By Rachel Ellis, Partner & Employment Rights Regional Manager
The government has announced plans to overhaul the fit note system, following concerns that the current approach is not supporting effective conversations about work and health.
At the centre of the proposals is a series of pilot schemes across England, designed to test new ways of managing sickness absence. These pilots will introduce personalised “stay in work” and “return to work” plans, moving beyond the traditional fit note model.
It is proposed that:
- Workers who fall ill will receive tailored support plans setting out how they can remain in or return to work, rather than relying solely on certification.
- In some areas, GPs will continue to issue initial fit notes before referring individuals to community-based services.
- In others, the fit note may be replaced entirely by a system led by clinical and non-clinical practitioners.
These reforms follow a call for evidence which revealed significant differences in how the current system is viewed. While a large majority of patients reported that fit notes work well, most employers considered the process ineffective, highlighting a disconnect between those using and implementing the system.
Employers raised concerns about the lack of practical detail in “may be fit for work” notes, pointing to limited guidance on adjustments, timelines, and how to support a return to work. Healthcare professionals, meanwhile, identified pressures on time and resources, as well as gaps in occupational health expertise.
There was broader support for reform, including extending certification powers to a wider group of healthcare professionals and improving integration with occupational health services.
The pilots, which are expected to involve up to 100,000 appointments, will run for up to a year, with ongoing evaluation.
While the proposals signal a shift towards a more proactive and integrated approach to sickness absence, questions remain as to whether these changes will address the underlying pressures faced by both employers and healthcare systems.
What is clear, however, is that the current system is failing to consistently deliver meaningful support for keeping people in work — and that reform is now firmly on the agenda.
