England fit note pilots to test return-to-work plans

If you have ever needed a fit note, you will know how strange the system can feel. One appointment, one form, then a statement about whether you are fit for work. In a new announcement, the Department for Work and Pensions says that system is failing patients, frustrating employers and taking up too much GP time, so England is about to test a different model in four NHS pilot areas. This matters because a fit note is not just admin. It can shape your pay, your relationship with your employer and the path back to your job after illness. The Government's argument is that too many notes end the conversation instead of starting one.

At the moment, around 11 million fit notes are issued each year, and more than nine in ten say the person is 'not fit for work'. Fit notes were supposed to leave room for more tailored advice, including changes that might help somebody stay in work, but ministers say the system has drifted into a paper exercise. The Government's own call for evidence found that only 29% of primary care staff think issuing fit notes is a good use of GP time. It also found that six in ten employers think the current process does not properly support workers' health and work needs. **What it means:** the case for reform is not that unwell people should carry on regardless. It is that the current form often stops at certification, with little practical help attached.

The proposed answer is a set of four pilots in England, covering up to 100,000 appointments and running for up to a year. Instead of simply issuing a note and leaving the worker to manage the rest, the pilots will test personalised 'stay in work' and 'return to work' plans that can also be used for Statutory Sick Pay purposes. Some patients will still get an initial fit note from a GP before being referred onwards. Others will go straight to a separate support service without that first note. Those services will be staffed by a mix of clinical and non-clinical practitioners, and the idea is to offer real conversations about reasonable adjustments, recovery and how to keep somebody linked to their workplace where that is safe.

From July, the testing will run through existing NHS WorkWell sites. In Birmingham and Solihull, GPs may issue the first fit note and every patient will then be referred to a mainly non-clinical support service, including social prescribers and work and health coaches. In Coventry and Warwickshire, the first note will also come from a GP, but the support team will include both clinical and non-clinical staff. Cornwall and the Isles of Scilly will test a route where GPs refer patients straight to a non-clinical support service without issuing a fit note at all. Lancashire and South Cumbria will do something similar, but with a mixed team of clinical and non-clinical staff. That makes this a genuine test of different systems, not one single national model in miniature.

The change did not appear out of nowhere. Sir Charlie Mayfield's Keep Britain Working Review recommended trials of a new approach and said the fit note system was not working as intended, partly because it could become a barrier to contact with employers. Ministers are now using that argument to say early support could help people recover, stay connected to work and reduce the rise in economic inactivity. Stephen Kinnock, the care minister, says NHS staff have been telling him since July 2024 that the current system is not working for patients or clinicians. Pat McFadden, the Work and Pensions Secretary, is framing the pilots as part of a wider push to get a broken process working better for public services and the labour market. We should read that carefully: this is about health support, but it is also clearly about employment policy.

Support for the pilots is real, but it is not uncritical. The BMA helped with the design and says any new system must reduce unnecessary GP appointments while giving patients better support. The Royal College of GPs says reform must put patient wellbeing first, be properly funded and avoid adding new pressure to general practice. National Voices says patients themselves must help shape the pilots so that problems are spotted early. Other groups see promise in bringing in wider expertise. Doctors Association UK says GPs are not always the right people to judge every workplace option. The Society of Occupational Medicine and the Royal College of Occupational Therapists both think broader teams could improve returns to work. **What to keep in view:** nobody who is too ill to work should be pushed back before they are ready, and several organisations are stressing that point plainly.

The pilots sit inside a much bigger Government programme. WorkWell, the health-led service linking NHS, council and community support, is being expanded nationally with the aim of helping up to 250,000 people with a disability or health condition get into work or stay there. The first focus is on people already in work, while ministers continue looking at how any future reform would interact with the benefits system and people who are out of work. The Government says its wider employment support package is worth £3.5 billion, includes the right for some benefit claimants to try work without immediate reassessment, and includes 1,000 Pathways to Work advisers. It also says Statutory Sick Pay reforms will mean employees get support from day one of sickness absence, putting an extra £400 million a year into workers' pockets. Alongside the NHS pilots, Keep Britain Working Vanguard employers, including EDF Energy, will test what practical support from workplaces looks like when somebody falls ill.

There is also serious money behind the wider WorkWell rollout. The published maximum regional allocations range from £21.6 million in the South West to £47.1 million in the Midlands. London is set at £40.3 million, the North East and Yorkshire at £36.3 million, the North West at £35.4 million, the South East at £30.5 million and the East of England at £24.2 million. For you as a reader, the key point is simple. England is not abolishing fit notes overnight. It is testing whether sickness certification can become a support plan instead of a dead end. If the pilots help patients, reduce admin and keep decisions safe, ministers say legislation will follow. If they do not, the Government will have to answer a harder question: whether this reform helped sick workers, or just moved pressure from one part of the system to another.