Rethinking Fit Notes: Government Review Highlights Need for Change

The Department for Work and Pensions and the Department of Health and Social Care launched a call for evidence in April 2024 to review the Statement for Fitness for Work (“fit note”) system. The Government’s response, published on 26 May 2026, considered feedback from patients, employers, healthcare professionals and other stakeholders on whether the current system effectively supports people to manage their health while remaining in or returning to work.

Patients

Patients and representatives from the charity sector were generally positive about the current system, describing it as straightforward and accessible and as providing a legitimate basis for discussions about sickness absence and workplace support.

Employers

Employers were considerably less satisfied with the current system, with around two-thirds describing it as ineffective or very ineffective.

A common concern was that healthcare professionals often lack sufficient understanding of individual job roles and workplace environments to provide practical return-to-work advice. Employers also expressed concerns that fit notes can be obtained too easily.

Many respondents called for more detailed advice where an employee is assessed as “may be fit for work”, including clearer recommendations on workplace adjustments, realistic recovery timescales and greater involvement from occupational health professionals.

Healthcare Professionals

Views among healthcare professionals were mixed. While most agreed that fit notes should remain clinician-led, many supported extending certification responsibilities to a wider range of healthcare professionals to reduce pressure on GPs.

Fit Note System Pilots

Alongside the publication of the call for evidence, the Government announced a series of pilot schemes across England to test potential reforms to the fit note system. Running for up to 12 months and covering around 100,000 appointments, the pilots aim to identify the most effective way of reducing reliance on fit notes while improving support for people whose health affects their ability to work.

From July 2026, the NHS will trial four models through existing WorkWell sites. These will test different approaches to the role of GPs in the fit note process, including both GP-led certification with onward referral to support services and direct referral to multidisciplinary or non-clinical work and health services without a fit note being issued. The findings will help shape future reforms to the fit note system and the wider integration of health and employment support.

Conclusion

The Government’s review suggests that, while the fit note system remains important, it no longer fully meets the needs of all users.

The WorkWell pilots mark the first practical step towards testing potential reforms. Employers should monitor developments closely, as future reforms could significantly affect sickness absence management and return-to-work processes.

Sources

Fit Note Reform: Call for Evidence – Results – GOV.UK

Broken fit note system to be overhauled  – GOV.UK

The contents of this article are a general guide only at the date of publication. It is not comprehensive, and it does not constitute legal advice. Specific legal advice should be sought in relation to the particular facts of a given situation.