The government has announced an overhaul of the fit note system, following the launch of several pilots.

Under the current system, there are 11 million fit notes issued every year. More than nine in ten declare the person not fit for work.

Four pilots across different areas of England will look at the best way to end what the government describes as a 'tick-box exercise', which doesn't offer support or guidance and replace it with personalised ‘stay in work’ and ‘return to work’ plans.

The new approaches will be tested through four existing WorkWell sites, backed by £3 million in the first year.

The pilots will cover up to 100,000 appointments and last up to a year.

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. 

Patients will be provided a range of work and health support, including three-way conversations between patients, employers, and trained professionals, which will cover reasonable adjustments and keeping people connected to their workplace from the first day of absence.

A call for evidence on fit notes shows that just three in 10 Healthcare Professionals in Primary Care say fit notes are a good use of GPs time, while six in 10 employers think the current process is ineffective at supporting their employees’ work and health needs.

In Birmingham and Solihull, GPs will issue the first fit note where needed, then all patients will be referred to a new support service led primarily by non-clinical staff, including social prescribers and work and health coaches.

In Coventry and Warwickshire, GPs will issue the first fit note, with patients able to be referred to a support service made up of both clinical and non-clinical staff.

In Cornwall and the Isles of Scilly, GPs will refer patients directly to a non-clinical support service, without issuing a fit note.

In Lancashire and South Cumbria, GPs will refer patients to a support service made up of both clinical and non-clinical staff, without issuing a fit note.  

Work and Pensions Secretary, Pat McFadden, said: "Fit notes are too often a dead end - a piece of paper that tells people they can’t work but does nothing to help them get better.

"We’re changing that. By bringing employers, the NHS, and patients together we can help people recover faster, stay connected to their jobs, and get the economy firing on all cylinders.

"That’s what these pilots are about, and that’s what this Government is committed to – fixing what is broken."

BMA’s Practice Business policy lead for GPs committee England Dr Clare Bannon said: “The BMA has contributed to the design of these pilots with DWP to overhaul the fit note system as we feel the current system is not working for GPs or patients. We welcome the opportunity to test how different models work and ensure the new process reduces unnecessary appointments for GPs, but most importantly provides support to patients.

“We will continue to input into the pilots to ensure they have appropriate occupational health support and do not inadvertently increase pressure on general practice or affect patient care. While we are supportive of this pilot, it must be underpinned by appropriate training, clinical oversight and clear governance.”