Fit Note Reform Pilot Schemes

Together with my right hon. Friend the Secretary of State for Health and Social Care, I am today announcing a series of pilots to test a new approach to managing sickness absence in England.

We have known for some time that the fit note is not working as intended. Over 11 million fit notes were issued last year, with around 93% being issued as “not fit for work”. Far too often, employees are not receiving the advice that might help them return to work earlier, and employers are not being offered advice on how to support their employees in the workplace.

In April 2024, the previous Government launched a call for evidence seeking views from a wide range of stakeholders on the fit note process. Today I have published its findings, which reveal several challenges with the fit note process. Many healthcare professionals do not feel sufficiently equipped to bridge the barriers between a patient’s work and health. Employers, meanwhile, expressed concerns that “may be fit for work” fit notes lack sufficient detail and also report the need for a greater understanding of workplace contexts. Although patients appreciated the simplicity, accessibility and legitimacy of the current system, they also supported the need for more detailed work and health discussions.

That is why, from July 2026, we will begin pilots in four areas across England to test reforms to the traditional fit note. The pilots will offer up to 100,000 appointments and move away from a system focused primarily on sickness certification and instead offer personalised work and health support.

In participating areas, new community work and health teams will work with patients and their employers to develop workability plans that support them to remain in work or return sustainably. These plans are focused on what people can do, the support they may need, and when time away from work is right. Crucially, this model is designed to keep people connected to their workplace from day one of absence. This shift will enable earlier, more tailored support for individuals, while freeing GPs from administrative processes so that they can focus more on care.

The pilots will be backed by £3 million of funding in their first year and will be delivered in partnership with the NHS and employers. They will operate initially in four integrated care board areas: Birmingham and Solihull; Cornwall and Isles of Scilly; Coventry and Warwickshire; and Lancashire and South Cumbria.

These pilots are the first step in the Government’s ambition for radical fit note reform, moving towards a more holistic and partnership-based approach to supporting sickness absence. Designed in collaboration with patients, employers and GPs, we will take a “test and learn” approach, with findings shaping future legislation and implementation as we scale what works.

This sits alongside wider action that we are taking to drive change across the work and health system, such as clearing the Access to Work backlog, to ensure people receive timely and effective support to stay in work. In parallel, Sir Charlie Mayfield’s “Keep Britain Working” programme is convening Vanguard employers to test new employer-led approaches and develop a healthy workplace standard.

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