Financial incentives for GPs ‘effective’ to help reduce demand on fit notes, Government finds

Financial incentives for GPs referring patients to a scheme designed to reduce demand for fit notes could improve its chances of success, a new Government evaluation has found.

The WorkWell programme was recently expanded to cover the whole of England, following a £64m pilot across 15 ICB areas which began in 2024.

The scheme received £259m funding over three years and will help 250,000 people with health conditions stay in or return to work, according to Government estimates. It provides ‘personalised’ and ‘early’ help for people struggling with their health, connecting them to local services such as physiotherapy, counselling and workplace adjustments.

Now the Government has published initial findings covering the early phase of the pilot, from its launch in October 2024, through to March last year. 

Within that timeframe, 5,661 individuals began receiving support through the scheme across 12 pilot sites, with the largest numbers of participants being from ICBs in Northwest London, Greater Manchester and North Central London.

They received ‘personalised one to one coaching’, signposting, and referrals to health, employment, and community and voluntary sector services as part of the scheme, and following an initial assessment, participants were expected to agree ‘return-to-work’ or ‘thrive-in-work’ action plans with WorkWell staff.

The report found that nearly half were experiencing a primary health barrier to work that was ‘mental health related’ and that the majority were not in employment in the month before starting the pilot.

The Government analysis found that some pilot areas reported that they were experiencing difficulties in raising awareness of the service among PCNs, ‘due to lack of capacity amongst GPs’ and ‘a lack time to engage with the service’.

To overcome issues with engaging GPs, pilot areas cited a range of approaches from simplifying referral processes by using a dedicated app, through to reimbursing GPs for time spent on referrals, which the Government concluded were ‘effective’ in getting more referrals to the scheme.

The report said: ‘Stakeholders described how they are financially reimbursing GPs for the time they spend making referrals to the programme.

‘For example, Cambridge and Peterborough described their local incentive scheme which involves paying for the administrative time that goes into a member of staff reviewing fit notes, checking suitability for WorkWell and then completing a referral with the participant’s consent.

‘Stakeholders reflected that these approaches have resulted in increased referral volumes from GPs and improved their relationship with PCNs. This is echoed by the data on referrals, as 62% of referrals in Cambridge and Peterborough were from primary care.’

It concluded: ‘There are signs that these approaches are effective, as amongst all referrals, GPs and primary care were one of the top three referral routes to WorkWell to date, alongside Jobcentre Plus and self-referrals.’

Yesterday the Government announced that GP practices in four areas of England will pilot different ways of issuing fit notes as part of a reform of the system.

As part of the pilots, patients will be offered either an initial fit note from a GP and then be referred to community health workers, or go through the whole process without an initial fit note from a GP.

The Government published the results of a call of evidence launched last year, which found that the majority (83%) of patients, carers or those who access fit notes agreed or strongly agreed ‘it was a good use of GP time’, while just under half (46%) of employers agreed or strongly agreed.

It said: ‘In general, patients valued fit notes, and the majority felt the fit note system is effective in supporting their work and health needs, while employers were more likely to feel it was ineffective in meeting patients’ and employers’ needs. Among healthcare professionals and representatives of a local system and local system partners there were mixed views about its effectiveness. Respondents from all groups made suggestions as to how the process could be improved.’

The Government also extended its scheme to embed job coaches in GP practices to provide intensive employment advice to 40,000 more sick or disabled people.

Sir Charlie Mayfield’s review into health-based economic activity, published last year, found 93% of fit notes in England deem the patient ‘not fit for work’ and are ‘often extended without further consultation’. 

It recommended adopting a Workplace Health Provision (WHP) service ‘to take the pressure off our GPs and healthcare professionals, freeing up their valuable time to be spent on diagnosing and treating patients’. 

It comes as a recent report warned of a sharp rise in the number of people not in education, employment or training (NEET) who say ill health is stopping them working.

Mental health conditions and autism accounted for more than two-thirds of NEET young people who said poor health is a barrier to them working, the analysis by the Health Foundation showed.