REPORT

The Fit Note Economy: what happens after the signature

Eleven million fit notes a year, a government calling the system broken, a flagship pilot that has reached thirty-odd thousand people. What can primary care and community services actually do about sickness certification, and what does the evidence say happens when they do?

Three numbers from the report: 99.9% of fit-note clients referred through general practice were already certified before their referral, so the consultation where the note is signed is the intervention window. Among 14,830 clients with a fit note before referral, certificate volume fell 55% across matched 13-week windows, and 53% received no further certificates at all after their case closed. Association, not cause, and the full report is explicit about what the data cannot claim.

What you get

• The national fit note picture, verified against NHS England, GOV.UK, Keep Britain Working and WorkWell sources
• Window-gated Joy evidence on certification before and after referral
• A limitations section: what we do not claim, and why
• Three recommendations plus a printable one-page stat sheet