a period before the date it is issued, but the GP must have a clinically reasonable basis for doing so. This may include previous medical records, hospital letters, assessment history, or a clear clinical picture discussed during the consultation.

If the GP did not assess the patient at the time, and there is limited evidence, the wording may need to reflect that limitation.

For example, a GP may be able to say that the patient reports symptoms started on a particular date, but they may not be able to independently verify the exact severity or cause of symptoms during that earlier period.

This is especially important for university appeals, missed exams, work absence, insurance claims and cancellation letters.

Letters for work and HR

Work-related letter requests are common.

Patients may ask for a letter about stress, anxiety, depression, pain, fatigue, migraine, sleep problems, pregnancy-related symptoms, or recovery after illness.

A GP can describe relevant medical issues and how they appear to affect the patient. A GP may also suggest that an employer considers adjustments, such as reduced hours, amended duties, remote work, avoiding certain triggers, or a phased return.

However, there are limits.

A GP letter is not the same as an occupational health report. Occupational health clinicians are better placed to assess specific workplace risks, job demands, long-term capability, legal duties and detailed workplace adjustments.

For complex workplace issues, a GP may recommend occupational health input.

University and examination letters

Students often need medical evidence for missed exams, extensions, mitigating circumstances, fitness to study, or support arrangements.

A GP can write a factual letter based on the consultation and available evidence. This may include symptoms reported, the timing of symptoms, whether they are likely to have affected concentration, attendance, sleep, functioning or examination performance, and what support or treatment was discussed.

But universities and examination boards make their own decisions.

A GP cannot guarantee that an appeal will be accepted. A letter is medical evidence, not a decision.

If the GP is assessing the student after the event, the letter should usually make that clear.

Travel, airline and insurance letters

Travel letters may be needed for medication, medical equipment, recent illness, cancellation, fitness to travel, or insurance.

A GP may be able to help where the request is within the scope of a remote GP assessment and enough evidence is available.

Examples include:

• a factual medication letter
• a summary of a recent consultation
• confirmation of a reported or evidenced condition
• advice that the patient has been assessed remotely
• a letter explaining why symptoms may have affected travel plans

Some forms are more complicated. Airline MEDIF forms, detailed fitness-to-fly certificates, occupational diving forms, extreme sports forms, and specialist medical clearance documents may require in-person examination, specialist assessment, or access to detailed records.

In those cases, a remote private GP may not be the right service.

What evidence helps?

The more relevant information the GP has, the more useful the assessment is likely to be.

Helpful evidence may include:

• NHS Summary Care Record
• hospital letters
• clinic letters
• medication list
• prescription records
• previous fit notes
• blood test results
• imaging reports
• discharge summaries
• university or employer forms
• airline or insurer requirements
• photographs, where relevant for visible symptoms
• details of the job role, exam date or travel date

Not every request needs all of this. But if the letter needs to comment on a diagnosis, medication, previous illness, or a past event, evidence is often important.

A GP can still assess a patient without full records, but the letter may need to state the limitations.

Why wording matters

Patients sometimes feel disappointed when a GP letter includes cautious wording.

But careful wording protects everyone.

It protects the patient because the letter is more likely to be seen as credible. It protects the doctor because the statement is accurate. It protects the receiving organisation because they can understand what has and has not been medically verified.

For example, there is a major difference between:

“This patient was unable to sit their examination.”

and:

“The patient reports that these symptoms affected their ability to sit their examination. I assessed them after the event, and this letter is based on the history provided during consultation.”

The second version may feel more cautious, but it is usually more professionally appropriate if the GP did not assess the patient on the exam day.

A responsible GP letter should not overstate certainty.

When AccessGP may not be able to help

AccessGP may not be suitable for every letter request.

We may not be able to help if:

• the request is for a child, as AccessGP is an adult-only service
• the situation is an emergency
• the form requires in-person examination
• the request requires specialist certification
• there is not enough evidence to support the statement requested
• the request is mainly legal, occupational or administrative rather than medical
• the patient wants wording that the GP cannot verify
• the request involves controlled drug prescribing or specialist medication outside our scope
• the receiving organisation requires a specific doctor or NHS GP to complete the form

This does not mean the concern is unimportant. It simply means that a different route may be safer or more appropriate.

Before booking: check what you actually need

Before booking a GP appointment for a letter or fit note, it is worth checking exactly what the receiving organisation requires.

Ask:

• Do they need a fit note, or would a factual GP letter be enough?
• Do they have a specific form?
• Does the form require an in-person examination?
• Does it need to be completed by your NHS GP or specialist?
• What dates need to be covered?
• What decision are they making with the evidence?
• Do they need diagnosis, symptoms, functional impact, medication, or treatment details?

This helps the consultation progress in a detailed and smooth manner.

Doing things properly

Private GP letters and fit notes can be very useful when they are done properly.

A GP can often provide factual medical evidence, explain symptoms and functional impact, issue a fit note where clinically appropriate, or support a patient with a clear medical summary.

But a GP cannot guarantee outcomes, write misleading statements, verify events they did not assess, or complete forms that require specialist or in-person assessment.

The best medical letters are clear, honest and clinically appropriate.

That is how AccessGP approaches them.

Need a private GP letter or fit note?

AccessGP offers online private GP appointments for adults in England.

We can assess your situation and consider whether a GP letter, fit note, referral or other support is clinically appropriate.

• ✓ Private online GP consultations
• ✓ Fit notes where clinically appropriate
• ✓ Medical letters where appropriate
• ✓ Same-day appointments available
• ✓ CQC-registered service
• ✓ GMC-registered UK-based GPs

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Key sources: NHS UK, Getting a fit note; GOV.UK, The fit note: guidance for patients and employees; GOV.UK, Fit note guidance for healthcare professionals; GOV.UK, Fit note guidance for employers and line managers; AccessGP Knowledge Base.