The government has announced a major shake-up of the GP fit note system in England, with new pilot schemes aiming to help more people remain in work rather than being signed off long-term due to illness.
Under the plans, traditional fit notes could eventually be replaced with a more support-focused approach designed to keep employees connected to their jobs while receiving help for their health conditions. Ministers say the current system is “broken”, arguing that too many people are being signed off work without receiving the support needed to recover and return.
More than 11 million fit notes are issued every year across England, with numbers steadily rising since the Covid pandemic. Currently, fit notes are used when someone is unable to work for more than seven days due to illness. Patients can either be declared “not fit for work” or “maybe fit for work” with adjustments. However, government figures suggest more than 90% of fit notes sign people off completely.
The reforms come amid growing concern over the number of people out of work due to poor physical and mental health. Rising economic inactivity has increased pressure on the NHS and contributed to higher welfare spending, with ministers keen to encourage more people back into employment where appropriate.
The four pilot schemes, backed by £3 million in funding and covering up to 100,000 appointments, will test different ways of supporting patients. In Birmingham and Solihull, as well as Coventry and Warwickshire, GPs will continue issuing fit notes where necessary but will also refer patients to support services. Meanwhile, in Cornwall and the Isles of Scilly, alongside Lancashire and South Cumbria, patients may be referred directly to support services without receiving a fit note at all.
The support available through the pilots will include services such as physiotherapy, counselling, social prescribing and work coaching. Employers may also be involved in discussions around workplace adjustments to help staff remain in work or return sooner.
The schemes will operate through existing NHS WorkWell sites, which already connect patients with employment and wellbeing support. The pilots will also explore whether support is best led by healthcare professionals or non-clinical staff such as work coaches and social prescribers.
The changes follow a government-commissioned review led by former John Lewis chairman Sir Charlie Mayfield. The review found the current fit note system was “not working as intended”, with many GPs lacking the time or specialist training to properly assess a patient’s ability to work. It also suggested fit notes can sometimes create barriers between employers and employees, reducing opportunities for early intervention and workplace support.
Reaction to the proposals has been mixed. Business groups have largely welcomed the reforms, saying the current system fails workers, employers and the economy. However, healthcare leaders and mental health charities have stressed that patient wellbeing must remain the priority.
The Royal College of GPs warned that any changes must be properly funded and should not increase pressure on already overstretched GP services. Meanwhile, mental health charity Mind said people must not feel pressured into returning to workplaces that do not adequately support their mental health.
As the government looks for ways to reduce long-term sickness absence and ease the growing benefits bill, these pilots could mark the beginning of a significant change in how health and work are managed across the UK.