For many years, the fit note has functioned as a largely administrative step in managing sickness absence. A GP assesses whether an employee can work, the relevant box is ticked, and the document is passed to the employer with little further guidance on what support might help that person return. The government now believes this approach is failing the people it is meant to serve, and from July 2026 four pilot schemes will begin testing a different model across selected NHS WorkWell sites in England.
A system under strain
The scale of the current system helps explain why reform is being considered. Around 11 million fit notes are issued each year, and more than nine in ten of them simply state that the individual is not fit for work. A government call for evidence found that only three in ten primary care healthcare professionals consider issuing fit notes a good use of GP time, while six in ten employers regard the existing process as ineffective in supporting their employees’ health and work needs. Those figures point to a system that satisfies almost nobody, least of all the employee whose return to work it is supposed to facilitate.
Four different approaches
The four pilot areas, each backed by £3 million of funding in the first year, will test slightly different referral routes. In Birmingham and Solihull, GPs will continue to issue an initial fit note where needed before referring the employee to a support service staffed mainly by non-clinical professionals such as social prescribers and work and health coaches. Coventry and Warwickshire will follow a similar pattern, with GPs issuing the first fit note but referring patients onward to a service combining clinical and non-clinical staff. Cornwall and the Isles of Scilly, along with Lancashire and South Cumbria, will go further still, removing the GP-issued fit note from the process altogether and referring employees directly to support teams from the outset. Between them, the pilots are expected to cover up to 100,000 appointments and will run for up to a year before the findings are used to shape future policy.
What unites all four models is a change in focus. Rather than asking only whether someone can work, the new services are designed to explore what support, adjustment, or phased approach might allow them to remain in or return to employment sooner. That can include conversations between the employee, their employer, and a trained professional about reasonable adjustments, alongside broader wellbeing and lifestyle support. The government has been clear that this is the first step towards more significant legislative reform of the fit note system, rather than the finished article.
The legal position remains unchanged
For now, employers should treat the pilots as a signal of direction rather than a change in the law. None of the existing legal obligations shift as a result of this announcement, and the duty to make reasonable adjustments for employees with a disability under the Equality Act 2010 continues to apply exactly as before. Fit notes themselves are not disappearing during the pilot period, and employees who are genuinely unable to work will continue to receive sickness certification in the usual way.
Even so, the direction of travel is worth taking seriously. Employers who already invest in occupational health referrals, structured return to work meetings, and proactive case management are likely to find themselves well placed if and when these approaches become more closely tied to the formal fit note process. Those who have relied on the current system’s simplicity, treating a fit note as the end of the conversation rather than the beginning of one, may find that approach increasingly out of step with where policy is heading.
It is a sensible moment to look again at how sickness absence is managed within your organisation. Reviewing absence policies, ensuring managers are equipped to hold constructive and well documented return to work conversations, and building stronger links with occupational health providers will all help employers stay ahead of a process that is clearly set to evolve.
Buckles’ employment team can help you assess your current approach and prepare for what these pilots may eventually mean for your business.
