Fit Note Reform 2026 - What the Pilot Means for Employers

In May 2026 the government announced the biggest change to the fit note in more than a decade. From July 2026, pilot schemes will run in four areas of England, offering up to 100,000 appointments and testing a system that moves away from simply signing people off sick towards active work and health support.

The reform follows a long-running view that the current fit note is not working. The large majority of fit notes record that a person is not fit for work, with little practical advice on what would help them stay in or return to a job. For employers, that leaves the hardest part of absence management, the return to work, largely unsupported.

This guide explains what the fit note is now, what the pilots change, and the practical steps employers should take while the reforms are tested.

How the Fit Note Works Today

The fit note, formally the Statement of Fitness for Work, is the medical statement an employee provides when they are off sick for more than seven calendar days. For absences of seven days or fewer, including weekends, an employee can self-certify and no fit note is required.

A fit note records one of two assessments: that the person is not fit for work, or that they may be fit for work with support. Where it says they may be fit for work, the healthcare professional can suggest measures such as a phased return, amended duties, altered hours or workplace adaptations.

Since 2022, fit notes can be certified by a range of registered healthcare professionals, not only GPs. Nurses, occupational therapists, pharmacists and physiotherapists can all issue them where the condition falls within their professional scope. Guidance for employers on using the fit note is set out at GOV.UK: getting the most out of the fit note, and the ACAS guidance on fit notes and proof of sickness remains the practical baseline.

Why the System Is Being Reformed

The central criticism is that the fit note has become a certification exercise rather than a support tool. In the great majority of cases it records that someone is not fit for work and stops there, without identifying what would help them remain in employment.

That matters because long-term sickness absence and economic inactivity due to ill health have risen sharply. The government's position is that a brief appointment focused on signing someone off does little to address the underlying barriers to work, and that clinical time is being spent on administration rather than support.

The Fit Note Reform call for evidence set out the case for change, and the pilots are the test-and-learn response. The Department for Work and Pensions and the Department of Health and Social Care are running the work jointly.

How the Fit Note Connects to Sick Pay and Cost

The fit note is not just a clinical document. It is the evidence an employer relies on to manage sickness absence and, in many schemes, to administer Statutory Sick Pay and contractual sick pay beyond the self-certification period.

This link matters more from April 2026, because the Statutory Sick Pay reforms removed the three-day waiting period and the lower earnings threshold, so SSP is now payable from the first qualifying day for far more workers. The result is that absence carries cost from day one, and the quality of the return-to-work process directly affects how long that cost runs. Our Statutory Sick Pay April 2026 employer guide covers the change in detail.

A reformed fit note that identifies workable adjustments earlier should, in principle, shorten absences. That is the outcome employers have a direct financial interest in, and it is why the "may be fit for work" route deserves more attention than it currently gets.

What the Pilots Change

From July 2026, pilot areas will test new ways of handling the work and health conversation. The detail varies by model, but the common direction is to separate the question of certification from the question of support.

• Community Work and Health Teams. New teams of clinical and non-clinical staff will work with individuals and their employers to identify what would help someone stay in or return to work.
• Workability plans. Rather than a short statement that someone is not fit for work, the aim is a structured plan setting out adjustments and support.
• Routing away from the GP. Under some models a person still receives an initial fit note from a GP before referral. Under others, the GP-issued fit note is removed and the person is referred directly to a specialist support team.

This is explicitly a test-and-learn exercise. The findings are intended to shape future legislation and a national rollout, so the pilots are a signal of direction rather than a finished framework employers must comply with today.

What This Means for Employers Now

For employers outside the pilot areas, nothing changes in the immediate term. The existing fit note rules continue to apply, the fit note remains relevant to Statutory Sick Pay and absence management, and self-certification for the first seven days is unchanged.

What does change is the direction of travel. Employers should expect the emphasis to shift towards earlier, more structured work and health conversations, and towards acting on recommendations rather than simply filing a note. The "may be fit for work" option, which is currently underused, is central to that shift.

There is also a clear overlap with existing legal duties. Where an employee is disabled within the meaning of the Equality Act 2010, the employer's duty to make reasonable adjustments already applies, and the support measures a reformed fit note points to will often be exactly those adjustments.

Will Fit Notes Become Harder to Get

A frequent concern is that routing people away from GPs will make fit notes harder to obtain, leaving employers without the evidence they rely on. The pilots are designed to test exactly this question, and no national change to certification has been made.

For now, the safe assumption is that the existing evidence requirements continue. Where a model removes the GP fit note, it replaces it with a structured plan and a referral, so the intention is to provide better evidence of what support is needed, not to remove evidence altogether. Employers in pilot areas will receive specific guidance, and those outside should not change their absence evidence requirements yet.

Practical Steps to Take While the Pilots Run

The reforms reward employers who already manage absence actively. The following steps prepare an organisation for the direction the system is moving in.

1. Review your sickness absence policy. Make sure it sets out how fit note recommendations are considered, who is responsible, and how phased returns and amended duties are handled.
2. Train line managers on the "may be fit for work" option. Managers should understand that a fit note can recommend support rather than time off, and how to act on it.
3. Hold structured return-to-work conversations. A short, consistent return-to-work meeting after every absence is the single most effective tool for managing it well.
4. Connect with occupational health. Where available, occupational health advice complements the fit note and helps translate clinical recommendations into workable adjustments.
5. Document decisions. Record what was recommended, what was put in place and why, both for fairness and to evidence compliance with the Equality Act.

Government guidance is collected at GOV.UK: fit note, which is the place to watch for updates as the pilots report.

Common Mistakes Employers Make With Fit Notes

Most fit note problems are procedural rather than clinical. They tend to recur across organisations of every size.

• Treating "may be fit for work" as "not fit for work". If an employer cannot accommodate the suggested support, the note takes effect as if the person is not fit for work, but the employer should first consider whether the adjustments are workable rather than dismissing them by default.
• Ignoring the recommendations. A fit note's suggestions are advice, not binding instructions, but failing to consider them undermines both a fair process and any later Equality Act position.
• No return-to-work conversation. Skipping the return-to-work meeting removes the moment where adjustments are agreed and absence patterns are spotted.
• Demanding fit notes too early. Requiring a fit note within the first seven days, when self-certification applies, is a common and avoidable error.
• Poor record keeping. Without a record of what was recommended and what was done, the employer cannot evidence a fair and consistent approach.

A Worked Example

An employee returns a fit note after three weeks off with a musculoskeletal condition. The note states they may be fit for work, with a suggested phased return and a recommendation to avoid heavy lifting for a period.

A strong employer response is to hold a return-to-work meeting, agree a phased schedule in writing, reassign the lifting element of the role temporarily, and set a review date. A weak response is to file the note, conclude that a phased return is too much effort, and treat the employee as not fit for work until the note expires.

The first response gets a productive employee back sooner and evidences compliance with the Equality Act where the condition meets the disability test. The second extends the absence, raises the cost and creates legal risk. The fit note reforms are designed to push more employers towards the first response.

How Policy Pros Can Help

A reformed fit note will put more weight on the policies and manager behaviours that surround it. Clear documentation is what turns a clinical recommendation into a consistent, fair response.

Policy Pros writes the sickness and sick pay policies and return-to-work procedures that set out how fit note recommendations are handled, who acts on them and how adjustments are recorded. These sit within your wider HR policies and procedures and connect to mental health support at work, which is a common driver of long-term absence.

For the related changes to sick pay, see our Statutory Sick Pay April 2026 employer guide, and for the disability dimension see our reasonable adjustments employer guide.