The government has announced an overhaul of the existing fit note system through a new pilot trial delivered through selected NHS WorkWell sites and major employers.
The current system sees some 11 million fit notes issued every year, with more than nine in 10 declaring the person not fit for work.
Pilots across England
Pilots in Birmingham and Solihull, Coventry and Warwickshire, Cornwall and the Isles of Scilly and Lancashire and South Cumbria will look at the best way to introduce personalised stay in work and return to work plans for workers who fall ill.
The pilots will cover up to 100,000 appointments and last up to a year, with continuous testing, in order to narrow down the most effective approach to tackling the inherited 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.
First step ahead of wider reform
It is the first step in the government’s plan for fit note reform – with pilot findings due to be shaped by patients, healthcare staff and employers – before the government brings forward legislation to further reform the system.
The launch comes as the government publishes the Fit Note Call for Evidence which shows 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.
Mayfield Review
Trials of a new approach was recommended by the former John Lewis chairman Sir Charlie Mayfield in his Keep Britain Working review, which noted that the fit note system is “not working as intended” and had become a barrier to contact with employers.
Constructive and modern approach
Brett Hill, head of health and protection at independent consultancy Broadstone, said: “It’s encouraging to see the government recognising that the current sick note system is no longer fit for purpose. For too long, the process has focused on signing people off work, rather than providing meaningful support to help them stay in work or return safely and sustainably following illness.
“These pilots represent a much more constructive and modern approach by encouraging earlier intervention, greater collaboration with employers and more personalised support for people dealing with both acute and chronic health conditions.
“Bringing employers into the conversation from day one should help create more realistic return-to-work plans, including phased returns, adjusted duties and workplace support that can prevent people from falling out of the workforce altogether.”
Filling the healthcare gap
Though Hill noted that reforming the sick note process alone will not solve the underlying problem.
“NHS waiting lists remain far above pre-pandemic levels and, while people continue to face long waits for diagnosis and treatment, many conditions are likely to worsen, leading to higher levels of long-term sickness absence and economic inactivity,” he continued.
“As a result, many employers are increasingly stepping in to fill the healthcare gap themselves through greater investment in preventative care and early intervention. We are seeing increased use of health screening, private GP access, mental health support and structured wellbeing services to identify and address issues earlier, before they escalate into longer-term absences.”
Key part of the solution
Hill added that the Keep Britain Working review rightly highlighted the important role that both employers and private healthcare providers can play in supporting the health of the workforce.
“We hope the government builds on this by recognising employers, and workplace benefits, as a key part of the solution – not only in helping people remain in work, but also in easing pressure on NHS services, reducing economic inactivity and supporting wider economic growth and productivity,” he concluded.
Quicker access to right support
Paul Shires, director at Health Shield Friendly Society, maintained moving beyond a system that simply signs people off work could help reduce long-term absence, but only if it gives people quicker access to the right support.
“Research in our Britain at Work report supports this, with findings showing 34% of employees have considered reducing hours or leaving work due to a health-related issue, but 75% believe that faster access to diagnostics or treatment would help them return to work sooner, showing how important early practical intervention can be,” he continued.
Wider shift
Shires noted that the government’s plans reflect a wider shift in how we think about health at work.
“Employee wellbeing, access to healthcare and business performance are now closely linked, with 53% of employees telling us NHS waiting times or access to treatment have affected their ability to work, and 55% saying they’ve struggled to get a GP appointment,” he continued.
“With indications that government policy is shifting towards keeping Britain working, employers should be considering implementing affordable wellbeing strategies that support the whole of the workforce by providing access to proactive care that addresses problems before they require time off.”
