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.’
Meanwhile, 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.
In the second case, they will instead be supported by a separate service ‘staffed by clinical and non-clinical practitioners’, the Department for Work and Pensions (DWP) has said.
From July, GP practices will test new approaches through four existing sites, backed by £3m, in the first year, testing the following models:
- In Birmingham and Solihull, GPs will issue the first fit note where needed, with all patients referred to a new support service led primarily by non-clinical staff, including social prescribers and work and health coaches
- In Coventry and Warwickshire, GPs will issue the first fit note, with patients able to be referred to a support service made up of both clinical and non-clinical staff
- In Cornwall and the Isles of Scilly, GPs will refer patients directly to a non-clinical support service, without issuing a fit note
- In Lancashire and South Cumbria, GPs will refer patients to a support service made up of both clinical and non-clinical staff, without issuing a fit note.
The BMA said that it has contributed to the design of these pilots with DWP to overhaul the fit note system, as the union feels the current system is ‘not working for GPs or patients’.
The RCGP said that they are ‘open to exploring evidence-based reforms’ that could help improve outcomes for patients, but that any reform of the fit note process must ‘avoid creating additional workload for general practice’.
Following the pilots’ findings, the Government will then bring forward legislation to reform the fit note system, it said.
The Government has also now 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.’
RCGP president Professor Victoria Tzortziou Brown said: ‘GPs take our responsibility to appropriately issue fit notes seriously, but the current system can involve significant administrative work that takes time away from patient care.
‘Any reform of the fit note process must put the health and wellbeing of patients first, be fully resourced and avoid creating additional workload for general practice. As such we look forward to seeing a comprehensive evaluation of this pilot.’
A version of this article was first published by our sister title Pulse
