The initiative, announced by the Department for Work and Pensions, will operate across four areas in England for up to a year. According to the Department for Work and Pensions, the pilots could cover as many as 100,000 appointments while examining alternatives to the existing fit note system.
The current system has been criticised by ministers as offering limited support beyond confirming that a person is unfit for work. The government says the trials will examine different ways of connecting patients with healthcare professionals and workplace support, while also reducing administrative demands on GPs.
Four Pilot Schemes Will Test Alternatives to the Current Fit Note Process
According to the Department for Work and Pensions, the pilots began in July and will test different models for supporting people who fall ill. Rather than relying solely on a GP-issued fit note, some patients will receive an initial fit note before being referred to community health workers. Others will complete the process without obtaining an initial fit note from their GP, instead receiving support from a separate service staffed by both clinical and non-clinical practitioners.
The government says the aim is to replace what it describes as a “tick-box exercise” with personalised “stay in work” and “return to work” plans. The four pilot areas will collectively cover up to 100,000 appointments and are expected to run for as long as one year.
Work and Pensions Secretary Pat McFadden said the existing system often leaves people without practical assistance during illness. He said fit notes are “too often a dead end” because they state that someone cannot work but “do nothing to help them get better”. He added that bringing together employers, the NHS and patients is intended to help people recover more quickly, remain connected to their jobs and support the wider economy.
Medical Leaders Welcome Evaluation While Stressing Patient Care Must Remain the Priority
The proposed changes have also prompted responses from healthcare leaders. According to the Royal College of GPs, doctors recognise that issuing fit notes forms an important part of patient care but that the existing process can involve substantial administrative work.
Professor Victoria Tzortziou Brown, President of the Royal College of GPs, said GPs take their responsibility for issuing fit notes seriously. She said the college is willing to consider evidence-based reforms that could improve outcomes for patients, while stressing that any changes must prioritise patients’ health and wellbeing, be properly resourced and avoid adding further workload to general practice. She also said the organisation looks forward to a comprehensive evaluation of the pilot programme.
Minister of State for Care Stephen Kinnock said NHS staff have consistently raised concerns about the current fit note system since he took up his post in July 2024. He described the pilots as the beginning of replacing what he called a broken system, arguing that personalised support could help people return to work while allowing GPs to spend less time on administrative tasks and more time caring for patients. He said the programme reflects the government’s wider 10 Year Health Plan by aiming to provide earlier support from the appropriate professionals in the appropriate settings.
