Fit notes

November 2025

RCGP position statement on fit notes

The Royal College of General Practitioners (RCGP) recognises the importance of supporting patients to remain in or return to ‘good work’, that is appropriate and beneficial for their wellbeing. We acknowledge the role that employment plays in improving health outcomes and wellbeing, as a signatory to the joint Healthcare Professionals’ Consensus Statement for action on health and work. The RCGP is committed to working with Government and system partners to ensure that any future reforms to the fit note system are aligned with the principles and expectations we set out below.

GPs have long taken much of the responsibility for certifying fit notes, with the specifics of the GP role and the process changing over time. The RCGP is clear that GPs should remain trusted patient advocates and autonomous medical professionals, not employment decisionmakers. Health and wellbeing principles must be the first priority in guiding fit note decisions, rather than economic or policy targets, although these may often align.

The RCGP has previously recommended digital expansion, sufficient resourcing, updated training and guidance for healthcare professionals, and improved access and input from specialist occupational health (OH) services. The College welcomed 2022 reforms that enabled digital signatures and extended the right to certify fit notes to a wider range of healthcare professionals as well as GPs, yet over 90% of fit notes are still issued by GPs. We continue to call for improvements to the fit note system, via evidence-based, well-resourced and patient-centred reform to reduce GP workload and improve outcomes and experiences for both patients and GPs. Similarly, the Government should formally uphold its commitment in the DWP Green Paper, to ensure that any reforms do not place additional un-resourced pressure on general practice.

The RCGP is aware of the potential for further reform of the fit note process and would support exploration of alternative models, which might include suitably trained specialist Work and Health Coaches, social prescribers, and occupational health professionals holding the responsibility for fit note assessments in pilot sites, with guidelines for referral to GPs and wider services as appropriate.

Given the complex and cross-domain nature of ‘work and health’, combined with significant workforce and workload pressures already facing GPs, the RCGP supports in principle proposals to transfer the majority of responsibility for long-term fit notes to other suitably trained professionals. GPs are typically not best placed to advise on workplace adjustments or work-specific matters and are not routinely in contact with employers or places of work. Strengthening a multi-disciplinary approach, including OH input and wider patient support is warranted, particularly to address health inequalities. This would ensure individuals are assessed by professionals who can, where appropriate, make referrals to medical or wider support services based on the specific circumstances, supporting personalised care delivered in the community and freeing up GPs time. Similarly, GPs and their teams should have the option to refer patients onto timely work and health support services, as we know early intervention improves outcomes.

To avoid duplication and bureaucracy, GPs and other suitable healthcare practitioners should, however, retain the ability to issue short-term fit notes (3 weeks or less) where appropriate. Patients typically see their GP for primary medical care when unwell, both about one-off sickness, and ongoing or fluctuating conditions such as asthma or mental health. If the patient is unable to work, it remains appropriate for GPs to issue a short-term fit note during that appointment/episode of care. Requiring referral to a separate work and health service in these cases could risk unnecessary delays, duplication, safety issues, and poorer experiences for both patients and providers.

Any reform of the fit note system must prioritise patient care and wellbeing as well as clinical autonomy, while recognising the realities of general practice. This reform must not be punitive in nature or driven solely by Government targets to reduce numbers of people out of work. A GP’s priority when making any clinical decision must be the health and wellbeing of the patient, not meeting Government targets to get people back into work. Similarly, wellbeing must be the priority for any member of the multidisciplinary team taking responsibility for certifying fit notes.

Whatever systems are put in place for fit notes in the future, it is critical to include appropriate resourcing, detailed guidance and clear communication, alongside transparent evaluation. The RCGP has emphasised the shared responsibilities of DWP, respective devolved bodies, and employers to provide a supportive environment for individuals with health conditions, and the need for rigorous training, safeguards, and holistic decision or assessment frameworks for any non-GP issuers. Any new model must be supported by appropriate OH expertise, functional infrastructure with integration of records and secure data system protocols, professional trust, and robust governance with audits of any automated or algorithmic processes, to protect personalised patient care.

ENDS.

You can read the College’s response to Sir Charlie Mayfield’s Keep Britain Working review on our news page.