As the government prepares to trial major changes to the sick note system in parts of England, many Independent readers have voiced alarm over plans that could see some patients referred to work and health coaches instead of being signed off sick by their GP.
Under the pilot schemes, GPs in some areas will stop issuing fit notes altogether, instead referring patients to support services staffed by a mix of clinical and non-clinical workers who will create personalised “return to work” plans. The government says the reforms are designed to move away from a “tick-box” system and help more people stay connected to work while recovering.
But many readers said the proposals misunderstood how fit notes are used in real life.
A recurring theme throughout the comments was that fit notes often help people remain in employment during periods of serious illness, rather than simply taking time off work.
Readers shared experiences of using fit notes while recovering from heart conditions, cancer treatment, mental health struggles and chronic illnesses, with many saying employers relied on them to make adjustments or approve phased returns.
Several warned that removing doctors from the process could leave vulnerable people under pressure to return to work too soon, while others questioned whether non-clinical staff could safely assess someone’s health needs without proper medical oversight.
Here’s what you had to say:
Fit notes helped me stay employed
I needed a fit note to help me STAY in my job. The recent onset of a heart condition means I am unable to perform the more strenuous tasks, and am off sick frequently. My employer has been very proactive, but quite reasonably requested a fit note. Not sure how you replace that. If too many are being issued, then that’s a GP issue, isn’t it?
GPs should also be challenged
That completely negates the responsibilities of GPs! People this, people that. How about you have a word with doctors who give out sick notes like they’re Smarties. They are the medical professionals – they shouldn’t be able to be hoodwinked, yet they never, ever get discussed as part of the problem. You can’t get a sick or a fit note without a GP! Take it to them, challenge them, and at the same time, if GPs believe they’ve given the right diagnosis, treatment and note, then they need to challenge the government and third parties like support services and say, “I am the medical professional here, back off!”
Sick notes prevented homelessness
Without my recent sick notes from my GP, I would not have been able to access Universal Credit and my self-employed income protection insurance, without which I would have become homeless while I recovered from my injuries at work. This has not been thought out properly.
A sensible pilot, not a crackdown
For all the noise, this note pilot isn’t the dawn of some Dickensian crackdown; it’s what happens when two actual adult elders are left alone in government long enough to tidy a corner of the room. One of them has the rare distinction of being both competent and unflappable, and the other has literally survived being stabbed by a constituent a few years back and still turns up to work – which, in the current climate, counts as a qualification in resilience bordering on the mythic.
Between them, they’ve managed something almost suspiciously sensible: a small-scale test to see whether the system can be nudged back towards sanity without punishing people who are genuinely ill. Genuine cases could still have their paper trail – this is Britain, after all, where bureaucracy is the closest thing we have to a national religion.
But because we live in a fast-fashion political culture, every pilot scheme is treated like a constitutional crisis. In reality, this is just two grown-ups saying, “Let’s try this properly, measure it, and adjust if needed,” which is so out of step with the usual Westminster theatrics that it feels borderline revolutionary.
If anything, the country should be relieved: for once, the machinery of state is being handled by people who don’t panic, don’t posture, and don’t need to check with a focus group before deciding whether the sky is blue.
Either fit for work or not
Either you are fit or you are not. It seems using detached, non-clinical specialists to determine this is a retrograde step.
Of course work should not be toxic and employers should be responsible for managing cooperatively with those that make their business function, and be keen that people are fit for work and not encouraged to return too early. I speak as a former employer in large and small businesses I owned.
Our health secretary should be focused on why people are getting or staying sick, what expedites becoming better, and what is causing illness that can be prevented throughout our working environment – like poor H&S enforcement, high stress levels, parental pressures and overworking, stress created by targets and penalties in schools, and more.
How will this get me back to work quicker?
I’m on a fit note at the moment that says I am not fit for work.
I had emergency surgery last weekend. Until I am healed enough to safely return to my lab job, I have to have a sick note so that after seven days I can get statutory sick pay. I would love it if there were some adjustments that could be made so that I could go back to work earlier, but the nature of my job means that there aren’t.
I wonder how the government thinks that people are magically going to heal from surgery or injuries? Or how hauling me out of the house to go to a “work consultant” when I need to be resting is going to get me back to work quicker?
Pain made returning impossible
I suffered an extreme attack of sciatica two years ago. No way in hell I could work as a bus driver. Tried to go back on a couple of occasions but the pain was too intense. Only returned after almost four months off. Still suffering the after-effects today. How in hell they think they could have got me back sooner – heaven help those in similar situations….
Forcing the sick back to work
So they will go after the sick and force them to work by using non-clinical staff to deny them financial support, so we basically have to work to death in a world of plenty. Having just survived two cancer operations, instead of hoping for support, people like me will be forced to work no matter the fatigue and sickness. Daily, people will be forced to quantify this to non-clinical work coaches who gain points from forcing the sick into work. To save money, how about the government reversing uncapped executive and bankers’ pay and stopping fighting wars?
Health decisions belong with the NHS
A return, if possible, to being fit and healthy enough to work 9–5, Monday to Friday, for example, is BEST assisted by the NHS.
The DWP know nothing about a person’s health and legally should NOT KNOW anything about the very personal details of one’s injury, illness, etc – not even if it is acute or chronic.
Medical is NHS and only NHS.
Cancer patients still face more hurdles
So say you have a cancer diagnosis and need urgent treatment. A fit note and discussions with your employer would ensure you had the time off needed to engage with treatment and recovery.
But Starmer’s Labour thinks that these people are having it easy. So not only do you have to negotiate with your employer, you also have to negotiate with a jobsworth with no medical background. Of course, it would be breaking tradition not to have a year-long wait for these services.
I wonder if they are hoping that people will be long dead before they get a penny in sick pay?
Five years from note to treatment
The problem is not the sick note. The problem is trying to find a pathway to treatment.
I found this out in 2010. After many workarounds, I had to have a total knee replacement because I could not function at work. It took five years from receiving the first sick note to having the operation.
Some of the comments have been edited for this article for brevity and clarity.
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