On 20 May 2026, the Government announced the launch of four pilots across England aimed at reforming the current fit note system for workers who fall ill. It is hoped that reform to the current position will benefit patients, employers and healthcare professionals.
It is estimated at present that approximately 11 million fit notes are issued each year, with more than nine in ten of those declaring people ‘not fit for work’. The current system, which has been labelled as a ‘tick-box exercise’, has received widespread criticism due to the lack of support or guidance that it provides to both workers and employers in the facilitation of returning to work. In particular, many employers have criticised the current system as it allows individuals to be signed off work indefinitely without providing any clear timeline for return or guidance on adjustments. As such, this often creates uncertainty and, rather than facilitate people back to work, can often act as a barrier instead.
2024 Call for Evidence
In April 2024, the Department for Work and Pensions and Department for Health and Social Care launched a call for evidence which focussed on gathering views about the current fit note system from individuals, healthcare professionals and employers.
Based on the findings of the call for evidence, 66% of employers felt that the current fit note process was ineffective at meeting employer needs.
In particular, the majority of employers and stakeholders who took part considered that the current process did not work well and did not allow them to effectively manage sickness absence amongst their staff members. Many also felt that fit notes were too readily issued under the current system.
With regards how improvements could be made to the way fit notes are issued, employer respondents suggested the following:
- provision of information regarding what employees can do, as well as clear dates to allow for adequate cover to be arranged;
- introduction of a more holistic approach to facilitate people back to work, particularly where mental health conditions are concerned;
- integration of fit notes with occupational health services to avoid the provision of conflicting advice; and
- reduction of the issuance of fit notes without medical evidence.
Evidence gathered from employers and employer stakeholders also highlighted the need for the provision of clearer advice on reasonable adjustments, including the duration of time that such adjustments are required for.
How the Pilots will Work
In a bid to overhaul the “broken” system, the Government has now launched a total of four pilots across England which will cover up to a total of 100,000 appointments over a period of up to one year. The aim of the pilots is to analyse and devise an approach to effectively tackle the staggering number of fit notes that are currently issued by GPs.
During the pilot, patients will be offered either an initial fit note from a GP before being referred to community health workers or they will instead be referred to separate support service staffed by both clinical and non-clinical practitioners without receiving an initial fit note from a GP. It is hoped that by providing a range of work and health support, including three-way conversations between patients, employers and healthcare professionals, workers will remain connected with their workplace from the first day of absence and that this will assist more people to stay in work with support, for example, with reasonable adjustments.
The launch of the pilots is the first step that the Government has taken in an effort to make radical change to the current system. It will therefore be interesting to see what further action it intends to take in future.
