GPs Face Uncertainty Over Fitness-to-Work Reforms: What It Means for Patient Care

Dr Helen Salisbury, a general practitioner from Oxford, has expressed significant concerns about proposed reforms to England’s fit note system, warning that shifting responsibility for assessing fitness to work away from GPs could damage the quality of patient care and clinical decision-making.

Writing in the British Medical Journal, Dr Salisbury outlined her fears about a potential new system where independent occupational health services—rather than GPs—would determine whether patients are fit to work. The concerns come as the government explores ways to reduce long-term sickness absence and support people back into employment through its Back to Work Plan and WorkWell programme.

“I fear that any change in the current system may mean that my patients encounter a more arbitrary, less qualified, and less compassionate face of bureaucracy precisely when they most need the skilled support of their GP,” Dr Salisbury wrote. Her warning reflects broader anxieties within general practice about maintaining the therapeutic relationship between doctors and patients during periods of ill health.

The fit note system has become a focal point for government reform efforts. According to analysis by the Centre for Social Justice, approximately 11 million fit notes were issued in England during 2025, with over 90 per cent concluding that employees were “not fit for work.” This figure translates to roughly 40,000 people being signed off work each working day, highlighting the sheer volume of cases that GPs manage.

The fit note, formally known as the Statement of Fitness for Work, was introduced in 2010 as an improvement on the previous sick note system. Designed to support both employees and employers, the fit note can indicate that someone might be fit for work with certain workplace adjustments, rather than providing a simple yes-or-no verdict on work capability. However, in practice, the system has been dominated by binary “not fit for work” decisions, often for extended periods.

The government’s proposed approach aims to address what ministers view as a worklessness crisis. The WorkWell programme, which began trials in selected areas in October 2024, represents a significant cultural shift. Rather than treating sickness absence as the automatic response to illness, the new approach encourages earlier intervention with integrated health and employment support, focusing on what individuals can do rather than what they cannot.

Under WorkWell, the fit note system is being reframed around functionality and tasks rather than blanket fitness judgments. Additionally, the scope of who can issue fit notes has expanded. As of now, nurses, physiotherapists, occupational therapists, and certain pharmacists can certify fitness for work within their scope of practice—a change intended to bring more specialist understanding of rehabilitation and workplace impact into assessments.

Dr Salisbury’s concerns highlight a critical issue: the foundation of good medical practice rests on trust between doctor and patient. She notes that clinical teaching emphasises that at least 80 per cent of diagnostic information comes from listening to what patients tell you about their symptoms. In assessing fitness to work, particularly for mental health conditions, this principle remains central. When a patient describes anxiety-related insomnia that prevents concentration or depression with intrusive thoughts making it difficult to leave the house, the GP’s clinical judgment—informed by knowledge of the individual patient—becomes invaluable.

Dr Salisbury acknowledges that not all fit note requests are straightforward. Some requests come from employers attempting to resolve workplace disputes by having staff signed off sick. Others come from employees facing genuine crises—such as caring for elderly parents—that necessitate time away from work even when they are not medically unwell. These nuanced situations require the contextual understanding and ethical judgment that a trusted GP relationship provides.

Dr Salisbury draws attention to existing concerns about work capability assessments, the system used to determine eligibility for personal independence payments. According to data she references, over two-thirds of decisions challenged on appeal are overturned, raising questions about the accuracy and fairness of non-GP assessments.

The challenge facing policymakers is genuine: long-term sickness absence has become a significant economic and social issue, with people sometimes remaining out of work longer than their condition necessitates. Early intervention and support to facilitate return to work can be beneficial when delivered sensitively.

However, transferring assessment responsibility to services less familiar with individual patients and lacking the continuity of care that general practice provides carries real risks. The government has committed to working with employers and GPs to develop best practices, but the details of how new systems will operate remain unclear.

Key Takeaways

• Dr Helen Salisbury, a GP writing in the British Medical Journal, has raised concerns about government plans to move fitness-to-work assessments away from GPs to independent occupational health services
• Over 11 million fit notes were issued in England in 2025, with more than 90 per cent concluding employees were unfit for work
• The government’s WorkWell programme aims to refocus on functionality and earlier intervention, with expanded scope for non-doctor professionals to issue fit notes
• Work capability assessments show high appeal overturn rates, raising questions about non-GP assessment reliability
• The debate reflects tensions between managing long-term sickness absence and preserving quality patient care

What This Means for Kent Residents

For patients across Kent and Medway, these reforms carry practical implications. If you are currently receiving support through your GP for sickness-related workplace matters, or if you are navigating long-term health conditions affecting work capacity, changes to the fit note system could affect how quickly you receive assessment and what type of support is available.

NHS Kent and Medway Integrated Care Board is monitoring the rollout of WorkWell locally, and GP practices across the region continue to issue fit notes as part of their standard clinical services. If you have concerns about your fitness to work or need support in managing health conditions alongside employment, speaking with your GP remains your first port of call. They can discuss your individual circumstances, explore workplace adjustments through occupational health where available, and access referrals to employment support services.

For further information on fit notes and workplace support, contact your local GP practice or visit the government’s WorkWell resources online.