GPs across England will no longer automatically issue sick notes for patients unable to work. Instead, from November, family doctors will prescribe support such as job coaching, physiotherapy, or gym memberships under a major overhaul of the fit note system announced by Health Secretary Wes Streeting.
New Fit Note System: A Shift from 'Sick Note Britain'
The WorkWell scheme, initially piloted in 15 regions with high unemployment and sickness levels, is now being rolled out nationwide. GPs will collaborate with employment coaches to help patients write CVs and covering letters, and social prescribing link workers who refer patients to activities like gardening classes or gym memberships. Patients will also be connected to charities assisting with debt management and housing issues.
Streeting told the Mirror that England is “moving away from a system that just treats illness” after data revealed the number of fit notes issued annually has more than doubled over the past decade, from around five million to 11 million. However, recent figures show a slight decline: 2,853,624 fit notes were issued in the final quarter of 2025, down 14,935 from the same period in 2024.
How the Fit Note System Works
Fit notes are required if a person is unwell and cannot work for more than seven days. During the first week, workers can self-certify. Fit notes may confirm a person is ‘not fit for work’ or recommend they ‘may be fit for work’ with adjustments. They are used to claim benefits or statutory sick pay. Under the new system, GPs will prescribe specialist support from career coaches, physiotherapists, and occupational therapists rather than simply signing patients off work.
The reform has been funded from last month, allowing all family doctors to prescribe such support. The WorkWell rollout will come into force from November, marking the first major change to the fit note system since its introduction in 2010.
Regional Variations and Early Signs of Change
Data shows that the North East has the highest rate of fit notes per 100,000 registered patients, while London has the lowest. Streeting noted: “After a decade in which fit notes more than doubled, it is encouraging to see these early signs of change. But far too many people are still being quickly signed off without addressing the cause of the absence.”
Work and Pensions Secretary Pat McFadden added: “Too often, people with health conditions are signed off sick without the support they need to stay in or return to work—and that doesn’t help anyone. Now we’re rolling WorkWell out nationwide because supporting people to stay healthy and employed benefits individuals, businesses and our economy.”
The Government’s Health and Growth Accelerators are also bringing together NHS teams, occupational therapists, and employment advisers in areas with high health-related economic inactivity to prevent people from falling out of work in the first place.
