Managing Long-Term Sickness Absence: UK Employer Guide

Last updated: April 2026. This guide reflects the Employment Rights Act 2025 changes now in force, including SSP from day one.

Long-term sickness absence is one of the most difficult situations UK employers face. You want to support a genuinely unwell employee. You also need the work done. And if you get the process wrong, you face unfair dismissal claims, disability discrimination claims, or both.

There is no single law that tells you exactly how long an employee can be off sick before you can act. Instead, you need to follow a fair process that balances the employee's rights against your legitimate business needs. This guide walks you through exactly how to do that.

Long-Term Sickness Absence Management: UK Employer Obligations

When an employee is off sick for an extended period, you have legal obligations under several pieces of legislation:

Statutory Sick Pay (SSP) under the Social Security Contributions and Benefits Act 1992, as amended by the Employment Rights Act 2025
Unfair dismissal protection under the Employment Rights Act 1996
Disability discrimination protection under the Equality Act 2010
The right to a fair process as set out in the ACAS Code of Practice

Getting any one of these wrong can be costly. Tribunals regularly award five-figure sums where employers have dismissed someone on ill health grounds without following a proper procedure.

What Counts as Long-Term Sickness Absence?

There is no legal definition of "long-term" sickness absence. Most employers define it as any single period of absence lasting four weeks or more.

What matters is that your sickness absence policy defines the point at which short-term absence management transitions to a long-term process. This should be clearly stated in your company handbook and applied consistently.

Common triggers for long-term sickness management include:

A single continuous absence lasting four or more weeks
A pattern of recurring absences for the same underlying condition
An absence where the employee's GP indicates a prolonged recovery period
An absence related to a condition that may qualify as a disability under the Equality Act 2010

How Long Can an Employee Be Off Sick in the UK?

This is the question every employer asks, and the honest answer is: there is no fixed legal limit.

An employee can be off sick for as long as their medical condition requires. You cannot set an arbitrary maximum and terminate employment automatically. Any such clause would be unenforceable if it led to an unfair dismissal.

What you can do is follow a fair process: keep regular contact, obtain medical evidence, consider adjustments, and only move to dismissal when you have genuinely exhausted all reasonable options.

SSP runs for up to 28 weeks. From 6 April 2026, SSP is payable from the first day of sickness absence with no waiting period and no lower earnings threshold. Once SSP is exhausted, the employee may be entitled to Employment and Support Allowance or Universal Credit. The end of SSP does not, on its own, justify dismissal. For full details, see our guide on SSP from day one.

Step-by-Step Process for Managing Long-Term Absence

1. Keep in Regular Contact

Once an employee triggers your long-term absence process, maintain regular contact. Agree a schedule that works for both sides.

Arrange a welfare call within the first two weeks
Check in fortnightly (or as agreed)
Ask how the employee prefers to be contacted
Keep the tone supportive, not interrogatory
Record what was discussed

The burden of staying in touch sits with the employer, not the employee.

2. Obtain Medical Evidence

You are entitled to seek medical information about the employee's condition, prognosis, and ability to return to work.

Fit notes from the employee's GP tell you whether they are not fit for work or may be fit with adjustments. They do not provide enough detail for long-term planning.

Occupational health referrals are the gold standard. An OH assessment covers the nature of the condition, likely recovery timeline, recommended adjustments, and whether the condition may be a disability under the Equality Act.

You need the employee's written consent before making an OH referral. Under the Access to Medical Reports Act 1988, the employee can see any report before it is sent to you.

3. Hold a Formal Absence Review Meeting

With medical evidence in hand, hold a formal meeting. This is not a disciplinary hearing. Make that distinction clear.

Cover: the current medical position, whether and when the employee expects to return, adjustments that could help, the impact on the team, available support (phased return, redeployment, Employee Assistance Programme), and next steps.

The employee has the right to be accompanied by a colleague or trade union representative.

4. Consider Reasonable Adjustments

If the condition amounts to a disability under the Equality Act 2010 (a physical or mental impairment with a substantial and long-term adverse effect on day-to-day activities), you have a legal duty to make reasonable adjustments.

Options include:

A phased return with reduced hours
Amended duties avoiding tasks the employee cannot perform
Changed working hours or shift patterns
Working from home (temporarily or permanently)
Redeployment to a suitable alternative role
Provision of specialist equipment
Extended time off beyond your normal policy

What counts as "reasonable" depends on your organisation's size, the cost, and the likely effectiveness. A large employer is expected to do more than a small one.

Failure to make reasonable adjustments is a standalone form of disability discrimination, even if you have not dismissed the employee.

5. Consider Alternative Roles

Before moving to dismissal, consider whether there are suitable alternative roles. You are not required to create a role that does not exist, but if a vacancy exists, you should offer it.

6. Make a Decision

After the steps above, you are in one of three positions:

Return possible: Agree a return-to-work plan and implement it.
Return possible but not yet: Set a further review date. Do not postpone indefinitely.
Return not possible in a reasonable timeframe: You may now consider dismissal on ill health grounds.

Fit for Work Assessments: What Employers Need to Know

A fit for work assessment evaluates whether an employee can perform their job, with or without adjustments. This is carried out by an occupational health professional, not the employee's own GP.

When to request one: before a return after extended absence, when fit notes are vague, when you need specific guidance on adjustments, or when considering ill health dismissal.

What you can ask: whether the employee is fit for their role, when they might be, what adjustments would help, whether the condition is likely to be a disability, and whether any duties should be avoided.

What you cannot do: access full medical records without consent, override medical advice, or treat the employee less favourably based on information from the assessment.

If the employee refuses OH, you can proceed on the evidence available, but warn them in writing first.

Dismissal on Grounds of Ill Health in the UK

Ill health capability is a potentially fair reason for dismissal under section 98 of the Employment Rights Act 1996. A tribunal will assess whether you acted reasonably.

To defend a claim, you need to show:

You followed a fair process. Regular contact, medical evidence, formal meetings, genuine effort to find alternatives.
You obtained up-to-date medical evidence. A stale OH report will not suffice.
You considered reasonable adjustments. Especially if the condition is or could be a disability.
You considered alternative employment. Show you looked, even if nothing was available.
You gave the employee the opportunity to respond before any decision.
The decision maker genuinely weighed the evidence. No rubber-stamping.
You offered a right of appeal.

Notice period: The employee is entitled to their full contractual or statutory notice, whichever is longer. If you have a permanent health insurance scheme, check that dismissal does not cut off the employee's benefits. This is a common and expensive mistake.

For more on fair dismissal procedures, see our disciplinary procedure employer guide.

The Disability Discrimination Risk

The Equality Act 2010 is the biggest legal risk in long-term sickness cases.

You do not need a formal diagnosis to have a duty. If you know or ought to know an employee has a disability, the duty applies.
Mental health conditions count. Depression, anxiety, and PTSD can all qualify.
Cancer, HIV, and MS are automatically disabilities from diagnosis.
Fluctuating conditions can still be disabilities if they are likely to recur.

Disability discrimination claims have no compensation cap. The potential exposure is significantly higher than unfair dismissal alone.

SSP and Long-Term Absence: The April 2026 Changes

From 6 April 2026, the Employment Rights Act 2025 removed both the three-day waiting period and the lower earnings threshold for SSP:

SSP is payable from day one of qualifying sickness absence
Workers earning below £125 per week are now covered
SSP still runs for a maximum of 28 weeks

For employers managing long-term absence, your payroll costs are slightly higher because SSP starts from day one rather than day four. Update your absence policy to reflect this. See our full guide: SSP from day one in 2026.

Common Mistakes to Avoid

Treating the end of SSP as an automatic dismissal trigger. It is not. You still need a fair process.
Relying solely on fit notes. Tribunals expect specialist OH advice in long-term cases.
Skipping steps because absence is disruptive. Cutting corners is the top reason employers lose at tribunal.
Ignoring the disability question. If you do not ask, and the condition turns out to be a disability, the tribunal will not be sympathetic.
Failing to document everything. If it is not written down, it did not happen.

Sickness Absence Policy Checklist

Your policy should cover:

[ ] Definition of short-term vs long-term absence
[ ] Notification requirements (who to call, by when)
[ ] Fit note requirements
[ ] Your right to request an occupational health referral
[ ] How SSP is paid (from day one, rates, 28-week duration)
[ ] Any company sick pay above SSP
[ ] The process for absence review meetings
[ ] The employee's right to be accompanied
[ ] How reasonable adjustments will be considered
[ ] Circumstances in which dismissal may be considered
[ ] The right of appeal

Is your sickness absence policy up to date for ERA 2025 changes? The EmployerKit Audit checks your documents and flags exactly what needs updating. From £49. Visit employerkit.com/tools/employerkit-audit.

Frequently Asked Questions

Q: How long can an employee be off sick before I can dismiss them?

A: There is no fixed legal limit. What matters is whether you followed a fair process: regular contact, medical evidence, consideration of adjustments, and exploration of alternatives. Tribunals assess the overall reasonableness of your actions, not the calendar. Most employers begin formal long-term absence management after four consecutive weeks.

Q: Do I have to hold someone's job open indefinitely?

A: No. You are entitled to weigh the employee's situation against the impact on your business. But you must show you gave a reasonable opportunity to recover, sought proper medical advice, and considered all alternatives before dismissing.

Q: What if an employee refuses to attend occupational health?

A: Explain in writing why the referral matters and what happens if they decline. If they still refuse, you can make decisions based on the evidence you have. Warn them of this first. A refusal to engage with OH can weaken the employee's position at tribunal, but does not remove your obligation to act fairly.

Q: Can I contact an employee while they are off sick?

A: Yes, and you should. ACAS recommends maintaining reasonable contact during absence. Agree a schedule the employee is comfortable with, keep the tone supportive, and avoid anything that could be seen as pressure to return early.

Q: Is long-term sickness always a disability under the Equality Act?

A: Not always, but it often is. A condition qualifies if it has a substantial and long-term (12 months or more, or likely to recur) adverse effect on day-to-day activities. If there is any doubt, get occupational health advice and treat the condition as a potential disability until you know otherwise.

Q: What is the difference between a capability dismissal and a conduct dismissal?

A: Capability relates to the employee's ability to do the job, including ill health. Conduct relates to behaviour. Long-term sickness is a capability issue. Never treat sickness absence as misconduct unless it involves dishonesty. For guidance on conduct issues, see our disciplinary procedure guide.