Question to the Department for Work and Pensions:

To ask His Majesty's Government, further to the Written Answer by Baroness Sherlock on 19 January (HL13274), whether they have now responded to the recommendations from the Keep Britain Working Review regarding the fit note; what further reforms to the fit note system they plan beyond the WorkWell Primary Care Innovation Fund pilots; and when they expect to publish those plans.

On 20th May 2026, the Government announced that it would test reform of the fit note, beginning with pilots across four integrated care boards in England. These pilots are funded by £3m in the first year and will take place within a small number of GP surgeries across the following areas: Birmingham and Solihull, Cornwall and Isles of Scilly, Coventry and Warwickshire, and Lancashire and South Cumbria.

The pilots will explore replacing the traditional GP-led fit note process with newly designed plans that provide better support to people who fall ill at work. They aim to move from a process of administrative sickness certification to a new service focussed on getting people the support they need to stay in work and sustainably return.

Whilst specific elements of pilot design are to be shaped locally, broadly, the pilots will test:

• New stay in work and return to work plans that provide patients with timely, proportionate, and actionable advice and support to manage their health condition
• New work and health teams who develop the plans and facilitate joined-up conversations between patients and their employers around support or adjustments needed in the workplace

The pilots have been designed through close engagement with GP leaders and the health system. We are also working with employer and patient groups to shape design as pilots progress. Within all four pilots, teams will be able to sign people off work who need time to recover from their illness. The pilots are focussed on the in-work population (either those who are at risk of falling out of work due to illness or those who are already signed off sick). Participation will be voluntary, and the pilots will not determine eligibility for any benefit entitlement or replace the Work Capability Assessment. Any future rollout or legislative reform will be informed by learnings from the pilots.

The fit note pilots are a key element of the Government's response to the recommendations made in the Keep Britain Working Review, published in November 2025. The Review was clear that the fit note is 'not working as intended', and called for the Government to test alternatives and replacements to the fit note. Any long-term system reform is expected to combine employer and state funded provision, balancing the engagement benefits of employer-led support with the necessity for non-workplace provision (for example, for those who leave work due to illness). We are working closely with the Keep Britain Working Vanguards as they test the 'best case' for an employer-led intervention, with the NHS-based pilots running in parallel, and learnings from each model being used to inform future reform.