Doctor's Note Optional: DWP Just Cut GPs Out Of Two Of Its Four Sick Note Pilots

The Government has declared the UK fit note system "broken" and from July 2026, two of its four new pilots will let patients skip the GP entirely.

The Department for Work and Pensions announced on 20 May 2026 that it will trial four different models of fit note reform through existing NHS WorkWell sites, backed by £3 million in the first year. Around 11 million fit notes are issued each year in the UK, with more than nine in ten simply declaring the patient “not fit for work”, what Work and Pensions Secretary Pat McFadden called "a piece of paper that tells people they can't work but does nothing to help them get better."

The same press release reveals that just 29% of primary care staff believe issuing fit notes is a good use of GP time, and six in ten employers say the current process is ineffective at supporting their staff's work and health needs.

• From July, the four pilot areas will each test something different. Across Birmingham and Solihull, the GP still issues the first fit note, but all patients are then referred to a non-clinical support service of social prescribers and "work and health coaches." Coventry and Warwickshire keep the GP fit note but add a mixed clinical/non-clinical support route. Then it gets bolder: in Cornwall and the Isles of Scilly, the GP issues no fit note at all and refers the patient straight to a non-clinical service. Lancashire and South Cumbria do the same, but with a clinical/non-clinical mix. The pilots will cover up to 100,000 appointments over a year, with results feeding into legislation.

Crucially for employers, the new model includes three-way conversations between patients, employers and trained professionals covering reasonable adjustments, from day one of absence.

The numbers behind the reform are eye-watering. 2.8 million working-age adults are now economically inactive due to ill health, up around 800,000 since the pandemic, with projections of another 600,000 by 2030 without action. UK sickness absence costs employers an estimated £103 billion a year, closer to £138 billion if you factor in presenteeism. The CIPD's latest figures put average sickness absence at 9.4 days per employee per year, with mental ill health the number one cause of long-term absence.

The pilots run alongside Statutory Sick Pay reforms taking effect from April 2026 that make SSP payable from day one, putting an extra £400 million a year into employees' pockets but also onto employer payrolls. The Keep Britain Working Vanguards,  including EDF Energy, will be testing the employer-side practices in parallel.

Industry reaction has been broadly supportive but cautious. The CBI's John Foster welcomed the pilots while noting that "an improved system also needs to restore employers' confidence that absence from work is only recommended when it is justified." The BMA's Dr Clare Bannon backed the trials but warned they must include "appropriate occupational health support and not inadvertently increase pressure on general practice." The RCGP's Professor Victoria Tzortziou Brown urged that any reform must be "fully resourced" and put patient health first.

We'd like your views:

• Removing GPs from the sign-off in two of the four pilots is this freeing doctors from box-ticking, or is it stripping clinical judgement out of a genuinely medical decision?
• Is a "social prescriber" or "work and health coach" really qualified to decide whether someone with depression, long COVID, or a slipped disc should be back at work?
• The new model brings employers into three-way conversations from day one of absence. Is that supportive, or does it pressure sick employees to come back before they should?
• If 94% of fit notes currently say "not fit for work", does that mean the system is broken — or does it just mean most people who see their GP genuinely are not fit for work?
• With SSP now paid from day one from April 2026, will employers actually welcome an aggressive "stay in work" approach, or are we about to see a wave of disputes when someone signed off by their GP is told by a work coach they could be back in the office?
• Should there be a national rule that all employees on long-term absence get a structured stay-in-work conversation, or do you trust your line managers to handle this without a Government-mandated process?

For small business owners, you don't have an HR department, an occupational health provider on speed dial, or the bandwidth to run a "three-way conversation" with a work coach. We'd like your views:

• If one of your five employees is signed off tomorrow, would you actually want a Government-funded work coach involved, or do you think you and your member of staff can sort it between yourselves over a coffee?
• The SSP day-one change from April 2026 hits SMEs hardest. Are you planning to introduce stricter return-to-work interviews, or just absorbing the cost?
• The pilots assume employers will engage in three-way conversations. As an SME, do you have the time, training and confidence to sit in one of those with an employee and a clinician, or does the idea make you nervous?
• Could a service that connects your sick employee directly to support (physio, mental health, debt advice via social prescribers) actually be a gift to small businesses who can't afford private occupational health?
• Would you back a "buddy SME" version of the WorkWell scheme, where a cluster of local small businesses shares a return-to-work coach? Or is this a job for government, not the high street?
• Honest answer: When someone in your team last went off sick long-term, did you have a documented return-to-work plan, or did you wing it? And if the Government rolls this out nationally, will your absence policies pass the test?