What to Do If an Employee Goes Off Sick Long Term: A Guide for UK Employers

Long-term sickness absence is one of the most difficult situations a small employer faces. You need the work done. You may have already covered the absence for weeks. But the law does not allow you to simply dismiss someone because they are ill. This guide tells you exactly what to do, in the right order and when dismissal becomes an option.

What long-term sickness absence means legally

There is no legal definition of long-term sickness, but in practice most employment advisers treat four weeks or more of continuous absence as the point at which a structured management approach is required.

At this stage, the absence moves from a day-to-day management issue to a capability matter. The employee may have a condition that prevents them from doing their job. Your job is to find out the full picture, consider what support or adjustments are possible and make a decision based on the evidence - not on frustration or operational pressure alone.

Step one: maintain contact and request medical evidence

From the first week of absence, maintain reasonable contact. A weekly or fortnightly check-in call is appropriate. Keep a record of every contact - date, who spoke, what was said, what the expected return date was.

Once the absence reaches four weeks, request written medical evidence. This usually means asking the employee to consent to an occupational health referral or a report from their GP. You cannot force them to consent, but you can explain that you need medical information to make informed decisions and that a refusal to engage with the process is itself something you will have to take into account.

The medical report should tell you the nature of the condition, how long it is likely to last, whether the employee is likely to be able to return to their role and whether any adjustments could facilitate an earlier return.

Step two: consider reasonable adjustments

If the medical evidence suggests the employee could return with some adjustments - reduced hours, lighter duties, a phased return - you must genuinely consider these before taking any further action.

For small businesses, this does not mean you must agree to every request. It means you must consider what is reasonable given your size, your resources and the nature of the role. A one-person trade business cannot always absorb a six-month phased return. Document your consideration of adjustments, even if you conclude they are not practicable.

If the underlying condition may amount to a disability under the Equality Act 2010, the duty to make reasonable adjustments is a legal obligation, not a choice.

Step three: hold a formal absence review meeting

Once you have medical evidence and have considered adjustments, hold a formal meeting with the employee. This is not a disciplinary meeting - the employee has not done anything wrong. It is a capability meeting to discuss the medical position, the impact of the absence on the business and the options available.

The employee has the right to be accompanied by a trade union representative or a work colleague. Tell them this in the written invitation.

At the meeting, discuss the prognosis, whether a return is realistic and if so when, what adjustments have been considered and why and what the business impact of the continuing absence is. Listen to the employee's perspective.

Step four: make a decision

After the meeting, you have several options. If the employee is likely to return within a reasonable timeframe and adjustments are possible, agree a return plan and review it. If the prognosis is uncertain or the absence is likely to continue indefinitely, you may need to consider capability dismissal.

A capability dismissal on grounds of ill health is a potentially fair reason for dismissal under UK employment law. However, it requires a fair process - the steps above - and a genuine conclusion that the employment relationship can no longer continue. Tribunals look at whether you acted reasonably, whether you obtained medical evidence, whether you considered adjustments and whether you gave the employee the opportunity to respond.

Confirm your decision in writing. Include the right of appeal.

Statutory Sick Pay: what you must pay

SSP is currently £116.75 per week and is payable for up to 28 weeks. After 28 weeks, SSP ends. Your contract may provide enhanced sick pay - check your terms. Once SSP ends and the employee remains absent, your contractual obligation to pay stops, subject to any enhanced terms you have agreed.

What changes from January 2027

How Birchlow helps

Birchlow generates the letters you need to manage long-term sickness absence correctly - the formal absence review invitation, the outcome letter and the capability dismissal letter if required - all updated to reflect current employment law. The platform also logs your contact record and meeting notes so your process is fully documented if a claim is made.