Conservatives will end the broken sick note system

• Reforms to broken sick note system to get Britain working again
• Changes will free up GP time to allow them to focus on patient care
• New approach will mean no one who can return to work will be left for months on a repeat fit note 

Today [Friday 2^nd October 2026], the Conservatives have announced we will end the sick note system as we know it which sees 11 million sick notes issued each year, and 93 per cent of sick notes recorded as not fit for work', most with no explanation of why. 

Being signed off sick can be the first step on the way to a lifetime on benefits. Yet we do too little to prevent people from sliding towards claiming benefits. As the recent Mayfield review noted: Someone absent for 4 to 6 weeks has a 96 per cent chance of returning to work. Once absence extends beyond 3 months, the odds begin to fall in earnest. After a year, fewer than half return. And once somebody has become economically inactive for health reasons, the probability of moving into work within a year is just 3.8 per cent, against 47 per cent for someone who is unemployed. 

There have been numerous attempts to reform the system. In April 2010 fit notes replaced the old sick notes. The old sick note asked the GP for a diagnosis and a yes/no on whether the person should work, with little room for anything else. The fit note added a third option, may be fit for work. But in practice this has changed little. GPs rarely use the may be fit option. In the DWP-commissioned evaluation (IES and University of Liverpool, 2013, covering 58,695 fit notes), it appeared on 6 per cent of notes, or 12 per cent of patients. NHS Digital data put not fit for work at 93.8 per cent of fit notes in England in 2023.

The Fit for Work service, a government occupational health referral service, ran from 2014 until it ended in March 2018 after very low GP referral rates.

In 2022 nurses, occupational therapists, pharmacists, and physiotherapists could certify fit notes alongside doctors, to try and take the load off, and the process was made digital.

But meanwhile the numbers have exploded. According to a Policy Exchange report the total number of fit notes' issued each year since 2015 has doubled from 5.3m in 2015/16 to over 11m in 2022/23. 

In 2023 we launched the WorkWell pilots  15 pilots, each run by a local NHS integrated care board (ICB) in England, backed by £64m. The goal was to connect people to help to get back into work. The Labour government has finally started rolling WorkWell out nationally, but the crucial missing element is fit note reform.

Before the last General Election, the now-Shadow DWP Secretary Helen Whately announced plans to overhaul the fit note system, trialling shifting the responsibility for issuing the fit note away from GPs and reforming the way fit notes are issued alongside the WorkWell programme. The Labour government dropped this agenda on coming into office, and it took until May this year for Pat McFadden to announce a £3m pilot.

We need to increase the level of ambition and fundamentally change the system.

The most promising approaches in WorkWell are those in which GPs no longer issue fit notes to some or all patients. In the Cornwall pilot GPs refer patients directly to a non-clinical support service, without issuing a fit note. In Lancashire and South Cumbria, GPs refer patients to a support service made up of both clinical and non-clinical staff, without issuing a fit note.

The current system is broken:

• GPs are not the right people to lead this system they are not occupational or work specialists and do not want to be the gatekeepers of the welfare system. Time pressure does not allow GPs to consider fully a patient's occupation and what they may or may not be capable of doing. As the Health Foundation note, many health care professionals are not specifically trained or do not feel well-placed to have conversations about work and health.
• Data sharing between GPs and DWP has been poor during 2025 the BMA suspended cooperation regarding WorkWell and some pilots stopped.
• We do not really track or help people who may be on a trajectory towards benefits with escalating numbers of sick notes. The Health Foundation were right to call Fit Notes a missed opportunity for intervention.

We will overhaul the system:

1. GPs will refer patients seeking a fit note for 4 weeks or more (or seeking a repeat fit note which would take them beyond 4 weeks off sick) for assessment by an appropriate alternative health professional such as an occupational therapist, who will assess the individual's capacity to work and the extent of work they can do during any treatment or recovery period. This assessment will inform whether the individual may be able to claim SSP or temporary access to Universal Credit. 
2. We will build a system to triage, track, and help those who may be at risk of drifting towards a benefit claim and trial different forms of help to turn people around before they claim. At the moment this is not being attempted.

Depression and anxiety are the leading medical diagnoses associated with fit note provision. We will look into requiring all requests for fit notes for these reasons (not just those over 4 weeks) to be referred by GPs for assessment.

This new approach will be funded from the Department of Work and Pensions' budgets and wider welfare savings in the short term, though we think it will yield net savings in the longer term.

Individuals signed off sick will be reassessed: no one who may be able to return to work will be left for months on a repeat fit note we will start to track the use of repeat notes and start to target interventions on those drifting towards long-term sickness.

Kemi Badenoch MP, Leader of the Conservative Party, told The Times:

The fit note system is completely broken and is one reason we have ended up with millions of people stuck on long-term benefits.

The next Conservative government will fix this. We will stop passively waiting for people to drift on to benefits and take action to turn things round for them before they even end up at the benefits office. That's part of our common-sense plan to get Britain working again

Helen Whately MP, Shadow Work and Pensions Secretary, said:

The sick note system has failed. In Government I saw this failure and acted. But Labour caved to union pressure and abandoned our fit note reforms wasting two years in limbo.

Many GPs say fit notes should not be part of their job. They do not want to be gatekeepers to welfare. It's high time to change the system and make it someone else's responsibility people with the time and expertise.

Fixing this would free up GPs' time, keep more people in work and stem the flow from fit note to welfare. Better for everyone not least the taxpayer.

ENDS

Notes to Editors:

The Conservative plan to overhaul the fit note:

• GPs will refer anyone seeking a fit note for four weeks or more to a work specialist for assessment. Patients seeking a fit note for four weeks or more, or a repeat fit note that would take them beyond four weeks off sick, will be referred by their GP to an appropriate alternative health professional such as an occupational therapist. That professional will assess the individual's capacity to work and the extent of work they can do during any treatment or recovery period. The assessment will inform whether the individual can claim Statutory Sick Pay or temporary access to Universal Credit.

• The Conservatives will build a system to triage, track and help people at risk of drifting from a fit note onto benefits. The system will identify people on escalating or repeat fit notes who may be heading towards a benefit claim, and trial different forms of help to turn them around before they claim.

Sick notes are signing millions off work:

• Over 11 million fit notes were issued last year, around 93 per cent of them declaring the patient not fit for work'. In a statement to Parliament, the Work and Pensions Secretary, Pat McFadden, said we have known for some time that the fit note is not working as intended', confirming that over 11 million fit notes were issued last year and that around 93 per cent were issued as not fit for work' (Hansard, HCWS56, 21 May 2026, link).

• The number of fit notes has doubled in less than a decade, and most give no diagnosis. Policy Exchange analysis of NHS England data found that the number of fit notes issued each year doubled from 5.3 million in 2015-16 to over 11 million in 2022-23, and that 71 per cent of fit notes issued between April 2021 and December 2023 contained no diagnosis. Where a diagnosis was given, mental and behavioural disorders were cited in 37 per cent of cases (Policy Exchange, Not Fit for Purpose, 13 April 2024, link).

• After a year off sick, fewer than half of people return to work. The Keep Britain Working review found that someone absent for four to six weeks has a 96 per cent chance of returning to work, that the odds begin to fall in earnest once absence passes three months, and that after a year fewer than half return. Once somebody is economically inactive for health reasons, the probability of moving into work within a year is 3.8 per cent, against 47 per cent for someone who is unemployed (Department for Work and Pensions, Keep Britain Working: a national growth opportunity, September 2026, 23 September 2026, link).

• When people off sick for four weeks were last assessed by occupational health professionals, 94 per cent were found fit for work with adjustments or likely to be fit within three months. Under the Fit for Work service, assessments were carried out by occupational therapists, physiotherapists and mental health nurses. In England and Wales, 36 per cent of assessed employees were found fit for work with adjustments and a further 58 per cent were found not currently fit but likely to be fit within three months, against around 93 per cent of GP fit notes declaring the patient not fit for work' (Department for Work and Pensions, Fit for Work: Final Report of a Process Evaluation, Research Report 959, June 2018, link).

• One in five people signed off for five weeks or more never return to work. Policy Exchange found around a third of all fit notes are issued for five weeks or longer, and that 20 per cent of those receiving a fit note of this length will not return to work (Policy Exchange, Not Fit for Purpose, 13 April 2024, link).

• Acting early pays off more than ten times over. The Keep Britain Working review found that around 300,000 people with a health condition leave work every year, that health-related inactivity costs £45 billion a year in health-related benefits, and that the same effort applied a year earlier has an impact worth more than ten times as much (Department for Work and Pensions, Keep Britain Working: a national growth opportunity, September 2026, 23 September 2026, link).

• Occupational therapy clinics in GP surgeries cut sickness absence from 71 per cent to 15 per cent. A University of Nottingham study of occupational therapist-led vocational clinics across eight GP surgeries found the sickness absence rate among patients fell from 71 per cent to 15 per cent and the use of GP fit notes fell from 76 per cent to 6 per cent, with GPs reporting a lighter workload (Drummond A et al, Using occupational therapists in vocational clinics in primary care: a feasibility study, BMC Family Practice 21:268, 13 December 2020, link).

Previous attempts to fix the system have failed:

• GPs rarely use the may be fit for work' option introduced in 2010. A Department for Work and Pensions evaluation, carried out by the Institute for Employment Studies and the University of Liverpool, examined 58,695 fit notes issued to 25,000 patients in 49 GP practices between October 2011 and January 2013. Only around 12 per cent of patients received a fit note advising that they may be fit for work' (Department for Work and Pensions, Evaluation of the Statement of Fitness for Work (fit note): quantitative survey of fit notes, Research Report 841, 1 June 2013, link).

• The Fit for Work occupational health service was scrapped after low referrals. Fit for Work offered occupational health assessments to employees referred by their GP or employer. Following low referrals, the assessment service was closed in England and Wales on 31 March 2018 (Department for Work and Pensions, Fit for Work: final report of a process evaluation, June 2018, link).

The previous Conservative Government were overhauling the fit note process:

• Rishi Sunak, the Prime Minister at the time, gave a speech pledging to reform the sick note. On 19 April 2024, the then Prime Minister Rishi Sunak, gave a speech setting out plans to reform the sick note. In his speech, Rishi Sunak called for an end to Britain's sick note culture' and said the government would trial a system where specialist work and health professionals' determine if a person requires a fit note (10 Downing Street, Speech, 19 April 2024, link).

• The previous Conservative Government launched a call for evidence on fit note reform in April 2024. The call for evidence was explicitly described as a prelude to a full consultation on specific policy proposals which will be launched later this year'. The proposed new system had three core components involving a triage service directing patients to the most appropriate pathway; a work and health assessment with a trained professional; and the ability to refer patients to more intensive occupational health support. The programme was backed by £24 million announced at Autumn Statement 2023. As stated in the call for evidence at the time: We are testing shifting the responsibility for issuing the fit note away from primary care and reforming the way fit notes are issued so that people who can stay in work, or return to work sooner with the right help, are given exactly that. Labour failed to publish the outcome of the call for evidence for over two years, finally making it public on 21 May 2026 (Department for Work and Pensions, Call for Evidence outcome, 21 May 2026, link).

• The previous Conservative Government announced fit note trailblazers' to test different ways of supporting people seeking fit notes, but Labour failed to ever launch them. In May 2024, the previous Conservative government launched 15 WorkWell' pilots across England, backed by £64 million, covering a third of integrated care boards. In some areas, fit note trailblazers' were to be introduced to trial better ways of triaging, signposting, and supporting people seeking a fit note, with the aim of preventing those with long-term health conditions from falling out of work. The Labour government then failed to ever launch those trailblazers. (Department for Work and Pensions, Press release, 7 May 2024, link).

• The 2024 Conservative Party manifesto committed to overhauling the fit note process. The 2024 Conservative Party manifesto pledged to design a new system which moves the responsibility for issuing fit notes away from our hard-pressed GPs towards specialist work and health professionals, and we will test integrating this with the new WorkWell service to provide tailored support to help people stay in or get back to work' (The Conservative Party, The Conservative and Unionist Party Manifesto 2024, 11 June 2024, link).

Labour scrapped those reforms, belatedly setting out regurgitated plans:

• Labour did not publish the call for evidence findings until May 2026, nearly two years after it closed. The call for evidence closed on 8 July 2024. Its findings were published alongside Labour's pilot announcement in May 2026, showing that just three in ten healthcare professionals in primary care say fit notes are a good use of GP time, while six in ten employers think the current process is ineffective at supporting their employees' work and health needs (Department for Work and Pensions, Press Release, 20 May 2026, link; Department for Work and Pensions, Fit Note Reform: Call for Evidence Results, May 2026, link).

• Labour have launched 4 pilots across England looking to test reforms to the fit note system. In July 2026, the Government began pilots in four areas across England to test reforms to the traditional fit note. The pilots are testing whether patients should get a fit note from a GP first before being referred to a support worker, or skip the GP entirely. This is a watered-down version of the pilots launched by the Conservative Government two years prior (Department for Work and Pensions, Press release, 22 May 2026, link).