Managing long-term sickness absence in the United Kingdom
Reviewed by Mellow Editorial Team, HR & payroll content team
Long-term sickness absence — usually defined as a continuous absence lasting four weeks or more — requires a structured, consistent approach from employers. Handled well, it protects the employee, limits business disruption and reduces the risk of an employment tribunal claim.
What counts as long-term sickness absence
Most HR professionals treat four or more consecutive weeks off work as the threshold where short-term absence management gives way to a more formal, supportive process. At this point the absence is likely to involve an underlying health condition, and your obligations as an employer become more involved.
From this stage you need to think about Statutory Sick Pay eligibility, fit note evidence, potential reasonable adjustments under the Equality Act 2010, and — eventually — a structured return-to-work plan or capability process.
Statutory Sick Pay and fit notes
Statutory Sick Pay (SSP) is payable to eligible employees from day four of sickness absence. The employee must earn at least the lower earnings limit and must have notified you within your stated deadline. SSP continues for up to 28 weeks; after that the employee moves onto state benefits and your SSP liability ends.
From the eighth day of absence, you are entitled to request medical evidence. In practice, this means a fit note (formerly the sick note) issued by a GP or other authorised clinician. A fit note may state the employee is "not fit for work" or "may be fit for work" with suggested adjustments such as reduced hours, amended duties or a phased return. You are not obliged to implement every suggestion, but you must genuinely consider them. If you cannot accommodate the adjustments, the employee remains off sick.
Keep a clear record of every fit note received, noting the dates covered and any recommendations made.
Your duty to consider reasonable adjustments
Where a long-term condition amounts to a disability under the Equality Act 2010 — broadly, a physical or mental impairment that has a substantial and long-term adverse effect on normal day-to-day activities — you have a legal duty to make reasonable adjustments. This is not optional.
What is "reasonable" depends on factors including cost, practicality and the size of your organisation. Examples include:
- A phased return to full hours over several weeks
- Temporary redeployment to a less demanding role
- Amended start and finish times
- Regular check-in calls rather than daily attendance monitoring
- Modifications to workspace or equipment
You do not need to know with certainty that a condition is a legal disability before making adjustments. If there is a reasonable possibility that it qualifies, treat it as though it does. This is both good practice and the safer legal position.
The Employment Rights Act 2025 has strengthened day-one employment rights, so ensure you are not applying qualifying-period assumptions to protections that now attach from the first day of employment.
Staying in touch without putting pressure on the employee
Maintaining reasonable contact during long-term absence is important. It keeps the employee connected, helps you plan operationally and — if the matter later reaches a capability or dismissal process — demonstrates that you acted fairly.
"Keeping in touch" does not mean weekly calls to ask when someone is returning. Agree a contact method and frequency with the employee early on, and respect it. Email often works better than phone calls for people who are seriously unwell. Be clear that contact is for welfare purposes, not performance management.
Consider an Occupational Health (OH) referral once an absence passes the four-week mark. An OH report gives you an independent clinical view of the employee's prognosis, likely return date and any adjustments that would help. It also strengthens your position if capability proceedings become necessary, because it shows you took informed, evidence-based steps rather than acting on assumption.
Moving to a capability process
If an employee has been absent for a sustained period, medical evidence suggests no imminent return and you have genuinely explored alternatives, you may reach the point where you need to consider whether the employment relationship can continue.
A fair capability process in these circumstances typically involves:
1. Seeking up-to-date medical evidence, usually via OH
2. Meeting with the employee (with the right to be accompanied) to discuss the medical position and any remaining options
3. Giving the employee a meaningful opportunity to respond
4. Considering alternatives to dismissal — redeployment, reduced hours, ill-health retirement where applicable
5. If dismissal is the outcome, giving full notice pay and a right of appeal
Dismissal for long-term sickness absence can be fair, but only where a reasonable investigation has been carried out, all alternatives have been considered and the procedure followed is consistent and documented. Skipping steps — especially the genuine exploration of adjustments and redeployment — is the most common reason these cases fail at tribunal.
Accurate payroll records throughout the absence are equally important. Knowing precisely what SSP has been paid, when it expires and what contractual sick pay (if any) applies prevents costly errors and disputes down the line. If you manage payroll across multiple employee types, how Mellow runs payroll across six countries shows how a consistent process helps regardless of employment arrangement.
This article provides general information only and does not constitute legal advice. Employment law is fact-specific; seek qualified legal advice for your particular situation.
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