Question to the Department for Work and Pensions:

To ask His Majesty's Government what pilots are currently underway to test reforms to the fit note system, including the locations and duration of those pilots, and the groups of patients and employers involved; what further reforms to the fit note system they are planning, beyond the current pilots; and when they expect to publish further details.

On 11th July 2025, we announced a WorkWell Primary Care Innovation Fund, which offered a portion of £1.5 million of single year funding to each of the fifteen WorkWell pilot sites to test innovative approaches to the fit note within primary care.

The funding is supporting local areas to boost capacity in primary care to provide better work and health support via the fit note process, with the longer term aims of reducing pressure on GPs and improving patients’ work and health outcomes.

Each of the 15 WorkWell Integrated Care Boards has received up to £100,000, with interventions running from October 2025 to March 2026. The locations of the sites are:

Birmingham and Solihull,

Black Country,

Bristol North Somerset and South Gloucestershire (BNSSG),

Cambridgeshire,

Cornwall and Isles of Scilly,

Coventry,

Frimley,

Greater Manchester,

Herefordshire,

Lancashire and South Cumbria,

Leicester, Leicestershire and Rutland (LLR),

North Central London,

North West London,

South Yorkshire, and

Surrey Heartlands.

One of the key aims of the funding is to build the evidence base for how the fit note process within primary care can be improved, and findings will inform future policy development. Most sites are using the funding to test new or additional roles within Primary Care Networks, including social prescribers, work and health coaches, or physiotherapists, to either issue the fit note instead of the GP or provide wraparound work and health support to the fit note recipient.

However, we know that we need to go further. The Keep Britain Working Review was clear that the fit note is ‘not working as intended’ and recommended that we test alternative approaches to the fit note, working with GPs and health services to explore improvements and replacements. We are currently considering how to respond to the Review’s recommendations on the fit note, and we will bring forward more information in due course.