Fit note reform – what’s happening (and will it work)?

The Government has announced the launch of several pilot schemes as part of its proposals to reform the current “broken” fit note system. 

This follows the recommendations of the Keep Britain Working Review, led by Sir Charlie Mayfield and published in November 2025 (see our previous article). The Government has also published its key findings from the responses to its earlier ‘call for evidence’ on the reform of fit notes, which was conducted between April and July 2024. 

Call for evidence: key findings 

The exercise gathered views from a wide range of stakeholders, including patients, employers and healthcare professionals. It focused on how well the current system supports work and health outcomes.  

The findings highlight widespread dissatisfaction with the current system, particularly among employers. However, there was a clear divergence of opinion between stakeholder groups. Most patients considered the system effective and valued its simplicity and role in legitimising absence. The majority of employers viewed the system as ineffective, and views among healthcare professionals were mixed. 

The evidence identifies a number of consistent employer concerns. 

1. Lack of useful information  

Many respondents reported that fit notes lack sufficient detail about what the employee can do, what adjustments may be required, and how long those adjustments should last.  This lack of clarity can make it difficult for employers to plan effectively or to implement appropriate return‑to‑work strategies. 

2. Occupational health input 

Another recurring theme is the limited integration of occupational health and wider employment support services. Employers, alongside other stakeholders, identified a need for fit notes to be better linked to occupational health, vocational rehabilitation and other forms of employment support. 

3. Accessibility and quality of certification 

Employers also raised concerns about the ease of obtaining fit notes (often without face-to-face consultation) and highlighted that healthcare professionals often lack understanding of specific job roles or working environments, which limits the practical value of the advice provided.  

Overall, the Government concluded that the current system is not functioning as effectively as it could and requires reform to better support individuals to remain in and return to work.  

Proposed reforms: pilot schemes 

On 20 May 2026, the Government announced a series of four pilots in different areas of England to test new approaches to the fit note process through NHS WorkWell sites and major employers. These pilots (covering Birmingham and Solihull, Coventry and Warwickshire, Cornwall and the Isles of Scilly, and Lancashire and South Cumbria) are expected to run for up to a year and will cover up to 100,000 appointments. 

The aim is to move away from the current model, which is heavily reliant on GP-issued fit notes, towards a more integrated approach linking health support with employment outcomes. Instead of fit notes functioning primarily as certification of incapacity, the focus will be on early intervention and helping individuals remain connected to work. 

The pilots are designed to test alternative pathways. In some cases, a GP will issue an initial fit note but then refer the individual to a support service delivered by a mix of clinical and non‑clinical staff, such as work and health coaches or social prescribers. In others, the GP may not issue a fit note at all, instead referring the individual directly into a support pathway. 

A key feature of the pilots is the introduction of more structured engagement between the employee, employer and support professionals. The intention is that individuals remain connected to their workplace from the outset of absence, supported by discussions about adjustments and return-to-work planning at an early stage. 

This represents a shift away from a binary ‘fit’ or ‘not fit’ model towards a more collaborative, multi‑disciplinary model, involving a wider range of professionals beyond GPs, in line with the recommendations of the Keep Britain Working Review. Depending on the outcome of the pilot schemes, the role of the traditional fit note may change significantly in the future, either being supplemented or, in some cases, replaced by referral pathways into support services.  

The Birketts view 

If the pilots are rolled out more widely, it is likely that employers will have earlier and more direct engagement with employees during sickness absence, including participation in structured work and health conversations. This may increase expectations on employers to engage proactively and consider adjustments at an earlier stage, and to justify decisions around return to work. 

In principle, the reforms aim to address valid and longstanding employer concerns about the lack of clarity over sickness absence and limited occupational health input. However, the evidence also indicates that many of the underlying issues relate to a lack of NHS resources and restricted access to occupational health provision. It is therefore too early to predict whether these structural reforms will have any material impact on overall sickness absence rates, at least in the short term.