DWP launches four pilot schemes to reform ‘broken’ fit note system
The Department for Work and Pensions has launched four fit note pilot schemes designed to replace the current tick-box exercise with a more proactive, personalised approach to work and health support.
The current system is staggering in its scale and inefficiency. Approximately 11 million fit notes are issued annually, with over 90% declaring the individual ‘not fit for work’. This often leaves patients without a clear path back to employment and creates an administrative burden for GPs, with only 29% of primary care staff viewing the task as a good use of their time. This dissatisfaction is echoed by employers, with 60% finding the current process ineffective in supporting their employees’ work and health needs. The Keep Britain Working Review, led by former John Lewis chairman Sir Charlie Mayfield, identified the system as a barrier to employer contact, calling it “not working as intended”.
From July 2026, four pilots will operate through selected NHS Work Well sites, backed by £3 million in funding, and will cover up to 100,000 appointments. Crucially, they will test different models to see what works best. In areas like Birmingham and Solihull, GPs will issue an initial fit note before referring patients to a support service led by non-clinical staff, including social prescribers. However, in Cornwall and the Isles of Scilly and Lancashire and South Cumbria, GPs will refer patients directly to a support service, completely bypassing the traditional fit note. The aim is to replace a binary “fit” or “not fit” decision with a collaborative workability plan that focuses on what an employee can do and what adjustments might help them remain in or return to work.
A key feature of the reform is the move away from a purely medical model towards a more holistic, biopsychosocial approach. The new support services will offer three-way conversations between patients, employers, and trained professionals to discuss reasonable adjustments and keep people connected to their workplace from the first day of absence. This shift, supported by organisations like the Society of Occupational Medicine, could help bridge the gap between healthcare and employment. The government is also working with employer groups, including representatives for small businesses, to ensure the new models are viable for all employers.
These pilots are a crucial first step in a long-term ambition for reform, with the findings intended to shape future legislation. While many organisations, including the BMA and Royal College of GPs, welcome the opportunity to test new approaches, they also urge caution. Experts writing in the BMJ have warned that reforming the form is not enough; a true solution requires addressing wider issues like long NHS waiting times and the lack of universal occupational health support. Ultimately, the goal is to create a compassionate state that focuses on improving people’s health and enabling those who can work to do so with the right support.
