Fit Note Reform: The Pilots Reshaping Sickness Absence Management

For many years, the fit note has functioned as a largely administrative step in managing sickness absence. A GP assesses whether an employee can work, the relevant box is ticked, and the document is passed to the employer with little further guidance on what support might help that person return. The government now believes this approach is failing the people it is meant to serve, and from July 2026 four pilot schemes will begin testing a different model across selected NHS WorkWell sites in England.

A system under strain

The scale of the current system helps explain why reform is being considered. Around 11 million fit notes are issued each year, and more than nine in ten of them simply state that the individual is not fit for work. A government call for evidence found that only three in ten primary care healthcare professionals consider issuing fit notes a good use of GP time, while six in ten employers regard the existing process as ineffective in supporting their employees’