GP fit notes that declare people unable to work are being replaced in parts of England with support meant to help them stay in their jobs, under a government pilot scheme announced on Tuesday. In two areas, GPs will refer patients for help alongside fit notes. In two others, doctors will stop issuing fit notes entirely and send patients straight to support services.
The four pilot schemes will run for up to a year, cover up to 100,000 appointments and are backed by £3m of funding. The government says the current system is broken and has left too many people signed off work with no help to return, even as more than 11 million fit notes are issued every year and the number has risen since the Covid pandemic.
The pilots are aimed at people who are unwell or unable to work for more than seven days, the point at which a fit note is normally used. Those notes can say someone is not fit for work, or maybe fit with adjustments, and they can also unlock certain benefits and sick pay. Ministers say more than nine-in-10 fit notes currently sign people off entirely, feeding a problem that is now being linked to pressure on the economy, benefits and the NHS.
In Birmingham and Solihull, and in Coventry and Warwickshire, GPs will initially issue a fit note where needed but patients will also be referred to support services. In Cornwall and the Isles of Scilly, and in Lancashire and South Cumbria, patients will be sent directly to those services without a fit note being issued. The government says the tests will help determine whether support should be led by healthcare professionals or by non-clinical staff such as work coaches and social prescribers.
That matters because the question is no longer only whether a patient should be signed off, but what happens next. Under the pilot, community groups or activities may be recommended to improve a patient’s health, turning the fit note process from a paper certificate into a route back into work.
The change lands after years of criticism from ministers that the system does not help people return to work. Earlier this year, hundreds of GPs told the they had never refused to sign a patient off work for mental health issues, while many doctors have also said issuing fit notes should not be part of a GP’s job. The pilots now put that dispute at the centre of a policy test that could reshape how sickness and work advice is handled if the programme is widened.
The immediate answer is that the government is trying to replace a sign-off culture with a support-first model, and it is doing so where the burden of sickness-related worklessness is already acute. What remains unresolved is whether patients get better help, or simply a different kind of bureaucracy.
