29 May 2024
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In sickness and in health: Government issues call for evidence on fit note reform

To The Point

The UK government has issued a call for evidence on reforming the fit note process in England.  The aim is to ensure that people are not signed off work without an assessment of what support might be required to remain in or return to work sooner. The move follows an increase in economic inactivity due to long-term sickness after the COVID pandemic. The call for evidence intends to gather information about how the current fit note process helps with discussions about work and health to inform trials and plans for wider fit note reform, including a full consultation on specific policy proposals later in the year. However, the Prime Minister has since called a General Election for 4 July, a few days before the call for evidence closes.  What does this mean for the future of fit notes? 


Fit notes are issued to employees to evidence a request for sick pay from their employer and for supporting a claim for health-related benefits.  They were first introduced in 2010 to replace the ‘sick note’.  The aim was to ensure patients received advice about the benefits of returning to work, and employers had the information they need to make changes to facilitate an earlier return to work.  The 2010 reforms included a new option to allow a GP to indicate that a patient ‘may be fit for work subject to the following advice’ and to provide general details of the functional effect of the individual’s condition and recommend common types of workplace adjustment: phased return to work, altered hours, amended duties and workplace adjustments.

Despite these aims, 93.8% of fit notes in 2023 were issued as ‘not fit for work’ and only 6.2% of fit notes issued between October 2022 and September 2023 included advice on how a patient might be fit for work.  In a speech on welfare on Friday 19 April 2024, the Prime Minister said "We don’t just need to change the sick note, we need to change the sick note culture so the default becomes what work you can do – not what you can’t.”  

The fit notes rules were amended in 2022 to allow a wider range of healthcare professionals (including registered nurses, occupational therapists, pharmacists and physiotherapists) to sign fit notes in addition to doctors.  However, between April and September 2023, only 8.4% of fit notes were issued by these groups, with the vast majority still issued by GPs.

In November 2023, the government announced plans to consult on reform to the fit note system in 2024 and published information about WorkWell, a proposed pilot scheme (England only) announced in the Spring 2023 budget, backed by £64 million in funding, which aims to better integrate local employment and health support for disabled people and people with health conditions.

On 7 May 2024, the government announced the initiation of "WorkWell" pilots in 15 areas across England from October 2024. The voluntary service aims to provide a single assessment and gateway to local employment support and health services for people with health conditions or disabilities. Participants can self-refer or be referred by their employer, GP or the community sector, and will be supported by a Work and Health Coach to create a plan to overcome work-related health and social barriers. The pilots will also test the integration of the fit note process with WorkWell in some areas before informing the potential future rollout of a national WorkWell service.

What do we know so far about the proposals for reform?
What happens now? Is fit note reform still likely?
What does this mean for employers?

The call for evidence invites employers to provide their views and experiences on the current fit note process and proposed changes until 8 July 2024. It is unclear whether this deadline might be extended after the general election on 4 July and what could happen next.  If the Conservative party were to regain power, it is likely that the  feedback gathered would inform the final design of the fit note reform and employers would have another opportunity to provide input during a consultation later in 2024 on specific policy proposals.  Things are less certain if the Labour party were to gain power.  In the meantime, Personnel Today has reported that the Society of Occupational Medicine has urged all major political parties to commit to introducing universal access to occupational health if voted in at the next general election, including, amongst other things, (a) a legal requirement for larger organisations to invest in occupational health services; (b) reforms to the fit note regime; and (c)  investment in a national centre for work and health to generate evidence for employers.  So, reform in this area could be on the agenda whatever the outcome of the general election. 

Next steps

Please let us know if you would like to discuss any of the issues or would like us to respond to the call for evidence on your behalf.

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