The British government has initiated a series of pilot programs in four English regions to transition from traditional medical fit notes toward integrated employment support services.

英國政府已在英格蘭四個地區啟動一系列試行計畫，旨在將傳統的醫療就診證明轉型為綜合就業支援服務。

The current administrative framework, characterized by the annual issuance of over 11 million fit notes, has been identified by the Department for Work and Pensions (DWP) as dysfunctional. Statistical data indicates that approximately 90% of these documents result in a total cessation of work, which the administration asserts contributes to economic stagnation, increased welfare expenditures, and heightened pressure on the National Health Service. This systemic failure was further corroborated by a review conducted by Sir Charlie Mayfield, which suggested that general practitioners (GPs) often lack the requisite temporal and clinical resources to conduct comprehensive vocational assessments, thereby rendering the fit note a barrier to employer-employee communication.

目前的行政框架以每年發出超過 1,100 萬份就診證明為特徵，已被工作與退休金部 (DWP) 認定為功能失效。統計數據顯示，約 90% 的證明導致完全停止工作，行政部門主張這導致了經濟停滯、福利支出增加，以及國民健康服務 (NHS) 的壓力加劇。查理·梅菲爾德爵士 (Sir Charlie Mayfield) 進行的審查進一步證實了這一系統性失敗，該審查指出全科醫生 (GP) 通常缺乏必要的時間與臨床資源來進行全面的職業評估，導致就診證明反而成為雇主與雇員溝通的障礙。

To address these deficiencies, a £3 million investment will fund four distinct regional trials involving up to 100,000 appointments. In Birmingham and Solihull, as well as Coventry and Warwickshire, GPs will maintain initial fit note issuance while referring patients to support services. Conversely, in Cornwall and the Isles of Scilly, and Lancashire and South Cumbria, the issuance of fit notes will be bypassed in favor of direct referrals to support services. These interventions, delivered via NHS WorkWell sites, will utilize a combination of clinical professionals and non-clinical staff—such as social prescribers and work coaches—to facilitate personalized reintegration plans and employer negotiations.

為了改善這些缺陷，將投入 300 萬英鎊資助四個不同的區域試驗，涉及最多 10 萬次預約。在伯明翰與索利哈爾，以及考文垂與華威郡，全科醫生將維持初步發出就診證明，同時將患者轉介至支援服務。相反地，在康渦爾與西利群島，以及蘭開夏與南坎布里亞，將跳過發布就診證明的步驟，直接轉介至支援服務。這些干預措施將透過 NHS WorkWell 站點提供，利用臨床專業人員與非臨床職員（如社會處方師與就業教練）的組合，以促進個人化的重返職場計劃與雇主協商。

Stakeholder responses reflect a cautious rapprochement with the proposed reforms. The Royal College of GPs has expressed a willingness to explore evidence-based modifications, provided that patient wellbeing remains the primary objective and administrative burdens on practitioners are not exacerbated. Simultaneously, advocacy groups such as Mind and Scope have emphasized the necessity of a collaborative approach, cautioning against the premature coercion of individuals with mental health challenges or disabilities back into the workforce.

利益相關者的反應反映出對擬議改革的謹慎接納。英國皇家全科醫生學院表示願意探索基於證據的修改，前提是患者的健康仍為首要目標，且醫生的行政負擔不會加重。同時，如 Mind 和 Scope 等倡議團體強調了協作方法的必要性，警告不可過早強迫患有精神健康挑戰或殘疾的人士重返勞動力市場。

The government is currently testing diverse referral models to determine the most effective method for reducing health-related workforce attrition.

政府目前正在測試多種轉介模式，以確定減少健康相關勞動力流失最有效的方法。