Reforming the Fit Note Process

The Government noted that whilst some Employees could return to work promptly without additional support following the issue of a fit note for short, or time-limited, illness (such as an infection or to recover from an injury or surgery), others may require more detailed assessments and discussions surrounding their work and health, including signposting more intensive support where appropriate. The call for evidence was intended to provide a better understanding of how the Government could enable those with long-term health conditions to access timely work and health support.

Employers and Employees were invited to comment on:

• the efficiency of the current fit note process in meeting their needs;
• what could be improved and what, if any, additional information provided by a “may be fit for work” fit note could support Employees returning to work from sickness absence; and
• their experience of private providers who offer to supply online fit notes (often described as a “work sickness certificate”) from a registered healthcare professional for a fee.

Employers largely view the current process as ineffective in meeting their needs. They raised concerns about how easily fit notes can be obtained without a face-to-face consultation and felt that healthcare professionals require a better understanding of workplace contexts.

Employers called for:

• clearer guidance on workplace adjustments,
• more realistic timelines for returning to work, and
• increased involvement from occupational health services.

They also suggested that individuals with long-term conditions, mental health issues, and disabilities would benefit most from more in-depth work and health discussions rather than the fit note system currently in force.

On 7 May 2024, the Department for Work and Pensions and Department of Health and Social Care launched “WorkWell” pilots which began in October 2024 in 15 areas in England. The pilot service provided a single assessment and access to local employment support and health services. It aimed to help people manage their health condition or disability and identify workplace adjustments that would help them to stay in work or return sooner than a fit note would allow them to.

The service was voluntary and open to anyone with a health condition or disability. People were able to self-refer to WorkWell or be referred by their Employer, GP or the community sector. Once referred, they were supported by a Work and Health Coach who would carry out an assessment and develop a plan to help them overcome health and social barriers to work. They connected with local support services, including physiotherapy, employment advice and counselling, and referred to other relevant local services such as support groups and the Citizens Advice Bureau.

The results of WorkWell provide useful insight. According to the Gov.uk website, seven in ten participants (70%) were satisfied with the overall support received through the pilot programme. Most notably:

• 43% of participants were most satisfied with the friendly and supportive work and health coaches;
• 13% were most satisfied with the clear and useful advice they received;
• 12% were most satisfied with the support and advice they received on a health condition;
• 11% were most satisfied with the support they received with looking for a job; and
• 9% were most satisfied with having a clear and positive plan moving forward with their condition and returning to the workplace.

There are some encouraging early indications of positive outcomes from WorkWell, although stronger evidence is expected to emerge later in the evaluation. As the pilot programme remains in its early stages, outcomes are not necessarily anticipated at this point; however, participants reported some initial results during qualitative interviews. These included both softer outcomes and more concrete, measurable achievements.

Those softer outcomes included, but were not limited to:

• raised awareness of local services
• improved general motivation and confidence
• raised aspirations around work
• development of job-related skills
• better understanding of roles suitable for their situation, and
• confidence having health-related conversations with Employers.

These outcomes help individuals build a foundation for future employment, sustained work, or improved work management. Employee’s also recorded:

• improved physical health
• improved mental health and wellbeing
• finding paid employment
• remaining or returning to work, and the development of new skills and qualifications.

These outcomes represent key indicators of the WorkWell pilot programme’s success, demonstrating that it has delivered a positive and measurable impact on individuals.

On 20 May 2026, the Government announced the launch of several pilot schemes in England aimed at reforming the “broken” fit note system. Delivered through selected NHS WorkWell sites and major Employers, the pilots have been designed to benefit Employees, Employers and GPs.

The WorkWell pilot is expected to run for a further year and cover around 100,000 appointments from 01 July 2026. It aims to identify the most effective ways to reduce the number of fit notes issued. Currently, around 11 million fit notes are issued annually, with over 90% stating that the individual is “not fit for work.” The pilots will test a range of approaches, including:

• Issuing an initial fit note from a GP followed by referral either to a new support service led mainly by non-clinical staff (such as social prescribers or work and health coaches), or to a mixed clinical and non-clinical service; and
• Removing the fit note altogether, with GPs referring patients directly to either a non-clinical support service or a combined clinical and non-clinical service.

By offering integrated work and health support, including three-way discussions between patients, employers and trained professionals, the pilots aim to support earlier and more sustainable returns to work.

Although these reforms remain at pilot stage, Employers should begin considering how increased focus on early intervention and workplace adjustments may affect their absence management processes.