On 20 May 2026, the Department for Work and Pensions and the Department of Health and Social Care announced four England pilots to test a replacement for parts of the current fit note process. From July 2026, the trials will run through existing NHS WorkWell sites and selected major employers, covering up to 100,000 appointments over as much as a year. The stated aim is to move away from a narrow sign-off model and towards personalised stay-in-work and return-to-work plans, with ministers intending to use the findings to inform later legislation. (gov.uk)
The case for intervention is now well established in government documents. The 20 May press release said around 11 million fit notes are issued each year, with more than nine in ten recording a worker as not fit for work. Sir Charlie Mayfield’s Keep Britain Working final report said the system is not working as intended, partly because clinicians are being asked to judge work capacity without enough occupational health time or support, and partly because the note can become a barrier between employer and employee rather than a route to early assistance. (gov.uk)
The evidence base published by DWP and DHSC on 21 May 2026 adds more detail. In the Fit Note Reform: Call for Evidence – Results report, only 29% of respondents from primary care said issuing fit notes was a good use of GP time. The same report found that 66% of employers considered the current process ineffective or very ineffective at meeting employer needs. The report drew on 1,959 responses, which gives ministers a broader evidence base than the press release alone and helps explain why the reform is being framed as both an NHS workload issue and an employment policy issue. (assets.publishing.service.gov.uk)
The pilot design is deliberately varied. In Birmingham and Solihull, and in Coventry and Warwickshire, GPs will still issue an initial fit note where needed before patients are referred on for support. In Cornwall and the Isles of Scilly, and in Lancashire and South Cumbria, patients will instead be referred directly into support without a GP issuing the first note. Some sites will rely mainly on non-clinical staff such as social prescribers and work and health coaches, while others will use mixed clinical and non-clinical teams. That structure should allow officials to compare whether a GP-first route or a service-led route produces better results for recovery, retention and practice workload. (gov.uk)
The wider delivery vehicle is WorkWell, which the government is now expanding across England. According to the official WorkWell prospectus, the service offers voluntary, person-centred support for people with a disability or health condition who are in work or could move into work with the right help. The expansion is backed by up to £259 million over three years and could support up to 250,000 people. Support varies by area but can include physiotherapy, mental health help, workplace adjustment advice, employer liaison, and links into debt, housing and other local services. In policy terms, the fit note pilots sit inside a much larger attempt to join up NHS care, local government provision and employment support earlier in an absence. (gov.uk)
For employers, the practical significance is immediate. The departments said the new plans will support three-way conversations between the worker, the employer and trained staff from the first day of absence, including discussion of reasonable adjustments and safe routes back to work. Patients in the pilots will also be able to use the new stay-in-work and return-to-work plans for Statutory Sick Pay purposes. That matters because Statutory Sick Pay rules changed on 6 April 2026: eligible employees can now receive SSP from the first full day of sickness absence, and the government says the reform will add around £400 million a year in sick pay. The pilots therefore sit alongside a legal framework that already expects earlier income protection and earlier case management. (gov.uk)
For general practice and other clinicians, the government is testing whether administrative work can be shifted without weakening clinical safeguards. The BMA said it supports testing different models if they reduce unnecessary GP appointments and improve patient support, but it also warned that any new process must be backed by occupational health input, training, clinical oversight and clear governance. The Royal College of GPs took a similar position, saying reform must be evidence-based, properly resourced and must not add further pressure to general practice. Those cautions are likely to carry weight, because the government’s own report shows support for the current process is weakest in primary care. (gov.uk)
What happens next is clearer than the final destination. The original call for evidence was launched in April 2024, ran for 12 weeks and closed on 8 July 2024; the results were then published on 21 May 2026. Ministers have said the first phase of reform is focused on people already in work, while officials continue to examine how any permanent changes would interact with the benefits system and support for people out of work. The government has also said that workers who genuinely need time away from work will still be able to take it. The pilots should therefore be read as an evidence-gathering stage before legislation, not as a settled redesign of sickness certification. (gov.uk)