Broken fit note system to be overhauled 

Patients, employers and GPs are set to benefit from an overhaul of the broken fit note system following the launch of several pilots by the Government today to reform the system for workers who fall ill. 

The current system sees some 11 million fit notes issued every year, with more than nine in ten declaring the person ‘not fit for work’. 

Four pilots, in different areas, in England will look at the best way to end this tick-box exercise which does not offer any support or guidance and replace it with personalised ‘stay in work’ and ‘return to work’ plans for workers who fall ill. 

The pilots will cover up to 100,000 appointments and last up to a year, with continuous testing, in order to narrow down the most effective approach to tackling the inherited steep increase in number of fit notes issued.  

Patients will be offered either an initial fit note from a GP and then referred to community health workers – or go through the whole process without an initial fit note from a GP, and will instead be supported by a separate service staffed by clinical and non-clinical practitioners. 

They will provide a range of work and health support, including three-way conversations between patients, employers, and trained professionals – covering reasonable adjustments and keeping people connected to their workplace from the first day of absence, helping more people to stay in work with support. 

It is the first step in the Government’s ambition for radical fit note reform – with pilot findings due to be shaped by patients, healthcare staff, and employers – before the Government brings forward legislation to further reform the broken system. 

Work and Pensions Secretary, Pat McFadden, said 

Fit notes are too often a dead end – a piece of paper that tells people they can’t work but does nothing to help them get better. 

We’re changing that. By bringing employers, the NHS, and patients together we can help people recover faster, stay connected to their jobs, and get the economy firing on all cylinders. 

That’s what these pilots are about, and that’s what this Government is committed to – fixing what is broken.

The launch comes as the Government publishes the Fit Note Call for Evidence which shows just three in 10 Healthcare Professionals in Primary Care say fit notes are a good use of GPs time, while six in 10 employers think the current process is ineffective at supporting their employees’ work and health needs. 

Trials of a new approach was recommended by the former John Lewis chairman Sir Charlie Mayfield in his landmark Keep Britain Working Review into economic inactivity, which noted that the fit note system is “not working as intended” and had become a barrier to contact with employers. 

Minister of State for Care Stephen Kinnock said 

Ever since I was appointed Minister of State for Care in July 2024, NHS staff have been telling me that the current fit note system isn’t working – not for patients, and not for the clinicians who sign them off. 

These pilots mark the beginning of the end for that broken system, giving people personalised support to get back into work and freeing up GPs from unnecessary admin so they can focus on what they do best caring for their patients. 

This is what our 10 Year Health Plan is all about – earlier support, from the right people, in the right place.

From July, the NHS will test new approaches through four existing WorkWell sites, backed by £3 million in the first year. The areas will test the following models 

• Birmingham and Solihull – GPs issue the first fit note where needed, with all patients referred to a new support service led primarily by non-clinical staff, including social prescribers and work and health coaches 

• Coventry and Warwickshire – GPs issue the first fit note, with patients able to be referred to a support service made up of both clinical and non-clinical staff 

• Cornwall and the Isles of Scilly – GPs refer patients directly to a non-clinical support service, without issuing a fit note 

• Lancashire and South Cumbria – GPs refer patients to a support service made up of both clinical and non-clinical staff, without issuing a fit note.  

BMA’s Practice Business policy lead for GPs committee England Dr Clare Bannon said 

“The BMA has contributed to the design of these pilots with DWP to overhaul the fit note system as we feel the current system is not working for GPs or patients. We welcome the opportunity to test how different models work and ensure the new process reduces unnecessary appointments for GPs, but most importantly provides support to patients. 

“We will continue to input into the pilots to ensure they have appropriate occupational health support and do not inadvertently increase pressure on general practice or affect patient care. While we are supportive of this pilot, it must be underpinned by appropriate training, clinical oversight and clear governance.” 

Professor Victoria Tzortziou Brown, President of the Royal College of GPs, said 

GPs take our responsibility to appropriately issue fit notes seriously, but the current system can involve significant administrative work that takes time away from patient care. 

We are open to exploring evidence-based reforms that could help improve outcomes for patients. However, any reform of the fit note process must put the health and wellbeing of patients first, be fully resourced and avoid creating additional workload for general practice. As such we look forward to seeing a comprehensive evaluation of this pilot.

The Government is also confirming local funding allocations for WorkWell – the proven health-and-employment service through which the NHS-based fit note pilots will be delivered – as the programme expands nationally to support up to 250,000 people with a disability or health condition to get into or stay in work. 

WorkWell is a local, health-led service connecting NHS, council and community support to keep people in work and help them return quickly if they don’t. 

It comes as part of the Government’s wider £3.5 billion employment support package which meets sick and disabled people where they are, and builds on recent changes including the right for people on benefits to try work without fear of immediate reassessment, and the redeployment of 1,000 Pathways to Work advisers who are supporting those left behind by the previous Government. 

Those who need time off to recover will still get it, with the Government’s Statutory Sick Pay reforms meaning employees receive support from day one of sickness absence, putting an extra £400 million a year into people’s pockets. 

Alongside the NHS pilots, Keep Britain Working Vanguard businesses – including EDF Energy – will work out how employers can play a practical role in preventing absence where possible, and supporting safe, swift returns when it does occur. 

Jacob Lant, Chief Executive of National Voices, said 

The current tick-box system for fit notes isn’t working for anyone, particularly patients. It makes people who are unwell jump through unnecessary admin hoops, and yet the process rarely offers people the support they need to get well and manage their conditions long-term.  

The Department for Work and Pensions is absolutely right to test out new ways of supporting those who are signed off, and it is vital that patients are fully involved in that testing process, able to feed back over what works and what doesn’t. This is the only way to reliably avoid unintended consequences and create a system that actually helps both those who can’t work and those who would be able to with the appropriate support.   

Ultimately the goal has to be about focusing on improving people’s health and getting them well, this is the hallmark of a compassionate state. In the end, investing in this approach will also pay dividends in terms of more people feeling able to work and being able to enjoy all the positives that come as a result.

Nottingham GP Dr Sanjoy Kumar said 

I am really pleased the government is looking seriously at new approaches to fit notes, a change which is urgently needed. As a GP for over 25 years, I know how much of our clinical time is taken up with issuing these, which for many patients is not the right approach.

Dr Steve Taylor GP Co-Lead Doctors Association UK said  

The Doctors Association UK has been involved in discussions over the past few months with the Department of Work and Pensions around Fit Note reform. These discussions were broad and included many groups GPs, employers, patients and occupational health. We agree that the current system of fit-notes isn’t working well for patients, GPs and employers. It often lacks the nuance to deal with specific work situations and reasons that people have for not being able to work their full or part of their role. 

We hope these pilots will give the opportunity to explore a different way for people to engage with the periods of ill health and ways to make work more accessible and achievable. This recognises that GPs aren’t always best equipped to understand the options for work and we hope that active engagement between patients, GPs, employers and this new service will provide a better experience for everyone.

It is important that no one is forced to work who cannot, but it is also important that those who can, should be encouraged and given options to work. This could be a great improvement and we look forward to seeing the outcomes from these 4 pilots.

Chief Policy & Campaigns Officer John Foster at Confederation of British Industry said  

The fit note system is broken and fails employers, workers, and the economy. Business welcomes these pilots. They are an important step towards building a better system. 

Employers have increased their investment in supporting employee health and wellbeing and hope that these pilots will direct efforts to interventions that have the greatest impact.  

An improved system also needs to restore employers’ confidence that absence from work is only recommended when it is justified.

Professor Neil Greenberg, the Society of Occupational Medicine said  

The Society of Occupational Medicine (SOM) welcomes DWP’s proposed fit note pilots, particularly the workability plan. The current fit note system is not working. Too many people who could potentially be supported to stay and return to work are not.  

The fit note reform offers clear benefits for employees, employers, and the NHS. SOM anticipate the pilots will generate useful data to improve how fit notes will support employees, alleviate GP pressures and help bridge the gap between employers and employees.  

SOM will be interested to see if the pilots will support better health outcomes through reduced absenteeism, and improved retention. SOM looks forward to working with the DWP to achieve a better fit note system.

Charlotte Osborn-Forde, Chief Executive of The National Academy for Social Prescribing 

We are pleased that social prescribers – also known as link workers – will play a part in the fit note pilots. Link workers can support people with social issues that affect their health, including loneliness, isolation and problems with debt or housing. They focus on what matters to people and connect them to community-based support – including advice on money or housing, carers’ support, physical activity groups or local activities. There is strong evidence that this approach can benefit wellbeing and mental health. 

No one who is unable to work should be pressured into doing so, but this voluntary scheme should help join the dots between the NHS, employers and communities, and help people get the right support for wider issues that affect their health.

Head of Policy and Practice at the Royal College of Occupational Therapists, Joe Brunwin, said  

These pilots are a real chance to help more people stay in or return to work and are centred around a core skill of occupational therapy understanding people as individuals and considering how their environment and circumstances affect their ability to work.  

Fit note evaluations and pilots show occupational therapists are more likely to take a work-focused approach, using ‘may be fit’ advice and adjustments to support return to work. As well as signing fit notes occupational therapists can provide clinical supervision and governance for non-clinical staff.  

It’s encouraging to see a shift away from a purely medical approach to work absence, towards taking a more holistic approach. We look forward to seeing how this initiative makes use of occupational therapy expertise and how we can continue to work together as part of a multidisciplinary team, supporting people to stay in, return to and thrive in work.

Further information  

• The previous Government launched a Call for Evidence in April 2024 and this government has now published its findings  To be published tomorrow 

• The initial focus is on people who are in work, while continuing to explore how reforms interact with the benefits system and support people who are out of work. Patients will be able to use the stay in work and return to work plans for Statutory Sick Pay, which the government recently strengthened through the Plan to Make Work Pay. 

• The NHS pilots will test different models of fit note reform – including some GPs issuing the first fit note in a sickness absence. In other areas, fit notes will be wholly replaced by the new plans. 

• The Keep Britain Working Vanguards are early adopters who will develop and refine workplace health approaches over the next three years to build the evidence base for what works.  

• WorkWell allocations