The government’s new fit note pilots signal a move away from sickness certification as a largely administrative process and towards earlier, more practical work and health support. For employers, the proposals point to greater involvement in return-to-work planning, workplace adjustments and keeping employees connected to work where appropriate.
The proposals form part of the government’s wider strategy to tackle economic inactivity and support more people with health conditions to remain in, or return to, work. GPs issue approximately 11 million fit notes each year, with more than 90% stating that the individual is “not fit for work”. The government has questioned whether the current system delivers the right outcomes for workers, employers and healthcare professionals.
Alongside the announcement of the pilots, the government published the findings of the 2024 call for evidence on fit note reform. Patients broadly valued the simplicity and accessibility of the current system, while employers raised concerns that “may be fit for work” notes often lack sufficient detail, including clearer guidance on workplace adjustments and realistic timelines. Health care professionals also identified several barriers to effective work and health conversations, including limited information about the workplace context.
What is changing?
From July 2026, four pilot schemes will operate through selected NHS WorkWell sites across England:
- Birmingham and Solihull: GPs will issue the initial fit note where needed, then refer employees to a new support service led primarily by non-clinical staff, including social prescribers and work and health coaches.
- Coventry and Warwickshire: GPs will issue the first fit note, with onward referral to a mixed clinical and non-clinical support service.
- Cornwall and the Isles of Scilly: GPs will refer employees directly to a non-clinical support service without first issuing a fit note.
- Lancashire and South Cumbria: GPs will refer employees directly to a support service comprising both clinical and non-clinical practitioners, again without first issuing a fit note.
The pilots are expected to cover up to 100,000 appointments and will test whether alternative support models can improve outcomes for workers experiencing health-related absence. The aim is to move away from a process that focuses primarily on whether someone can work and towards a more tailored, and earlier, assessment of what support might enable them to remain in, or return to, work.
The new services may include:
- work and health coaching;
- occupational health-style support;
- discussions about workplace adjustments;
- wellbeing and lifestyle support; and
- facilitated conversations between employees and employers regarding return-to-work plans.
What does this mean for employers?
Although the pilots have not yet started, they provide an indication of the government’s intended approach to sickness absence management. It increasingly expects employers to play a more active role in supporting employees to remain in work where appropriate, rather than focusing solely on managing absence once an employee goes off sick.
For employers, this may mean:
- increased engagement in return-to-work planning;
- more frequent and detailed discussions about reasonable adjustments;
- greater emphasis on workplace support measures;
- closer collaboration with healthcare professionals and work and health coaches; and
- a stronger focus on retaining employees with health conditions.
Many organisations already adopt this approach through occupational health referrals, return-to-work meetings and proactive absence management processes. However, the pilots suggest that these practices may become more firmly embedded in the fit note process itself.
Employers should continue to assess each case on its facts. The pilots do not change existing legal obligations, including the duty to make reasonable adjustments where an employee has a disability. They do, however, underline the importance of early, well-documented and practical conversations about what support might help an employee remain at work or return safely.
Conclusion
The government has made clear that these pilots are intended to inform future legislative reform. Fit notes will not disappear in the short term and employees who are not fit for work will continue to receive sickness certification. However, the clear longer-term direction is a system focused less on certifying absence and more on supporting continued employment wherever possible.
For employers, this is a useful prompt to review sickness absence procedures, manager training and the way you document return-to-work and adjustment discussions. Treating sickness absence management as part of a wider health, wellbeing and retention strategy will position organisations well to respond to future reform.
