The government has announced a major overhaul of England’s fit note system, launching new pilots aimed at replacing what ministers call a “broken” process with something more focused on helping people stay in work or return to it sooner.
The trial, backed by £3 million in its first year, will run through four NHS WorkWell sites and test different ways of supporting workers who fall ill.
The current system issues around 11 million fit notes a year, with more than nine in 10 saying a person is not fit for work, but the government says that too often leaves patients at a dead end rather than offering meaningful support.
Changing England’s fit note system and what the pilots will test
The new pilots will explore four different models across Birmingham and Solihull, Coventry and Warwickshire, Cornwall and the Isles of Scilly, and Lancashire and South Cumbria.
In some areas, GPs will issue the first fit note before referring patients to a support service, while in others they will refer patients directly without issuing one at all.
Those services will bring together clinical and non-clinical staff, including social prescribers and work and health coaches, to create personalised “stay in work” and “return to work” plans.
The idea is to move away from a simple yes-or-no judgment about work and instead look at what adjustments might help someone remain connected to their job while they recover.
Why ministers want to change the existing fit note system
Work and Pensions Secretary Pat McFadden said fit notes are “too often a dead end” and argued that the new approach will help people recover faster while keeping them tied to their workplace.
Minister of State for Care Stephen Kinnock also said the current system creates unnecessary admin for NHS staff and that the pilots are the first step towards wider reform.
The government says the push is backed by evidence from its Fit Note Call for Evidence, which found only 29% of primary care staff think fit notes are a good use of GP time, while six in 10 employers believe the current process does not properly support workers’ health needs.
A wider review by former John Lewis chairman Sir Charlie Mayfield also described the system as “not working as intended”.
The British Medical Association welcomed the chance to test different models but warned that any new system must be properly funded and not pile extra pressure onto general practice.
The Royal College of GPs struck a similar tone, saying reform could help, but only if patient wellbeing stays front and centre and the pilots are fully resourced.
Employers have largely backed the move. The Confederation of British Industry said the current system fails workers, employers and the wider economy, while occupational health groups said the pilots could help create a more practical, joined-up approach to absence and return-to-work support.
What happens next
The pilots will run for up to a year and cover as many as 100,000 appointments, with the results used to shape future legislation.
WorkWell, the health-led service delivering the pilots, is also being expanded nationally and the government says it could support up to 250,000 people with a disability or health condition to get into or stay in work.
For now, the government is promising that people who genuinely need time off will still get it, but with more help built in from the start.
