The British government has finally noticed that handing someone a piece of paper saying 'you can't work' without offering any support to get better might not be the most effective policy. In a groundbreaking move, they're testing out a system where GPs actually help patients stay employed instead of just signing them off forever.

Under four pilot schemes backed by £3m of funding, GPs in Birmingham and Solihull, Coventry and Warwickshire, Cornwall and the Isles of Scilly, and Lancashire and South Cumbria will try different approaches over up to a year, covering 100,000 appointments. In some areas, fit notes will still be issued but patients will also get referrals to support services; in others, the fit notes will be scrapped entirely in favor of direct referrals.

The current system issues over 11 million fit notes annually, a number that has risen since the pandemic, and more than 90% of them simply declare patients 'not fit for work' rather than suggesting adjustments. Work and Pensions Secretary Pat McFadden described fit notes as 'too often a dead end - a piece of paper that tells people they can't work but does nothing to help them get better.'

The pilots will test whether support should be led by healthcare professionals or non-clinical staff like work coaches and social prescribers, and will involve conversations with employers about adjustments. They'll be delivered through existing NHS WorkWell sites, which connect patients with physiotherapy and counselling.

The move follows a review by former John Lewis chairman Sir Charlie Mayfield, which found the system 'not working as intended' and noted most GPs lack the training and time to assess someone's ability to work. Hundreds of GPs told the BBC they had never refused to sign a patient off work for mental health issues, and many said fit notes shouldn't be part of their job.

Reactions were predictably mixed. The Royal College of GPs President Prof Victoria Tzortziou Brown welcomed reform but warned it must 'put the health and wellbeing of patients first' and not create additional workload. The Confederation of British Industry said the current system 'fails employers, workers, and the economy.' Mental health charity Mind urged caution, saying people with mental health problems 'must not feel pressured to work when they don't feel able.'

Shadow health secretary Stuart Andrew called it 'good to see Labour finally waking up to fit note reform,' while the government continues grappling with a ballooning benefits bill driven by rising mental health issues among young people and muscular skeletal issues in older groups. Last year, Labour dropped major welfare changes that would have saved £5bn a year after a rebellion by its own MPs.