The Department for Work and Pensions and the Department of Health and Social Care have set out the first stage of a fit note overhaul in England, with four pilots intended to replace a largely administrative process with more structured work and health support. The government says the present model produces around 11 million fit notes a year and that more than 90 per cent record a person as not fit for work, often without any wider plan for staying in employment or returning safely. Under the published approach, patients, employers and clinicians would move towards personalised stay in work and return to work plans. Work and Pensions Secretary Pat McFadden said the aim is to replace a paper-based dead end with a system that helps people recover and stay connected to work. Care Minister Stephen Kinnock said the pilots should also reduce avoidable GP administration and fit with the government’s 10 Year Health Plan.
The pilots are due to run for up to a year and cover as many as 100,000 appointments, with continuous testing built into delivery. According to the government announcement, some patients will still receive an initial fit note from a GP before being referred on, while others will be routed directly to a separate service staffed by clinical and non-clinical practitioners. That service is expected to handle discussions about reasonable adjustments, workplace contact and recovery planning from the first day of absence. The practical change is that responsibility for work-related planning would no longer sit solely with general practice, and employers would be drawn into earlier conversations about what can be done to keep someone in work where it is safe to do so.
The evidence published alongside the announcement explains why ministers are testing the model before legislating. The Fit Note Reform Call for Evidence found that only 29 per cent of primary care staff regard issuing fit notes as a good use of GP time, while 60 per cent of employers said the current process does not meet their work and health needs. The government has also relied on Sir Charlie Mayfield’s Keep Britain Working Review, which recommended trials of a new approach and said the current system was failing to operate as intended. Taken together, those findings give officials a case for reform, but they also point to a familiar difficulty in work and health policy: reducing GP workload without creating a new service that is harder for patients to use.
Each pilot area will test a different referral route through existing WorkWell sites. In Birmingham and Solihull, and in Coventry and Warwickshire, GPs will continue to issue the first fit note where needed before patients move into a support service. The difference between those two areas is staffing: Birmingham and Solihull will lean mainly on non-clinical roles such as social prescribers and work and health coaches, while Coventry and Warwickshire will use a mixed team of clinical and non-clinical staff. Cornwall and the Isles of Scilly, and Lancashire and South Cumbria, will test the more substantial departure from current practice. In those areas, patients can be referred straight to a support service without a GP first issuing a fit note. Cornwall will use a mainly non-clinical model, while Lancashire and South Cumbria will use a mixed workforce. The comparison between the four sites should give ministers evidence on whether clinical input at the point of referral changes results or simply adds delay.
Professional bodies have responded with cautious support rather than open-ended endorsement. The British Medical Association said it had helped shape the pilots with the DWP and wants the testing to reduce unnecessary GP appointments while improving support for patients. The Royal College of GPs made a similar point, stating that fit notes can consume substantial administrative time but that any new process must be properly resourced and must not shift extra pressure back onto general practice. That emphasis on governance is notable. The BMA said the pilots will need appropriate training, clinical oversight and clear lines of responsibility. The Royal College of Occupational Therapists and the Society of Occupational Medicine welcomed the chance to bring wider work-focused expertise into the process, but both organisations are looking for the same safeguard: a model that helps people stay in or return to work without weakening clinical protections.
Patient and employer groups broadly backed the direction of travel, although their priorities are not identical. National Voices said patients must be involved in testing so that the scheme does not create unintended barriers for people whose health genuinely prevents work. The Confederation of British Industry said employers want a system that gives more confidence that absence advice is justified and tied to practical interventions rather than simple certification. The National Academy for Social Prescribing supported the use of link workers, arguing that issues such as debt, housing difficulty and isolation can sit behind sickness absence and need non-medical support. Those differences in emphasis explain why the government is presenting the pilots as evidence gathering rather than immediate nationwide reform. For employees, the central question is whether a new plan-based system offers better support without pressure to return before they are well. For employers, the question is whether early contact and reasonable adjustments can reduce avoidable absence. For general practice, the question is whether administrative demand genuinely falls.
The pilots sit inside a wider WorkWell expansion. The government said the NHS-based programme will be rolled out nationally to support up to 250,000 people with a disability or health condition to enter work or remain in it, linking NHS services with councils and community provision. It also confirmed regional maximum allocations of £24.2 million for the East of England, £40.3 million for London, £47.1 million for the Midlands, £36.3 million for the North East and Yorkshire, £35.4 million for the North West, £30.5 million for the South East and £21.6 million for the South West. Ministers are also tying fit note reform to a broader employment support package valued at £3.5 billion. The same statement points to recent benefit rule changes intended to let people try work without immediate reassessment, the redeployment of 1,000 Pathways to Work advisers, and Statutory Sick Pay reform that will provide support from the first day of sickness absence. The government says those SSP changes will put an extra £400 million a year into workers’ pockets, and that the new stay in work and return to work plans will be usable for Statutory Sick Pay purposes.
What follows next is as important as the launch itself. The four NHS pilots are due to begin from July, with findings to be shaped by feedback from patients, healthcare staff and employers before ministers bring forward legislation. Separate work with Keep Britain Working Vanguard employers, including EDF Energy, is intended to test what role large employers can play in preventing absence and supporting safe returns. The initial phase is focused on people already in work, while the government continues to examine how any future fit note reform would interact with the benefits system and support people who are out of work. If the pilots succeed, the fit note may move from being mainly a form signed in general practice to part of a wider work and health service delivered by multidisciplinary teams. If they do not, the published evidence will still matter, because it will show whether the main weakness sits with the certificate itself, the lack of occupational health support around it, or the way sickness absence is handled across the NHS, employers and the welfare system.