The 2023 Guide to Fit-to-Fly Certificates

In the last 20 years, the number of global flights has been increasing steadily, reaching 38.9 million in 2019, with 4.4 billion people taking air trips in 2018. In 2020, courtesy of the COVID-19 pandemic, the number of flights dropped to 16.4 million.

But by 2022, despite the war in Ukraine and the Omicron variant of COVID-19, travel had bounced back – in Europe alone, 2 billion passengers took 9.3 million flights, back to 83% of pre-pandemic levels. And it’s forecast that in 2023 there will be 32.4 million passenger flights globally – about the same number as in 2013 but still 17% down on the pre-pandemic peak.

After almost three years of (sometimes complete) restrictions on flying, millions of Brits are desperate to get away on holiday abroad. But there are some hangover requirements relating to COVID-19 for some countries. In addition, you may sometimes require a certificate from your doctor if you have certain medical conditions. So it’s well worth knowing the regulations for the country or countries you’re planning to visit before you book.

Certificates of negative COVID-19 test

When travel first started opening up after the first wave of the pandemic, there were strict requirements for COVID-19 testing. Passengers scrambled to find providers who could offer the tests they needed to prove they were infection-free, both before leaving the country and before coming home.

By the start of 2023, only a small proportion of countries required a negative test to enter the country from the UK – and even then, many only required unvaccinated people to test. From February 2023, some of the last remaining countries removed this requirement.

But it’s not over everywhere.

You may still need to show a negative COVID-19 PCR test for some countries, such as Angola and Myanmar, if you’re not fully vaccinated. Because there are still new variants of COVID-19 appearing, the situation in some countries may still change. So it’s essential to check on the Foreign Office website before you travel for any restrictions in the country you’re visiting.

It also goes without saying that it’s not a good idea to fly if you have recently become unwell, either with COVID-19 symptoms or for another reason.

COVID-19 vaccination certificates

Once the vaccination programme was established, the focus largely moved to countries requiring proof of vaccination to enter the country.

As with proof of negative testing, many countries no longer require you to have proof of vaccination to enter. However, some still require a negative COVID-19 test if you don’t have proof that you’re fully vaccinated. What’s more, some countries only recognise certain vaccines. Again, you should check the Foreign Office website before you travel.

How do I get proof of vaccination?

If you do need proof of vaccination, you can download the NHS app, link it to your general practice and access your vaccine records on your phone or computer.

We’ll only show you quotes from providers who cover emergency medical expenses (including repatriation to the UK) if you catch the virus whilst travelling abroad.

Do I need proof I'm fit to fly if I have a medical condition?

If you have a health condition, you’ll want to ensure that you’re fit to fly before travelling abroad.

While you might feel well enough within yourself to tackle the journey, it’s always worth checking in with your doctor or nurse so that they can get a better understanding of your condition before you commit to flying. 

However, beyond a routine chat with your doctor, you might find that there are circumstances where you might need an official fit-to-fly certificate.

General restrictions on flying

There are certain long-term medical conditions that can flare up from time to time. As well as making you feel generally unwell, a flare-up of some conditions (including asthma, COPD, Crohn’s disease and ulcerative colitis) can make travelling riskier.

There are other medical conditions where the severity of symptoms varies widely. For instance, many people with Parkinson’s disease have only mild issues with mobility; and many people with multiple sclerosis feel entirely well between attacks. But others may need major modifications to their travel plans or have very limited mobility.

So if you have a long-term medical condition, you should always check with your travel agent or airline whether you’ll need a fit-to-fly certificate or medical letter confirming you’re currently fit to fly.

Time-limited restrictions on flying

There are certain situations where flying on passenger planes is not allowed. However, in most circumstances, these restrictions are:

• Time-limited (e.g. after stroke, heart attack, or surgery); or
• Dependent on the severity of your symptoms (for instance, you can usually fly if you have angina, but not if you’re getting symptoms at rest).

You can find out more details in our article on Flying with Medical Conditions.

When do you need a fit-to-fly certificate?

A fit to fly certificate is needed to be granted medical clearance by your airline. 

If your condition is stable, it’s very unlikely that you will be asked for medical clearance - but a fit-to-fly certificate may still be required if: 

• You’ve recently been discharged from the hospital
• You’re in recovery from an operation
• You’re more than 28 weeks pregnant
• You’re actually travelling for medical reasons (i.e. you’re going for some treatment)

Of course, whether you need a fit to fly certificate is at the discretion of your chosen airline, so you should always carefully check their individual guidelines to find out their specific requirements. 

Travelling with medicines or medical equipment

Travelling with medication

You’ll often need a letter from your doctor if you need to take medication abroad. In addition, some countries have restrictions on certain medicines (and even ban certain medicines, including some available in the UK without prescription, such as codeine-containing medicines).

You can find out exactly what you need to do to avoid any issues with your medication from our article on taking medication abroad.

Travelling with oxygen

One of the major issues in relation to fitness to fly is the fact that oxygen pressure in a plane is lower than on the ground. That means conditions affecting your heart and lungs, which can reduce your body's ability to carry oxygen around your body, can lead to new or worsening symptoms during flight.

In some situations, you may be able to fly if you have access to oxygen onto the plane – speak to your doctor about arranging this if needed. You will definitely need a letter from your doctor detailing:

• All your medical conditions.
• Why you need to travel with oxygen.
• That your condition is stable and that you are fit to fly with oxygen.

Remember that all airlines have different rules about travelling on a plane with oxygen: some supply it on board for free, while others charge for it. You’ll need to contact your airline well in advance to make arrangements. You’ll also need to make arrangements to access oxygen at your destination. You can find out more details in our travel guide.

Flying with a pacemaker or implantable defibrillator (ICD)

Having a pacemaker shouldn’t cause problems for travelling by air, but you will need your device identification card. It’s a sensible precaution to get a doctor’s letter, too.

Recent research suggests it’s usually safe to go through airport scanners with a pacemaker or ICD. But you can ask for a hand-held metal detector check instead – see our guide to travelling with a heart condition for more details.

Travelling with a plaster cast

Because of the risk of swelling inside a cast, many airlines choose to restrict flying during the first 24-48 hours after a cast has been fitted. If you do decide to travel before that time period has elapsed you can expect the airline to require your cast to be split along the full length. This will prevent any pressure build-up from impacting your circulation. Having a letter containing the date & time the cast was fitted will be helpful.

How much does it cost to get a fit-to-fly certificate?

This depends on how much your GP surgery charges - but typically this cost ranges from £20-£40. 

You can find a list of suggested fees from The British Medical Association if you want a more comprehensive idea of the different costs and fees you might expect.

When will my fit-to-fly certificate expire?

Again, there is no clear-cut answer to this. But at the very least, your certificate should indicate that you’re fit to fly at the exact time of your trip. 

So, if you have a letter from months ago, the likelihood is that this won’t be suitable for your airline today. 

If you have a recurring, or more permanent medical issue, you should probably speak to your doctor or specialist nurse about getting fit-to-fly certificate every time you travel - just to be on the safe side.