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Managing long-term sickness absence guide

This HR Guide provides a clear, consistent approach to managing long-term sickness absence so teams stay productive and supported.

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    What is long-term sickness absence?

    Long-term sickness absence typically refers to continuous absence lasting four weeks or more.

    These absences are often linked to more serious health conditions and require a sensitive, well-documented process.

    Long-term absence can involve:

    • Recovery from serious illness or injury
    • Mental health conditions
    • Chronic or fluctuating health conditions
    • Post-surgery recovery times
    • Conditions potentially covered under the Equality Act 2010

    • Why it matters

      • Long-term absence can significantly impact productivity, workload and team morale, particularly in SMEs with limited cover.
      • Regular, supportive contact promotes wellbeing and helps maintain trust and communication.
      • Employers have legal responsibilities to consider reasonable adjustments and follow a fair procedure.
      • Clear documentation is essential to ensure compliance and reduce legal risk.

    • Common causes of long-term absence

      • Serious physical injuries
      • Mental health conditions such as stress, anxiety, depression
      • Chronic illnesses (e.g. arthritis, MS, diabetes)
      • Cancer diagnosis or treatment recovery
      • Post-operative recovery
      • Pregnancy-related illness

    • Signs and indicators to watch for

      Early indicators that long-term absence may occur include:

      • Repeated absences linked to the same condition
      • Fit Notes suggesting extended or uncertain recovery periods
      • An employee raising concerns about workload or wellbeing
      • Noticeable decline in engagement or performance
      • Difficulties maintaining contact

      Identifying early signs helps you intervene appropriately and supportively.

    Managing long-term absence

    • Maintain Supportive Contact

      • Agree how and when you will stay in touch.
      • Keep conversations supportive, not pressurising.
      • Provide workplace updates when needed.
      • Record all contact to ensure consistency and fairness.

    • Request Medical Evidence

      • For absences over seven days, Fit Notes are required.
      • If recovery is unclear or prolonged, seek medical guidance via Occupational Health.

    • Use Occupational Health (OH)

      OH can advise on:

      • Fitness to work
      • Possible return date
      • Restrictions or adjustments
      • Equality Act considerations
      • Capability options

      Managers should review and act on OH recommendations where reasonable and practical.

    • Hold regular review meetings

      Meetings help:

      • Understand the employee’s current health position
      • Discuss likely return dates
      • Explore adjustments
      • Review medical evidence
      • Clarify pay (SSP or company sick pay)
      • Keep communication fair and consistent

      Record each review meeting and share a summary with the employee.

    • Reasonable adjustments

      Employers have a duty to consider reasonable adjustments under the Equality Act.

      Examples include:

      • Reduced hours or amended duties
      • Phased return to work
      • Temporary redeployment
      • Adjusted targets or workload
      • Assistive equipment or workplace adaptations
      • Reasonable adjustments should be documented with review dates.

    • Return-to-work planning

      Once the employee is fit to return, managers should:

      • Review OH or GP advice
      • Agree a phased return plan if needed
      • Adjust duties temporarily
      • Set review checkpoints
      • Monitor progress and provide support

      A clear plan helps employees reintegrate safely and confidently.

    Managing Long-Term Sickness Absence

    When a return is not possible

    If medical evidence shows the employee is unlikely to return – even with adjustments, employers may need to start a medical capability process.

    This requires:

    • Current medical evidence
    • Demonstration that adjustments have been explored
    • Consideration of redeployment
    • A fair, well-structured meeting process
    • Clear documentation
    • Opportunity for the employee to respond

    Dismissals must only occur after a fair process and with clear evidence.

    Your Questions Answered

    Everything you need to know about managing long term absence

    • What counts as long-term sickness absence?Reveal

      Long-term sickness absence usually refers to continuous absence lasting four weeks or more, often linked to more serious or chronic health conditions.

    • Why is long-term absence more challenging for SMEs?Reveal

      For smaller organisations, a prolonged absence can place significant pressure on operations, productivity and team morale. SMEs often lack internal HR support, making documentation, contact management and adjustments more complex.

    • When should employers involve Occupational Health?Reveal

      OH should be considered when:

      • A Fit Note indicates an extended or uncertain recovery
      • The condition may be covered by the Equality Act 2010
      • Managers need clinical guidance on adjustments or capability
      • A return-to-work date is unclear

      OH helps employers make fair and legally defensible decisions.

    • How often should employers stay in contact during long-term absence?Reveal

      Regular, agreed contact (e.g., weekly or fortnightly) is recommended. Communication should remain supportive, not pressurising. All contact should be recorded for fairness and consistency.

    • What medical evidence can employers request?Reveal

      After seven days, Fit Notes are required.

      Employers may also seek consent to gather medical reports or refer to OH if recovery is unclear, prolonged or linked to a complex condition.

    • What counts as a reasonable adjustment?Reveal

      Examples include:

      • Phased return to work
      • Reduced hours or temporary job redesign
      • Adjusted duties or workload
      • Assistive equipment
      • Redeployment to a suitable alternative role

      Employers must document adjustments, review them regularly and consider Equality Act requirements.

    • How should review meetings be managed?Reveal

      Review meetings should cover:

      • Current health status and recovery progress
      • Updated medical evidence
      • Likely return-to-work timescales
      • Required adjustments
      • Pay and sick pay status

      A short written summary should be shared with the employee after each meeting.

    • What happens if an employee cannot return to work?Reveal

      If medical evidence indicates the employee cannot return—even with adjustments—the employer may need to begin a fair capability process. This must include:

      • Up-to-date medical evidence
      • Evidence of all adjustments considered
      • Redeployment options explored
      • A structured meeting process
      • The opportunity for the employee to respond

      Dismissal is always a last resort and must be well-documented.

    • Does long-term absence automatically count as a disability?Reveal

      Not always. A condition may fall under the Equality Act 2010 if it has a long-term, substantial impact on day-to-day activities. Where potentially relevant, employers must apply the Act’s duty to consider reasonable adjustments.

    • Can employers ask for an employee’s return-to-work date?Reveal

      Yes—politely and professionally. Clarity helps with planning, but timelines must be guided by medical advice rather than pressure from management. Return dates may change as recovery develops.

    Where to find out more A collection of hand-picked useful resources for manging long-term absences from impact HR and beyond

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