By NHS England data shows 2.80 million fit notes were issued in England between April and June 2026, the first quarter of the 2026/27 financial year. The figure is a two-year high, up 163,940 from 2.64 million in the same period last year and 137,813 higher than the 2.66 million issued in Q1 2024/25, according to HR News.
Of those 2.8 million notes, 2.59 million, or 92.2%, declared the patient “not fit for work”. Only 217,254, or 7.8%, were marked “may be fit to work”, which can include advice on phased returns, altered hours, amended duties or workplace adaptations. Brett Hill, Head of Health & Protection at Broadstone, called the figures “concerning reading” and said the Autumn Budget is an opportunity to introduce tax incentives for employer-funded healthcare benefits.
Why the two-year high matters for employers
The quarterly rise is not simply a seasonal blip. The comparison with Q1 2024/25 shows the current figure is 137,813 higher than two years ago, suggesting a sustained upward trend rather than a one-off spike. For HR teams, the practical consequence is that more employees are presenting fit notes that say “not fit for work” without any accompanying return-to-work guidance.
Hill linked the rise to delays in NHS care, from GP appointments to specialist treatment, which risk turning manageable health problems into long-term barriers to employment. He identified mental health and musculoskeletal conditions as leading reasons for fit notes. Employers cannot fix NHS capacity, but Hill said they can act through early intervention, health screening, private GP access and targeted wellbeing support.
The reform pilots: what is actually changing
The Department for Work and Pensions and the Department of Health and Social Care announced pilots to overhaul the fit note system in May 2026. The government describes the current system as a “broken fit note system” and a “tick-box exercise”. Around 11 million fit notes are issued every year, and only 29% of primary care staff see issuing them as a good use of GP time.
Four pilots are being launched in different areas of England, covering up to 100,000 appointments and lasting up to a year, with continuous testing. Two pathways are being tested: patients either receive an initial fit note from a GP and are then referred to community health workers, or go through the whole process without an initial fit note. The pilots will run through selected NHS WorkWell sites and major employers. The replacement model is described as personalised “stay in work” and “return to work” plans.
The GOV.UK announcement does not name the four pilot areas or the major employers involved, and it does not give exact start dates beyond the May 2026 announcement. HR teams should check with their local integrated care board or WorkWell site to confirm whether their area is participating.
What the pilots mean for HR and payroll teams
The key practical question is whether a “stay in work” or “return to work” plan has the same legal status as a fit note. The GOV.UK material does not state this explicitly. Employers should treat the pilots as a parallel process for now and continue to follow existing fit note rules for statutory sick pay and absence management until the government publishes formal guidance.
The announcement does not clarify how the pilots interact with statutory sick pay, employer sick pay, or fit note certification for benefits. It also does not explain what happens to patients who still need a traditional fit note during the pilot period. These are gaps HR teams should flag with their payroll providers and legal advisers before changing any absence processes.
The pilots are England-only, while the 2.8 million quarterly figure also covers England only. Employers in Scotland, Wales and Northern Ireland should note that the reform pilots do not apply to them, though the underlying absence pressures may be similar.
Practical steps for employers now
The data suggests employers should prepare for continued high levels of sickness absence. Hill’s recommendations point to concrete actions: review occupational health provision, consider private GP access or health screening as part of benefits packages, and train line managers to have structured return-to-work conversations that explore adjustments such as phased returns or amended duties.
The “may be fit to work” category remains underused at 7.8% of all fit notes. Employers can encourage GPs to use this option by providing clear information about what adjustments are available, making it easier for a doctor to specify a phased return or altered hours rather than defaulting to “not fit for work”.
The Autumn Budget is the next policy milestone to watch. Hill called for tax incentives for employer investment in workplace wellbeing and healthcare benefits, arguing this would support the government’s “Keep Britain Working” ambitions. Whether the government acts on that suggestion remains to be seen.
Sources: HR News
Photo: USS Prometheus (AR-3) sick bay - NH 1 by Unknown authorUnknown author, Public domain
