Lancashire and South Cumbria to test new fit note reform pathway

Lancashire and South Cumbria ICB has been selected to take part in the national Fit Note Reform Pilot, helping to test a new approach that aims to improve support for people whose health affects their ability to work.

The pilot, which will commence in July 2026 and run for 12 months is designed to address a well-recognised system challenge: too often, the current fit note process focuses on certifying sickness rather than providing timely, practical support to help people remain in work or return to work safely.

Nationally, more than 11 million fit notes were issued electronically in general practice last year, with around 93 per cent recorded as ‘not fit for work’. In many cases, this does not lead to wider work and health support for the individual and adds avoidable pressure to GP services.

This pilot will test a different model. For eligible patients, GPs in selected areas will refer directly into a dedicated multidisciplinary service rather than issuing a fit note. The service will provide more tailored, work-focused support, helping individuals understand what they can do, what adjustments may be needed, and what support may help them stay in or return to work.

What the pilot will involve

Lancashire and South Cumbria ICB will test the nationally specified Model 3 approach. Under this model, fit note activity for eligible patients is shifted away from routine GP certification and towards a PCN-aligned multidisciplinary team (MDT) with both clinical and non-clinical expertise.

The MDT will work with patients to undertake a biopsychosocial assessment, develop a co-produced workability plan, and coordinate any follow-up support needed. With patient consent, the service may also engage employers to help identify reasonable workplace adjustments and support return-to-work planning.

The proposed delivery model will be hosted by Morecambe Bay Primary Care Collaborative, working in alignment with existing WorkWell provision. The intention is to provide a consistent end-to-end pathway that includes triage, assessment, planning, employer engagement where appropriate and follow-up support.

Where the pilot will operate

The pilot will be delivered through selected primary care network footprints to ensure consistency across participating practices.

Currently we have one PCN approved and this is the Barrow Together PCN which is made up of the following GP practices:

• Abbey Road Surgery
• Atkinson Health Centre
• Bridgegate Medical Centre
• Burnett Edgar Medical Centre
• Duke Street Surgery
• Norwood Medical Centre
• Risedale Surgery
• The Family Practice

There is the potential for a second PCN to take part in this pilot, pending approval. Once an update is available, we will include the detail on this webpage.

What this means for GP practices

For practices outside of the pilot area there is no change to the current fit note processes.

For participating GP practices, the pilot is intended to reduce the administrative burden associated with fit note issuing for eligible patients and offer a more supportive alternative for people whose health is affecting work.

In practice, this means that rather than issuing a fit note first, GPs will be asked to identify eligible patients and refer directly into the pilot service. The MDT will then take forward the assessment and workability support, with appropriate clinical oversight and escalation arrangements in place.