Government launches work return pilots to replace broken fit note system

The government moved to overhaul the fit note system on 20 May 2026, calling it “broken” and saying it leaves too many people signed off work with no help back. Four pilots in England will test whether personalised “stay in work” and “return to work” plans can replace the current tick-box process.

The Department for Work and Pensions said the pilots will run through selected NHS WorkWell sites and major employers, cover up to 100,000 appointments and last up to a year. One model will start with a GP issuing an initial fit note before referral to community health workers. The other will let patients bypass an initial GP fit note and instead be supported by a separate service of clinical and non-clinical practitioners. Ministers said the pilots were the first step toward legislation for wider reform.

The scale of the problem is one reason the government has moved. It said about 11 million fit notes are issued every year, and more than nine in ten say a patient is “not fit for work”. Its April 2024 call for evidence put the share at 93.8% in England’s primary care, meaning more than 10 million notes a year simply sign people off. That paper linked the issue to the rise in long-term sickness-related economic inactivity after the pandemic, saying long-term sickness had become the main cause of inactivity among working-age people.

The policy shift is also a test of where authority should sit. In 2022, the rules were changed to allow digital certification and to extend fit-note signing rights to nurses, occupational therapists, physiotherapists and pharmacists in certain settings. Yet the Royal College of General Practitioners says more than 90% of fit notes are still issued by GPs. The college has backed evidence-based reform, but says doctors should remain patient advocates rather than employment decision makers and should not be given extra pressure without the staffing and funding to match. In November 2025, it said GPs should keep short-term responsibility, up to three weeks, while longer-term notes could move to other suitably trained professionals.

Employers have pushed for change too. The British Chambers of Commerce said one in 10 businesses are being seriously hit by sickness absence, and that fit notes often look like indefinite sign-offs with no clear return date or advice on workplace adjustments. It also said too few employers know that professionals other than GPs can issue fit notes, adding delay to a system already widely seen as ineffective.

The wider backdrop is the Keep Britain Working review led by Sir Charlie Mayfield, which argued for a shared-responsibility model between employers, employees and government. It said disabled people remain locked out of work at twice the rate of non-disabled people, underlining the political tension at the heart of the reform: cutting inactivity numbers without turning sickness certification into an employment filter. Pat McFadden, the Work and Pensions Secretary, said fit notes were “too often a dead end” and that the aim was to help people recover faster, stay connected to work and get the economy firing again.