The Government has announced the launch of several different pilots intended to test reforms to the fit note system, which it has deemed to be “broken”. Currently, around 11 million fit notes are issued every year and in more than 9 in 10 cases, they declare the subject "not fit for work".
The pilots will cover up to 100,000 appointments and last up to a year. They will continuously test the models in place to identify the most effective approach to tackling what the Government has referred to as the “inherited steep increase” in the number of fit notes issued.
Depending on the model in operation, patients will be offered either an initial fit note from a GP and then referred to community health workers, or they will go through the whole process without an initial fit note from a GP. Instead, they will be supported by a separate service, staffed by clinical and non-clinical practitioners.
A range of health and work support will be offered, including conversations between patients, employers and trained professionals that will cover reasonable adjustments and ways to keep people connected to their workplace from the first day of absence, helping more people to stay in work with support.
From July 2026, the pilots will operate in select areas through NHS WorkWell sites. They are as follows.
- Birmingham and Solihull — GPs issue the first fit note where needed, with all patients referred to a new support service led primarily by non-clinical staff, including social prescribers and work and health coaches.
- Coventry and Warwickshire — GPs issue the first fit note, with patients able to be referred to a support service made up of both clinical and non-clinical staff.
- Cornwall and the Isles of Scilly — GPs refer patients directly to a non-clinical support service, without issuing a fit note.
- Lancashire and south Cumbria — GPs refer patients to a support service made up of both clinical and non-clinical staff, without issuing a fit note.
