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The government is introducing a pilot program to replace traditional GP fit notes, which currently declare individuals unfit for work, with enhanced support services aimed at helping people remain in their jobs. This new approach is being tested in four areas across England, with GPs in two regions referring patients to support alongside issuing fit notes, while in the other two regions, fit notes will no longer be issued at all. These changes come in response to concerns that the existing system is flawed, often resulting in long-term absence from work without sufficient assistance to facilitate a return.
More than 11 million fit notes are issued annually across England, a number that has steadily increased since the onset of the Covid-19 pandemic. Fit notes are typically given to individuals who are unable to work for more than a week, providing insight into how their health issues affect their capacity to work and enabling access to certain benefits and sick pay. Patients can be classified as either “not fit for work” or “maybe fit for work” with suggested adjustments. However, the government reports that over 90% of fit notes currently result in patients being signed off work entirely. Earlier this year, a survey of GPs revealed that many had never refused to issue a fit note for patients with mental health conditions, highlighting a shift towards questioning whether issuing fit notes should remain part of a GP’s responsibilities.
The pilot schemes, funded with £3 million and encompassing up to 100,000 appointments over a year, aim to explore alternative strategies in responding to workplace absence due to health. GPs in Birmingham and Solihull, along with Coventry and Warwickshire, will continue to issue fit notes when necessary but will also direct patients to additional support services. Conversely, in Cornwall and the Isles of Scilly, as well as Lancashire and South Cumbria, GPs will bypass issuing fit notes altogether and focus on referrals to support programs. The initiatives seek to determine whether healthcare professionals or non-clinical staff—such as work coaches and social prescribers—are better suited to lead these efforts, which may include connecting patients with community activities or coordinating with employers on workplace adjustments.
These pilots will utilize existing NHS WorkWell resources, which provide access to services like physiotherapy and counseling. This program follows a review earlier this year, led by former John Lewis chairman Sir Charlie Mayfield, which concluded that the current fit note system is not functioning as intended. The review criticized the lack of training and time GPs have to properly assess a patient’s work capability and identified fit notes as a possible barrier to communication between employers and employees. Work and Pensions Secretary Pat McFadden commented, “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.”
The Royal College of GPs’ president, Professor Victoria Tzortziou Brown, highlighted the burdensome administrative work involved in the current system, stating, “the current system can involve significant administrative work that takes time away from patient care.” She emphasized that any reforms must prioritize patient health and well-being, be properly resourced, and avoid increasing workloads on general practice staff. Business representatives, including John Foster from the Confederation of British Industry, expressed support for the pilot, noting that the existing system does not adequately serve employers, employees, or the economy. Mental health charity Mind’s Tom Pollard welcomed the initiative as a step in the right direction but stressed the importance of ensuring the process remains supportive and collaborative, cautioning that “People with mental health problems must not feel pressured to work when they don’t feel able, or to return to workplaces that are not supporting their mental health.”
With a rising benefits bill linked to increasing numbers of people out of work—driven largely by mental health issues among younger individuals and musculoskeletal problems in older adults—the government faces ongoing challenges in managing welfare costs. Last year, plans to introduce major welfare reforms, including changes to disability benefit eligibility designed to save £5 billion annually, were dropped following opposition within the ruling party. As reform efforts continue, this pilot represents a significant attempt to address the complex intersection of health, employment, and economic productivity
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