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Government pilots new fit note models to tackle rising work absences 

The pilots will trial personalised ‘stay in work’ and ‘return to work’ plans for workers who fall ill, offering support through clinical and non-clinical practitioners.

By Marvin Onumonu
Government pilots new fit note models to tackle rising work absences 

The Government launched pilots to reform the fit note system, aiming to benefit patients, employers, and GPs. 

Four NHS WorkWell sites and major employers will deliver trials covering up to 100,000 appointments. 

The pilots are set to last up to a year, with continuous testing to find the most effective approach.

The current fit note system issues around 11 million notes each year, with over 90% stating the person is not fit for work. 

A new report showed only 29% of primary care staff saw issuing fit notes as a good use of GP time. 

The pilots will trial personalised ‘stay in work’ and ‘return to work’ plans for workers who fall ill, offering support through clinical and non-clinical practitioners, and focusing on keeping people connected to their workplace.

Patients will either receive an initial fit note from a GP and be referred to community health workers, or go through the process without a GP-issued note, supported by a new service. 

The pilots will test models in Birmingham and Solihull, Coventry and Warwickshire, Cornwall and the Isles of Scilly, and Lancashire and South Cumbria.

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.”

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.”

The pilots will be delivered through WorkWell, a health-led service connecting NHS, council, and community support to keep people in work and help them return quickly if they don’t. 

REACTION:

John Foster, chief policy and campaigns officer at Confederation of British Industry: 

“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.”

Tom Pollard, head of policy, public affairs and campaigns at Mind: 

“These pilots could mark the start of real improvements to the fit note system. When people seek a fit note because of poor mental health, it rarely leads to them being offered the wider support they need. 

“Giving people the chance to have detailed conversations about the challenges they face and the support they need is a positive step. 

“However, it’s vitally important that this is a supportive and collaborative process. 

“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. 

“For too long, people with mental health problems have been forced to engage with a benefits system that can be punitive and makes them feel as though they have to ‘prove’ they need support. 

“Trust will need to be rebuilt if these reforms are going to work. In addition, employers have a responsibility to support their staff’s wellbeing, and a key part of these proposed reforms is giving employers better support to help people stay in work. 

“We need to see a joined-up approach where workplaces, health services and government all play a role in delivering compassionate and person-centred reforms.”

Ben Willmott, head of public policy at CIPD: 

“The current fit note system is not working for anyone as a way of supporting people back to work, whether that’s employees, GPs or employers. 

“These pilots can provide useful insights that can lead to the development of a much more effective and joined up system. 

“It’s encouraging to see a focus on enabling three-way conversations between patients, employers, and trained health professionals. 

“This approach has real potential to deliver personalised adjustments and timely support to help people stay in or return to work. 

“However, greater clarity is needed on how employers will be involved in practice. 

“Employers must have a clear role and input into what support and opportunities they can realistically provide. 

“We’ve long called for action to tackle long-term sickness absence and economic inactivity. 

“This is a welcome direction of travel, but employer engagement will be key to its success.”

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