Services | Patient Support

Fit Note Pilot

Supporting people to stay in and return to work well.

Some GP practices in Coventry & Warwickshire are taking part in a government pilot designed to provide better support to people who become unwell and need time off work. The new service provides personalised support based on individual health needs to help people recover and stay in or return to work with support. Patients registered with some GP practices in Rugby Primary Care Network or Sowe Valley Primary Care Network in Coventry, may be invited to take part in the pilot from autumn 2026 to March 2027. Find out more about what this means for you as a patient, an employer, or a health professional using the links below.

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I'm a patient

If you are eligible for this pilot, the process you normally follow to request fit notes will change, but you will still start by contacting your GP. Find out how this service will support you.

Guidance for patients
Patient FAQs

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I'm an employer

Find out how this pilot affects you and how you can help us learn what works well and what could be improved.

Guidance for employers
Medical evidence and Statutory Sick Pay

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I'm a health professional

Find out more about the pilot, including which PCNs are taking part and how it works.

Guidance for healthcare professionals
Sharing your feedback

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Guidance for patients

If you are registered with a GP practice participating in this pilot, you may be offered a referral into a Community Work and Health Team if you require more than one fit note from your GP. This team will provide tailored support based on your health needs.

How the pilot works

Our pilot is being introduced at several practices who are part of the Rugby Primary Care Network in Rugby and Sowe Valley Primary Care Network in Coventry. This pilot is for people who:

Are aged over 16
Are currently in work
Have a health condition affecting their ability to work for more than 7 days

If your GP practice is taking part, they will issue a first fit note in the normal way. If you return for another fit note, you will be offered a referral into a new Community Work and Health Team. This team includes social prescribers, physiotherapists, work and health coaches and occupational therapists. A member of the team will work with you to develop a workability plan which sets out ways to support you to remain in work or return to work in a managed way, or certify time off sick when needed. Participation is voluntary, but we encourage you to consider taking part as it will give you access to one-to-one support tailored to your specific needs. You will not be encouraged to return to work before you are ready and participation in the pilot will not be linked to or have any impact on eligibility for any benefits you may claim. Practices will join the pilot at different times and not all practices are taking part. If your GP surgery is not part of the pilot, the usual fit note process will remain in place.

What this means for you

When you are referred to the Community Work and Health Team, you will have an initial appointment with your case coordinator. They may be a social prescriber, an occupational therapist, or a different occupational health clinician depending on your health needs. During your first appointment, your case coordinator will explain the new approach in more detail and check you are happy to take part before proceeding. Your case coordinator will discuss how your health is affecting you, what you feel able or unable to do right now and what support, including from your employer, might help. You will work together to agree a workability plan which will replace your GP-issued fit note. Your workability plan might include:

What you are currently able to do at work
What you might be able to do with short‑term changes or support
What you should not do for now
Suggestions for temporary adjustments at work (such as changes to hours, duties, or a phased return)
A recommendation for time off work, if working is not appropriate
How long the plan should last

The new service will also certify time off for sickness where this is appropriate, including for benefits purposes. Your workability plan will enable the payment of Statutory Sick Pay, while valid and you will not need to request further fit notes from your GP.

Involving your employer

It’s often helpful for your employer to understand what changes or support are being suggested. You can share and discuss your plan with your employer yourself, or if you’d prefer, your case coordinator can approach your employer to help put your workability plan into practice. This might include:

Sharing your workability plan, so your employer understands what they need to do to support you
Explaining recommended adjustments
A three-way conversation between you, the case coordinator and your employer to help everyone understand what support or adjustments may be useful and to agree practical next steps

Only relevant information about how your health affects your work will be shared with your employer, to help your employer provide appropriate support. The service will not share detailed medical information with your employer unless you ask us to. Your employer is still legally entitled to request medical evidence (e.g. a fit note) for a sickness absence but we will encourage them to accept workability plans during the pilot, which should provide more tailored information to support you and them.

How we will support you

Your case coordinator will guide you through the process, help you understand your options, and coordinate any further support that you might need, such as from other services. They will also update your GP, so that they’re aware of what support you’ve been offered. A senior clinician will oversee your case coordinator, provide clinical guidance, support complex cases, and review any decisions that are needed. Your case coordinator will not:

Replace your GP or provide medical diagnosis or treatment – your GP will remain responsible for your clinical care.
Encourage you to return to work before you are ready
Decide or become involved with issues such as pay, sick pay, contracts, performance management, or other employment terms.

If you have any questions about the pilot that aren’t covered in our ‘frequently asked questions’ below, please contact our team on cwicb.fitnote@nhs.net

Frequently asked questions

Why is this pilot taking place?

Most patients, when they receive a “not fit for work” fit note, are not offered any advice that could help them stay in work or return to work sooner. These pilots are the first step towards a new approach to supporting sickness absence, providing earlier, personalised work and health support. The aim is to improve patient outcomes, reduce administrative pressure on GP practices, and provide practical advice for employers to help employees return to work safely.

What is changing during the fit note pilot

During this pilot, eligible patients registered at participating GP practices will continue to contact their surgery for a first fit note. GPs in the participating practices will issue a patient’s first fit note only. If you need another fit note, you will be offered a referral into a new Community Work and Health Team who will provide work and health support that is specific for you.

You will work with a dedicated work and health professional to understand how your health is affecting your work and what support may help. Together, you will develop a workability plan, which can be shared with your employer as evidence for time off or workplace adjustments, in the same way a fit note is used. The plan will also include the option to sign you off sick if needed.

Will I get the specialist care I need?

A workability plan replaces the fit note during the pilot. It sets out:

What a person is currently able to do at work
What they might be able to do with temporary adjustments
What they should not do for now
Whether sickness absence is recommended
When the plan should be reviewed

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Do I still have the right to be signed off sick?

Yes, absolutely. If needed, the service can recommend and certify time off work, and this will be clearly set out in your workability plan.

Do I have to take part?

No. Participation is voluntary, and you can choose to stop taking part at any time. But we recommend that you give the new service a go as we think that it will benefit you.

Will my employer be contacted?

Like with the current fit note, you will need to share relevant information from the plan with your employer, such as recommended adjustments or time away from work, to enable them to pay you statutory sick pay. But your workability plan is designed to help your employer understand any support that may help you stay in or return to work so we encourage you to share the relevant sections with them – or we can do this on your behalf if you prefer. Detailed medical information will remain confidential.

Will my medical details be shared with my employer?

No – detailed information about your health, medical condition, diagnosis, or treatment will remain confidential. The information shared with your employer focuses only on how your health affects your ability to work, including any temporary adjustments, restrictions, support needs, or recommendations for time off work.

What if I receive benefits or need a fit note for benefits purposes?

Taking part in the pilot will not affect any benefits you receive. If you receive, or need to claim, benefits such as Universal Credit or Employment and Support Allowance, and a second or subsequent fit note is required to support your claim, the Community Work and Health Team will provide one rather than your GP, alongside your workability plan.

I’m currently out of work. Does this pilot apply to me?

No, if you are not currently employed and need a fit note for benefits purposes, you will follow the normal process. However, additional support is available through the WorkWell scheme if you are facing mental health or health-related barriers affecting your ability to work.

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Guidance for employers

The Government is testing a new approach to supporting sickness absence. Coventry & Warwickshire is one of four pilots across the UK trialling different ways to support employees who are unwell and unable to work by providing earlier, tailored work and health support. The new approach also aims to help employers support people to stay in or return to work safely.

Within participating practices in Coventry and Rugby, a new Community Work and Health Team will support patients who request a second fit note. The team will work with patients and their employers where appropriate, to develop workability plans that set out ways to support them to remain in work or return to work in a managed way, or certify time off sick when needed.

Employers will have input into any recommendations, ensuring that they are reasonable, short‑term and practical, and to reflect what can realistically be done in the workplace.

What this means for you as an employer

If your employee is off work sick for more than 7 days, you may receive a workability plan instead of a fit note. The workability plan will include:

Where remaining at work is not appropriate, a recommendation for temporary sickness absence, including expected duration and review point.
A clear view of the employee’s work capacity, including:
- Which duties can be carried out as normal
- Which duties may be carried out with temporary adjustments
- Which duties should not be undertaken for a defined period
Practical recommendations for workplace adjustments, where appropriate.
Next steps and review arrangements, setting out:
- Actions for the employee, employer, and service where relevant
- When the plan should be reviewed or updated
To enable the pilots to be successfully evaluated, we strongly encourage you to accept the workability plan and to not request that your employee also provide a GP-issued fit note.

How you might be asked to participate in the pilot

With employee consent, you may be asked to:

Review draft workability plans by email
Engage in a three-way conversation with employee and practitioner
Discuss reasonable workplace adjustments
Support phased or flexible returns
Clarify expectations during recovery
Sign and implement the workability plan

The service will not:

Share detailed medical diagnoses with you
Replace any in-house occupational health provision
Make disciplinary or HR decisions

Medical evidence and Statutory Sick Pay

The workability plan will state where sickness absence is appropriate to enable the payment of Statutory Sick Pay if required. We strongly encourage you to accept workability plans instead of fit notes during the pilot, which should provide more tailored information to support an employer and their employee.

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Guidance for healthcare professionals

General Practice in Coventry & Warwickshire is contributing to a national fit note pilot run by the Department of Work and Pensions and the Department of Health and Social Care (Joint Work & Health Directorate). The aim is to improve outcomes for patients and employers, and reduce the administrative burden on GPs. This is an opportunity to shape policy and provide meaningful feedback on how potential changes to fit notes could impact general practice. The Coventry & Warwickshire pilot is taking place at two PCNs – Rugby PCN and Sowe Valley PCN in Coventry. The pilot is being delivered by Coventry & Warwickshire Integrated Primary Care (IPC) in partnership with practices and Coventry & Warwickshire ICB.

How our pilot works

The core principle of our pilot is that GPs will continue to issue first fit notes in the normal way. Patients requiring second fit notes will be referred to a dedicated multi-disciplinary Community Work and Health Team (CWHT) who will work with patients and employers (where appropriate) to provide personalised support. The pilot is voluntary – patients are encouraged to take part but they can opt out and follow the existing pathway.

A phased approach

The pilot will commence in October 2026 at two practices – Willenhall Primary Care Centre (Coventry) and Westside Medical Centre (Rugby). Once the new processes are established and the CWHT is fully staffed, we will begin rolling out to other interested practices within those PCNs. If your practice is interested in joining the pilot and you’re within Rugby or Sowe Valley PCNs, please contact us via cwicb.fitnote@nhs.net

Contact details

Access to the fit note pilot is via your GP if they are participating in the scheme. If you have any queries about the pilot, please contact cwicb.fitnote@nhs.net

About our fit note pilot

Coventry & Warwickshire Integrated Primary Care has been commissioned by Coventry & Warwickshire Integrated Care Board to deliver this pilot on their behalf. It is one of four Government pilots taking place across the country.