The Department has published guidance on GOV.UK for any healthcare professionals eligible to issue fit notes. The guidance states that the length of a fit note depends on the healthcare professional’s clinical judgement. During the first six months of a patient’s health condition, a fit note can be issued for a maximum of three months at a time. Where the condition has lasted for more than six months, a fit note can be issued for any clinically appropriate period, up to an indefinite period. Further information is available in the fit note guidance for healthcare professionals and the detailed guide to completing the fit note.

In May 2026, the Government announced that it would test reform of the fit note, beginning with pilots across four integrated care boards in England.

The pilots will test a fundamentally different approach, exploring replacing the traditional general practice (GP) led fit note process with newly designed plans, and new work and health teams, that provide better support for people who fall ill at work.

Clear clinical oversight and escalation routes are built into the pilots, which have been designed through close engagement with GP leaders and the health system. GPs will retain a meaningful role in complex cases, including providing clinical evidence where appropriate.

The Government is taking a test and learn approach to design and delivery, and any future rollout or reform will be informed by learnings from the pilots. The current fit note system, where fit notes can be certified by healthcare professionals including GPs following clinical assessment, will continue in non-pilot areas during the pilot period.

Fit notes can be certified by five groups of healthcare professionals: doctors; nurses; occupational therapists; pharmacists; and physiotherapists.

Fit notes are based on the professional’s clinical assessment of a patient’s health condition, and their clinical assessment of the patient’s fitness for work. In carrying out suitable clinical assessments of a patient’s health condition, this should include reference to National Institute for Health and Care Excellence (NICE) guidelines, where relevant.

NICE guidelines are not mandatory, however professionals and practitioners are expected to take NICE guidelines fully into account, alongside the individual needs, preferences, and values of their patients and service users, when exercising their professional judgement.

The Government’s recently announced fit note pilots will test reforms to the fit note in four integrated care boards across England. These pilots will test replacing the traditional general practice (GP) led fit note process with newly designed plans, and new work and health teams, to better support people who fall ill at work.

Clear clinical oversight and escalation routes are built into the pilots, including to ensure GPs retain a meaningful role in complex cases. Any future rollout or reform will be informed by learning from the pilots.

Legislation was amended in 2022 to widen the list of professionals eligible to issue a fit note to include pharmacists, physiotherapists, occupational therapists and registered nurses, alongside doctors.

The changes were made following extensive consultation with a wide range of healthcare professionals and their professional bodies. The aim of the changes was to ease the burden on GPs, streamline the interface between primary and secondary care, and enable fit notes to be issued by the clinician closest to the patient at the time they needed a fit note.

While paramedics are not able to issue fit notes, they and other Allied Health Professionals can contribute to decisions on sickness certification through completion of an AHP Work and Health Report. This may be considered by eligible professionals when issuing a fit note.

In May, the government launched pilot programmes across 4 Integrated Care Board areas in England to reform the fit note process. The pilots will test a fundamentally different approach, exploring replacing the traditional GP-led fit note process with newly designed plans that provide better support to people who fall ill at work. The long-term aim is for fundamental reform of the fit note process, and the pilots are not intended to revisit or reopen questions around paramedics issuing fit notes.

The total budget for the Fit Note Reform Pilots in 2026–27 is £3 million, distributed across four pilot areas. Funding allocations differ between each area, reflecting local workforce configurations, delivery models and expected patient volumes agreed with each Integrated Care Board (ICB). Lancashire and South Cumbria has been allocated up to £1.15 million to support delivery of the pilot.

The Lancashire and South Cumbria pilot will be delivered through a multidisciplinary Community Work and Health Team, with an agreed balance of approximately 50 per cent clinical and 50 per cent non‑clinical roles. It will include a mix of existing WorkWell Work and Health Coaches and clinical, care coordination and employer engagement roles, supported by appropriate clinical and operational leadership.

Final workforce numbers and role profiles will be confirmed as implementation progresses.

The total budget for the Fit Note Reform Pilots in 2026–27 is £3 million, distributed across four pilot areas. Funding allocations differ between each area, reflecting local workforce configurations, delivery models and expected patient volumes agreed with each Integrated Care Board (ICB). Lancashire and South Cumbria has been allocated up to £1.15 million to support delivery of the pilot.

The Lancashire and South Cumbria pilot will be delivered through a multidisciplinary Community Work and Health Team, with an agreed balance of approximately 50 per cent clinical and 50 per cent non‑clinical roles. It will include a mix of existing WorkWell Work and Health Coaches and clinical, care coordination and employer engagement roles, supported by appropriate clinical and operational leadership.

Final workforce numbers and role profiles will be confirmed as implementation progresses.

As announced on 20 May 2026, the Government is testing reform of the fit note through pilots in four ICB areas in England.

The pilots will support more effective conversations on workplace adjustments by replacing the traditional fit note with a voluntary service in which Community Work and Health Teams will work with individuals to develop personalised workability plans. These plans will set out work capacity, recommended workplace adjustments and any additional support needed to help people remain in or return to work sustainably. Employers will be encouraged to engage in the process, including through direct dialogue with the individual and their case coordinator where appropriate, helping to ensure that any adjustments are reasonable, proportionate and practical. Employers will retain responsibility for all employment decisions, and the service will not replace existing occupational health provision or override workplace policies.

Officials are working with a wide range of employer groups, including representatives for small and medium-sized employers such as the Federation of Small Businesses to shape design and delivery of the pilots. Evidence gathered through the pilots, including qualitative research, will capture the experiences and views of a range of stakeholders, including small and medium‑sized employers, to assess the viability and deliverability of the models being tested.

As announced on 20 May 2026, the Government is testing reform of the fit note through pilots in four ICB areas in England.

The pilots will support more effective conversations on workplace adjustments by replacing the traditional fit note with a voluntary service in which Community Work and Health Teams will work with individuals to develop personalised workability plans. These plans will set out work capacity, recommended workplace adjustments and any additional support needed to help people remain in or return to work sustainably. Employers will be encouraged to engage in the process, including through direct dialogue with the individual and their case coordinator where appropriate, helping to ensure that any adjustments are reasonable, proportionate and practical. Employers will retain responsibility for all employment decisions, and the service will not replace existing occupational health provision or override workplace policies.

Officials are working with a wide range of employer groups, including representatives for small and medium-sized employers such as the Federation of Small Businesses to shape design and delivery of the pilots. Evidence gathered through the pilots, including qualitative research, will capture the experiences and views of a range of stakeholders, including small and medium‑sized employers, to assess the viability and deliverability of the models being tested.

The fit note reform pilots are designed to support individual employees to remain in, or return to, work. This will include engaging with their employers, where appropriate, as part of that process, rather than targeting employers or businesses directly. As such, it is not possible to estimate how many employers in Lancashire and South Cumbria will participate.

Our initial modelling suggests up to 40,000 appointments lasting 30 minutes on average will be available for employees within Lancashire and South Cumbria. Officials are working with a wide range of employer groups, including representatives for small and medium-sized employers, to shape design and delivery of the pilots. Guidance will also be provided to support effective employer engagement with the pilots.

The Department is taking a test-and-learn approach to gathering evidence to determine the viability and deliverability of the tested models for the fit note reform pilots, so that we can take a rapid, iterative approach. We envisage a combination of qualitative methods to be used to assess the effectiveness of the pilots, such as qualitative interviews and focus groups, observational research of the processes and patient journey mapping

In the longer term, as the design of the pilots matures and we undertake wider testing the Department expects to move towards more quantitative analysis, including the development of metrics to assess outcomes, such as return to work rate, and effectiveness.

These test and learn pilots are anticipated to run until Spring 2027, with findings from this expected to inform any decisions on wider roll out along with any wider testing of these reforms.

The Department is taking a test-and-learn approach to gathering evidence to determine the viability and deliverability of the tested models for the fit note reform pilots, so that we can take a rapid, iterative approach. We envisage a combination of qualitative methods to be used to assess the effectiveness of the pilots, such as qualitative interviews and focus groups, observational research of the processes and patient journey mapping

In the longer term, as the design of the pilots matures and we undertake wider testing the Department expects to move towards more quantitative analysis, including the development of metrics to assess outcomes, such as return to work rate, and effectiveness.

These test and learn pilots are anticipated to run until Spring 2027, with findings from this expected to inform any decisions on wider roll out along with any wider testing of these reforms.

All healthcare professionals currently eligible to issue fit notes will continue to be able to do so. The Government is not bringing forward any changes to fit note legislation as part of the fit note reform pilots.

The four fit note pilots will test a voluntary service in which new Community Work and Health Teams work alongside patients and their employers to develop personalised workability plans to support people to remain in work or to return to work sustainably. All four pilots include, within the make-up of the team workforce, healthcare professionals eligible to issue fit notes where required.

The sick note was replaced by the fit note in 2010. Since 2022, fit notes can be issued by doctors, registered nurses, occupational therapists, pharmacists, and physiotherapists.

The latest data published by NHS England shows that out of the 10,974,495 fit notes issued electronically in primary care in England between January and December 2024, 9,898,344 were issued by general practitioners (GPs). This means that GPs issued 90.2% of these fit notes.

Data is only available for fit notes issued electronically within primary care in England, meaning that paper fit notes or fit notes issued in hospitals are not included in these figures. The published statistics can be found at the following link:

https://digital.nhs.uk/data-and-information/publications/statistical/fit-notes-issued-by-gp-practices

Updated figures will be published by NHS England on 23 October and will provide fit note data up to June 2025.