Tower Hamlets is one of England's most deprived boroughs, and health-related worklessness is a defining pressure on its general practices. Around 7-8% of working-age residents receive a fit note, sometimes known as a "sick note", from their GP each year. A fit note is issued when a person's health affects their ability to work and may be used to support time away from work or discussions with employers about workplace adjustments. When a patient requests a fit note, a GP reviews the request and issues the note if appropriate. While this meets an immediate need, it does not address the wider issues that may be affecting a person's ability to remain in work.
Many people seeking fit notes are living with long-term physical or mental health conditions. Others may be experiencing difficulties at work, financial pressures, stress, or challenges balancing health and employment. Without additional support, people can find themselves needing repeated fit notes while the underlying issues remain unresolved.
For GP practices, fit note requests also add to already significant workloads, particularly in areas where poor health and unemployment are closely linked.
Recognising this challenge, Wellington Way Health Centre and its partners asked a simple question: what if a request for a fit note could become the starting point for support, rather than the end of a process?
We've highlighted an issue that affects patients and the wider healthcare system. This has led us to take a quality improvement approach to build a sustainable delivery method within our current resources."
Wellington Way Health Centre is part of Bromley by Bow and Stepney Health, a group of GP practices working together to improve healthcare services across their local area.
The practice works closely with social prescribing link worker Nasrin Sardar and Connect to Work Tower Hamlets, a government-funded programme that helps people with health conditions or disabilities find, stay in or return to employment. The new approach creates a clearer connection between health services, employment support and social prescribing.
Employment is one of the strongest wider determinants of health. If someone is requesting repeated fit notes, that is the point at which to have a different conversation. The request should be the intervention point, not the end point."
At Wellington Way, when a patient requests a fit note related to a long-term physical health condition, musculoskeletal condition such as back pain, or a mental health concern, they'll be offered an appointment with the practice's social prescribing link worker.
The link worker takes time to understand the person's circumstances, what matters to them, and the factors affecting both their health and their ability to work. Where employment is part of the issue, the link worker can introduce the patient directly to a Connect to Work adviser based in the same building.
Rather than waiting weeks for a referral or navigating another service alone, patients can be connected quickly to specialist employment support. The link worker remains involved throughout, helping coordinate support and addressing wider wellbeing needs through social prescribing. This might include connecting people to community groups, physical activity programmes, welfare advice, peer support, arts activities or other local services that can support their health and wellbeing.
The vital role of the link worker
At the heart of the model is the relationship between the patient and the social prescribing link worker.
Nasrin Sardar has worked at Wellington Way Health Centre for more than 25 years and is a familiar face to many patients.
Patients already know me, so the conversation starts somewhere different."
Because link workers are skilled in building trusted relationships and understanding people's wider circumstances, they are well placed to explore sensitive issues around work, health and wellbeing.
Rather than focusing solely on paperwork or referrals, they help people identify what matters most to them, navigate services and access personalised support.
As this initiative is in its early stages, the service will continue to gather data and patient feedback over the coming months, helping the team understand what works well and where improvements can be made.
Wellington Way Health Centre hopes to expand the approach across more practices in the network and build confidence among social prescribing link workers in having conversations about work, health and employment support.
The longer-term goal is simple: to make fit note requests a gateway to meaningful support.
By bringing together social prescribing, general practice and employment services, the model recognises that health and work are often closely connected. Most importantly, it demonstrates the unique role that social prescribing link workers can play in helping people navigate challenges, access personalised support and improve their long-term wellbeing.
