The UK government has launched a pilot scheme aimed at reforming the use of GP fit notes, which declare people unable to work. Under the new initiative, GPs in certain areas will either provide fit notes alongside referrals to support services or refer patients directly to these services without issuing a fit note. The move seeks to address concerns that the current system is ineffective, with over 11 million fit notes issued annually, most of which sign people off work entirely without offering help to return. The pilots, taking place in Birmingham, Solihull, Coventry, Warwickshire, Cornwall, the Isles of Scilly, Lancashire, and South Cumbria, will test whether support is best provided by healthcare professionals or non-clinical staff such as work coaches and social prescribers. The initiative also encourages employer involvement in making workplace adjustments for employees. The programme is part of broader efforts to reduce the economic and healthcare impact of long-term work absences, particularly due to mental health and musculoskeletal issues. Stakeholders, including the Royal College of GPs and mental health charities, emphasise that reforms must prioritise patient wellbeing, avoid additional administrative burden, and ensure collaborative support. Business representatives have welcomed the approach, highlighting that the current system fails both employers and employees.