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Ministers call for GPs to refer people to life coaches instead of handing out sick notes


Doctors will be encouraged to refer people to life coaches rather than just sign them off sick, under reforms designed to get more people back to work.

Ministers have become increasingly alarmed about the growing welfare bill and want to overhaul the sick note system, with the aim of more people attending back-to-work programmes.

A record 2.5 million people are not working because of long-term sickness, leading to what ministers fear has become a “huge increase in the size of the welfare state” that is blowing a hole in the public finances.

The government is on course to breach its own £140 billion welfare cap by £4 billion next year as long-term sickness pushes up spending. Currently £53 billion is spent on health and disability benefits for working-age adults, up £13 billion in two years and projected to reach £69 billion by 2027.

“The general view is that parity of esteem between mental and physical health, as well as what’s happened with Covid, has meant that more people are being signed off sick,” a government source said. “It’s led to a huge increase in the size of the welfare state. Nobody is talking about cutting benefits, that would be politically disastrous, but we are looking closely at how we can incentivise people to go back to work.”

Some Conservatives also believe that welfare restraint could be a successful weapon against Labour before the general election after divisions within the opposition over Sir Keir Starmer’s decision to retain the two-child benefit cap.

A senior Tory said that benefits was a “massive chink in the armour” for Labour, arguing: “There are those in Labour who can’t bite their tongues and show fiscal restraint on welfare.”

However, the Labour leadership believes it can fend off such attacks after the party’s policy forum accepted that fiscal discipline comes first.

With about 40 per cent of those claiming universal credit in work, a senior Labour source said: “The Conservatives’ old ‘strivers and skivers’ narrative has collapsed because of the way they’ve mismanaged the economy. It’s hard to call someone a skiver when they are working and still struggling to put food on the table”.

Mel Stride, the work and pensions secretary, has largely avoided such rhetoric and is setting up schemes designed to help the long-term sick back to work. This includes a “universal support” programme, under which life coaches could help 50,000 people who are out of work with mental health, debt and other problems.

Stride is also planning to offer businesses and staff tax breaks for providing more occupational health schemes that allow people to continue their jobs.

Officials are considering how to steer as many people as possible towards such schemes. Stride has expressed frustration with an NHS system where people can be signed off sick after a seven-minute GP appointment. Last month he told The Times he wanted a system where “the GP is not necessarily just ticking a box that says ‘can’t possibly do any work’”.

He said that for people with conditions such as mental health problems, “we want to be able to have the GP say ‘right great, we’ve signed you off for two weeks [or] four weeks. Let’s now look at something different. Go over to Work Well [one of the schemes offering combined health and employment support].’ ”

It is understood that Stride thinks this can be achieved by changing the design of “fit notes” issued by GPs to prompt them to refer to job support schemes.

Currently fit notes can classify people as either not fit for work or possibly fit for work with certain adaptions such as limited hours or different duties. One option under consideration would see an extra “tick box” which would allow GPs to classify people as potentially able to work with the right help, leading to automatic referrals to support schemes.

Officials accept that the fit note system can be changed in this way only once support schemes are more widely available. Currently 12 areas have pilot schemes running and it is hoped they will go nationwide later next year.

Professor Kamila Hawthorne, chairwoman of the Royal College of GPs, said: “Being able to refer patients to employment advisers or coaches as part of the process has merit in principle, but we’d need to understand more about how this would work in practice.”

She said that “we know how beneficial working can be for patients”, but added: “When making a decision to issue a fit note, the health and wellbeing of an individual patient will be the GP’s principal concern, not meeting government targets for keeping people in work.”

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