Government to pilot new approach to fix "broken" fit note system

The government has pledged to overhaul the 'broken' fit note system, beginning with pilots in four different areas.

Through the pilots, patients will be offered either an initial fit note from a GP and then referred to community health workers, or the option to be supported by a separate service staffed by clinical and non-clinical practitioners.

These will cover up to 100,000 appointments and last up to a year, according to the Department of Health and Social Care and the Department for Work and Pensions.

The government said the new process would involve three-way conversations between patients, employers and trained professionals, covering issues such as reasonable adjustments and keeping in touch with employees from their first day of absence.

Currently, fit notes are issued after seven days of sickness absence. They can either confirm that a person is "not fit for work", or recommend that they "may be fit for work" with adjustments.

For the first six months of a condition, fit notes can last up to three months, with a review date. After six months, a note can last for a longer or even indefinite period.

The government estimates that around 11 million fit notes are issued every year, with more than nine in 10 declaring the employee not fit for work.

Only 29% of primary care staff see issuing patients with fit notes as a good use of their time, and a recent BBC survey found that the majority of GPs had never refused a fit note request.

The trials will be delivered across four existing WorkWell sites: Birmingham and Solihull; Coventry and Warwickshire; Cornwall and the Isles of Scilly; and Lancashire and South Cumbria.

Each site will test a slightly different model of referral. For example, in Birmingham and Solihull, GPs will issue a first fit note when needed, and all patients will be referred to a new support service that includes non-clinical staff such as social prescribers and work coaches.

Work and pensions secretary Pat McFadden said: "Fit notes are too often a dead end - a piece of paper that tells people they can't work but does nothing to help them get better.

"We're changing that. By bringing employers, the NHS, and patients together we can help people recover faster, stay connected to their jobs, and get the economy firing on all cylinders."

Reaction

Angela Matthews, director of public policy and research at the Business Disability Forum, said it welcomed plans to pilot a more flexible system.

"We are also pleased to see that the government is planning to consult with employers. This is vital if we want to make sure the new Fit Notes are fit for purpose and the process for delivering them is workable," she said.

"We are unsure about the practicalities of the three-way conversation between employee, employer and trained professional being proposed.

"We support this approach, but in our experience, this could be complicated to organise logistically and could make the return-to-work process longer. We will be feeding back on this."

Brett Hill, head of health and protection at consulting firm Broadstone, said the new approach was "more constructive and modern" than the existing fit note system.

"Bringing employers into the conversation from day one should help create more realistic return-to-work plans, including phased returns, adjusted duties and workplace support that can prevent people from falling out of the workforce altogether.

"That said, reforming the sick note process alone will not solve the underlying problem.

"NHS waiting lists remain far above pre-pandemic levels and, while people continue to face long waits for diagnosis and treatment, many conditions are likely to worsen, leading to higher levels of long-term sickness absence and economic inactivity."

Bertrand Stern-Gillet, CEO of EAP provider HA | Wisdom Wellbeing, said the new model would need to be accessible for people experiencing stress, anxiety, burnout or other mental health challenges.

"Time away from work without suitable intervention rarely resolves the underlying causes of mental-health-related sickness absence. In many cases, it actually increases the risk of long-term workplace absences and disengagement," he said.

"When someone reports mental-health-related sickness, organisations need to act and provide the necessary support immediately."

He also urged policymakers to look at the length of fit notes and how cases that progress into long-term sickness are managed.

"The sooner someone receives clinically governed support, the faster they are likely to return to work. Any trial that overlooks early intervention risks missing the single biggest factor in reducing long-term sickness absence," he added.

A new approach to the fit note system was initially suggested by Sir Charlie Mayfield in the Keep Britain Working review, published last year. He noted that the current system is "not working as intended" and had become a barrier to contact with employers.