The Department for Work and Pensions is using four England pilots to test a replacement for the standard fit note, with a new system built around personalised stay-in-work and return-to-work plans. For employers, this is more than an NHS process story. It is an attempt to turn sickness absence from a paper exercise into a supported conversation between patients, clinicians and workplaces. That matters because the present model is both large and blunt. Around 11 million fit notes are issued each year, and more than nine in ten record a person as not fit for work. In practice, many businesses receive a legal document with very little guidance on adjustments, timing or the support that might keep someone connected to their job.

The Department for Work and Pensions is presenting the pilots as a fix for a system that has drifted away from its original purpose. Findings from the government’s Fit Note Call for Evidence show only 29% of primary care staff think issuing fit notes is a good use of GP time. Among employers, six in ten said the current process is ineffective at supporting staff health and work needs. For business readers, that is the real point. This is not only about GP admin. It is also about lost hours, patchy communication and the cost of avoidable long-term absence. When a fit note becomes a binary sign-off rather than a route to workable adjustments, productivity suffers and workers can move further away from the labour market.

The pilots will run for up to a year and cover as many as 100,000 appointments. From July, four existing NHS WorkWell sites will test different operating models. Birmingham and Solihull, and Coventry and Warwickshire, will keep GPs involved in issuing an initial fit note before people can be referred onwards. Cornwall and the Isles of Scilly, plus Lancashire and South Cumbria, will test routes where patients are referred directly into support without a GP-issued fit note at the start. That design matters. Ministers are trying to find out whether the system works better when GPs remain the entry point, or when separate teams take on more of the process from day one. For general practice, it is a question of time and workload. For employers, it is a question of whether help arrives early enough to stop a short absence turning into a long one.

Under the proposed approach, support would not stop at a certificate. Patients could be guided by clinical and non-clinical staff, including social prescribers and work and health coaches, with a focus on reasonable adjustments and practical three-way conversations between the worker, the employer and a trained professional. The aim is to keep people linked to the workplace where that is safe and realistic, rather than letting contact fall away in the first weeks of illness. There is an important balance here. The government says people who need time off to recover will still get it, and medical groups have stressed that no one should be pushed into work when they are unwell. But the current model often leaves employers and workers with too little room between 'fully off' and 'fully back'. A better system would create more space for phased returns, altered duties and sensible adjustments.

The economic case sits behind the policy. Sir Charlie Mayfield’s Keep Britain Working Review argued that the fit note system is not working as intended and can become a barrier to contact with employers. The government is now tying reform to a wider effort to tackle economic inactivity, using the NHS-led WorkWell programme as the delivery route. The pilots have £3 million behind them in the first year, while WorkWell is being expanded nationally with a goal of supporting up to 250,000 people with a disability or health condition to get into or stay in work. The initial focus is on people already in work, with ministers still exploring how any larger reform will interact with the benefits system. The new stay-in-work and return-to-work plans are also meant to work for Statutory Sick Pay purposes, sitting alongside the government’s wider £3.5 billion employment support package and its claim that day-one Statutory Sick Pay changes will put an extra £400 million a year into workers’ pockets.

Reaction from the main groups is supportive but cautious. The BMA said it had helped design the pilots and wants evidence that they reduce unnecessary GP appointments without adding pressure elsewhere. The Royal College of GPs took a similar line, saying fit notes consume time that could be spent on patient care, but warning that any reform must be properly resourced and judged against patient wellbeing first. Occupational health and therapy bodies were more upbeat, arguing that a broader team can offer the kind of work-focused advice GPs are not always best placed to provide. The CBI backed the pilots as a route to a better system for workers and firms, while also making a point that many managers will recognise: employers need confidence that absence decisions are justified and backed by a process they can trust.

The next stage will be watched closely by larger employers involved in the Keep Britain Working Vanguard group, including EDF Energy, as well as smaller firms that often manage absence without in-house occupational health support. If the pilots show that early conversations and better adjustment plans reduce time away from work, the case for national reform becomes much stronger. If they simply move paperwork from one part of the system to another, employers are unlikely to see much benefit. That leaves ministers with a fairly plain set of tests. Does the new process cut GP admin. Does it help people recover without losing their foothold in work. Does it give employers a clearer route for safe returns. And can it reduce the drift into long-term inactivity that has become one of the UK labour market’s most stubborn problems. The government says positive findings would feed into legislation; the real measure will be whether the new system works in day-to-day business life.