Kemi Badenoch has pledged to overhaul Britain's fit-note system by requiring patients seeking to be signed off work for four weeks or longer to be referred for a tougher occupational-health assessment.
Under the Conservative proposal, GPs would refer patients seeking a fit note lasting at least four weeks — or repeat fit notes taking their total absence beyond a month — to an occupational therapist or another health professional for further assessment.
The assessment would consider the person's capacity to work and what support or adjustments could help them remain in or return to employment.
The policy is a Conservative proposal for a future government and is not currently in force.
Four-week trigger for further assessment
Badenoch said the Conservatives want to intervene before short-term sickness absence develops into long-term economic inactivity.
She told The Times that the current fit-note system was “completely broken”, arguing that too many people were becoming stuck on long-term benefits rather than receiving support to return to work.
Under the plans, the four-week threshold would also apply where a series of shorter fit notes cumulatively took somebody beyond a month away from work.
The Conservatives also propose that patients seeking fit notes because of depression or anxiety would be referred for further occupational-health assessment regardless of the length of time for which they were seeking to be signed off.
Those proposals should not be confused with an automatic finding that somebody is fit for work: the assessment would consider an individual's circumstances and capacity for employment.
Occupational therapists can already issue fit notes
The proposal would change the point at which further occupational-health involvement is required, rather than creating a new power for occupational therapists to issue fit notes.
Since July 2022, UK rules have allowed registered doctors, nurses, occupational therapists, pharmacists and physiotherapists to certify fit notes.
Government guidance says a fit note is an assessment of how a health condition affects a person's fitness for work and can also advise that somebody “may be fit for work” with appropriate workplace adjustments.
Government already running its own fit-note reforms
The proposal comes as the Government is already testing separate changes to the fit-note system in England.
Four pilots launched in 2026 are designed to cover up to 100,000 appointments and test alternatives to the traditional system, including models in which patients are referred to community work-and-health teams rather than relying solely on a GP-issued fit note.
Official figures cited by the Government show around 11 million fit notes are issued each year, with more than nine in ten recording the patient as “not fit for work”.
The Government says the pilots will test personalised “stay in work” and “return to work” plans and has said their findings will inform future legislation.
The Conservative four-week referral proposal is therefore distinct from the Government's existing pilot programme, although both approaches seek greater involvement from work-and-health professionals and less reliance on GPs simply certifying sickness absence.
Badenoch targets long-term economic inactivity
Badenoch said a future Conservative government would seek to prevent people moving from temporary sickness absence into long-term welfare dependency.
She argued that GPs can face pressure when deciding whether to issue fit notes and said occupational-health professionals would be better placed to assess what work somebody could undertake and what adjustments might make employment possible.
The Conservatives have not yet implemented the proposal and further detail would be required on its operation, funding and the availability of occupational-health professionals before it could take effect.