Conservatives will end the broken sick note system

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.”

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