Pilot to test out changes to ‘broken’ fit note system

Sara White, Editor, Business & Accountancy Daily. Croner.

Government launches series of pilots to trial brand new fit note system as general consensus current approach to sick notes fails patients, employers and GPs.

The current system sees around 11 million fit notes issued every year, with more than 90% declaring the person ‘not fit for work’, illustrating how ‘broken’ the system is, the government said.

A £3m fund has been allocated to four pilots across England running through NHS WorkWell sites and selected major employers. The year-long pilot scheme will test out the best way to end the current tick-box approach, which does not offer any support or guidance to anyone. The plan is to replace fit notes with personalised ‘stay in work’ and ‘return to work’ plans for employees who fall ill, although the timeframe is not likely to be quick. 

The government said ‘the pilots will cover up to 100,000 appointments and last up to a year, with continuous testing to narrow down the most effective approach to tackling the steep increase in number of fit notes issued’.  

Patients will be offered either an initial fit note from a GP and then referred to community health workers – or go through the whole process without an initial fit note from a GP, and will instead be supported by a separate service staffed by clinical and non-clinical practitioners. 

They will provide a range of work and health support, including three-way conversations between patients, employers, and trained professionals - covering reasonable adjustments and keeping people connected to their workplace from the first day of absence, helping more people to stay in work with support. 

The initial trials will run in Birmingham and Solihull, Coventry and Warwickshire, Cornwall and the Isles of Scilly, and Lancashire and South Cumbria, each taking a different approach.

The overhaul of fit notes is long overdue, with heavy criticism of the existing system from all sides. The government found that six in 10 employers said the current process was ‘ineffective at supporting their employees’ work and health needs’. An even higher percentage of 71% of healthcare professionals working in primary care said fit notes were ‘not a good use of GPs’ time’. 

There is general consensus the fit note system does not work and the government plan to pilot different systems is supported by employers.

Bertrand Stern-Gillet, CEO at HA Wisdom Wellbeing, said: ‘It’s been clear for some time that the sick note system is not working in the way in which it was intended, and we welcome the government’s intention to review the way fit notes are issued.

‘However, any new model must remain accessible for individuals experiencing stress, anxiety, burnout or other mental health challenges. For those experiencing such conditions, they require clinically led support to ensure their wellbeing and ability to stay connected to work. 

‘I would urge policymakers to ensure that the trial also reviews the length of initial fit notes and the management of cases that progress into long term sickness. The sooner someone receives clinically governed support, the faster they are likely to return to work.’

CIPD, the professional body for HR and people development, welcomed the pilot, but called for more detail on employers’ involvement.

Ben Willmott, head of public policy at the CIPD, said: ‘The current fit note system is not working for anyone as a way of supporting people back to work, whether that’s employees, GPs or employers.

‘These pilots can provide useful insights that can lead to the development of a much more effective and joined up system. However, greater clarity is needed on how employers will be involved in practice. Employers must have a clear role and input into what support and opportunities they can realistically provide. This is a welcome direction of travel, but employer engagement will be key to its success.’

It is also important that any new system is not over burdensome for SMEs as these employers and their staff need to be supported, especially as HR resources may be limited.

Alan Price, CEO at BrightHR added: ‘Long-term absence hits small businesses hardest. When you’ve only got a handful of staff, even one person being off work can disrupt the entire operation. The work has to be redistributed, so everyone feels the impact.’

‘What we’re seeing from the current fit note system is that it often stops at signing people off, rather than actively supporting them back into work. That leaves employers managing the consequences, without the tools or guidance to resolve the issue. 

‘The longer someone is out of work, the harder it is for both the employee and employer to recover momentum. Anything that helps people stay in work or return sooner will make a big difference to small businesses.’

It is the same problem for the largest businesses in the country, which are equally critical of the current fit note process.

John Foster, chief policy officer at the CBI, said: ‘The fit note system is broken and fails employers, workers, and the economy. Business welcomes these pilots. They are an important step towards building a better system.

‘Employers have increased their investment in supporting employee health and wellbeing and hope that these pilots will direct efforts to interventions that have the greatest impact. 

‘An improved system also needs to restore employers’ confidence that absence from work is only recommended when it is justified.’

There are also questions about future levels of employer responsibility under the latest proposals.

Chris Wagstaff, health & safety director at Croner, warned: ‘If GP involvement reduces, employers will likely have greater responsibility for assessing an individual’s fitness for work, determining reasonable adjustments, ensuring duties are safe, and potentially making medical decisions.

‘With access to competent health & safety advice, these changes could have a positive impact on employers and employees alike. Earlier intervention via social prescribing would mean employers act sooner rather than relying on a medical professional to assess individual risk and control it, and better integration between health and employment support, is always positive.’

Alongside the NHS fit note pilots, Keep Britain Working Vanguard businesses - including EDF Energy, Siemens and BT Group – are also considering how employers can play a practical role in preventing absence where possible, and supporting safe, swift returns to work. 

The full outcome of the fit note consultation will be published on 21 May.

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