The Government has announced a scheme of pilots aimed at finding a better framework for managing sickness absence than the current fit note system, which has been in place since 2010.
What is the pilot looking to ‘fix’?
When fit notes replaced sick notes in 2010, the intention was that GPs would be able to provide more nuanced advice about possible reasonable adjustments that could be made by an employer to enable a return to work. However, the ambitions for this scheme have never really been realised in practice; and it’s clear that the new pilots will seek to fix one of the major flaws in the current fit note system – the disconnect between what steps or measures the employee wants and the GP condones, and what the employer is able to deliver in practice.
Whilst there are four different models within the pilot scheme, each involves a more integrated approach between the employee / patient’s healthcare provider, the employee / patient themself and the employer and seeks to move away from a ‘tick box’ fit note towards personalised return to work (or stay in work) plans.
The initiative reflects the Government's stated ambition to overhaul what it describes as the current broken fit note system, moving away from a model that primarily certifies incapacity for work and towards one which actively supports individuals to remain in, or return to, employment.
Where is the pilot taking place?
The pilot, commencing in July 2026, forms part of the government’s wider WorkWell health and employment support programme, and has been developed by the Department for Work and Pensions (DWP) in collaboration with the British Medical Association (BMA).
The pilot is being rolled out in four areas already involved in the WorkWell initiative:
Solihull and Birmingham
Cornwall and the Isles of Scilly
Coventry and Warwickshire
Lancashire and South Cumbria
What is changing?
A key feature of the pilots will be use of non-clinical specialist professionals, including social prescribers and work and health coaches, to bridge the gap between the health and employment considerations in each case. [NN1.1]
In some pilot areas, GPs will continue to issue fit notes while patients are referred to additional work and health support services. In other areas, patients may simply be referred directly to dedicated support services staffed by clinical and non-clinical practitioners without first receiving a fit note from a GP.
This, it is hoped, will elicit a more integrated approach that will help us move from a straightforward sickness certification process to providing more comprehensive and useful support for employees to enable them to resume work.
The Government intends to evaluate the different approaches by capturing feedback from all stakeholders in the pilots – employees, GPs, employers, non-clinical practitioners - before deciding whether any changes should be implemented more widely.
A greater focus on staying in work
A notable feature of the pilot is its emphasis on preventing individuals from being absent from work, or, if they do need a period of absence, preventing them becoming detached from work and / or their employer during periods of ill health.
The programme is therefore focused around personalised ‘stay in work’ and ‘return to work’ plans tailored to individual circumstances.
Importantly for employers, the pilot is expected to involve three-way discussions between employees, employers and healthcare or community support professionals, with the aim of helping individuals remain engaged with their employment and identifying practical steps that may support a return to work.
Why does this matter for employers?
The pilot reflects the Government's continuing focus on reducing economic inactivity and supporting employees to remain in or return to work where possible, which sounds like good news for both employers and employees, but it represents a potentially significant cultural shift.
The pilots’ success or otherwise, from an employer’s perspective, is likely to rest on the practicalities of how it is implemented and whether the burden of the tripartite engagement required bears fruit by reducing absences.
It is anticipated the pilot will result in greater emphasis on:
Early intervention to prevent long-term absence.
Collaboration between healthcare providers and employers.
Tailored return-to-work plans.
Workplace adjustments designed to support sustained attendance.
Existing employer obligations remain unchanged
The pilot does not, and is not intended to, alter employers' legal obligations when managing sickness absence.
Even in the pilot areas, employers must continue to engage directly with employees regarding any recommendations contained in fit notes and consider whether workplace adjustments or other measures may facilitate an earlier return to work.
Employers should also remember that a fit note is not a substitute for occupational health advice and that any duty to make reasonable adjustments under the Equality Act 2010 remains the responsibility of the employer although any GP or other recommendations should be taken into account. It will remain to be seen how any new regime co-exists with the typical occupational health support already provided to many employers.
Comment
The fit note pilot represents a further step in the Government's wider strategy of linking healthcare, employment support and economic inactivity policy.
For employers, the most significant aspect of the pilot may be its focus on maintaining engagement between employees and the workplace during periods of ill health. If the initiative proves successful, sickness absence management could become a more collaborative process involving a broader range of healthcare and support professionals, with greater focus on helping employees remain connected to work while recovering.
While the pilot does not alter existing legal duties, it is a reminder that proactive absence management, meaningful communication and careful consideration of workplace adjustments remain central to reducing the risks associated with long-term sickness absence and supporting employee wellbeing.
