Scotland vs England: Are Sick‑Note (Fit Note) Rules Changing?

21st May 2026

The UK Government has announced plans to change the Fit Note system in England, including shifting responsibility away from GPs and potentially introducing new assessment hubs.

But here’s the key point for Caithness and the Highlands.

These changes do NOT automatically apply in Scotland.
Health is devolved. Scotland sets its own rules.

This is where the story gets interesting — and where the differences matter.

What England is changing
The UK Government (for England only) has proposed:

Moving Fit Note assessments away from GPs

Creating specialist assessment hubs

Tightening rules around long‑term sickness certification

Linking Fit Notes more closely to work‑capability assessments

These changes are still being developed and will take time to implement.

But they apply only to England, because the Fit Note system is part of the NHS — and the NHS is devolved.

What are the rules in Scotland right now?
In Scotland, the system remains:

GPs and hospital doctors issue Fit Notes

Nurses, physiotherapists and pharmacists can also issue Fit Notes (same as current UK‑wide rules)

No plans have been announced to move assessments to external hubs

No changes to the criteria for being signed off sick

The Scottish Government has not announced any intention to copy England’s reforms.

So for now:

Scotland keeps the existing GP‑based Fit Note system.

Will Scotland follow England’s changes?
At present:

There is no commitment from the Scottish Government to adopt the new English model

Ministers have emphasised that Scotland will make decisions “based on Scottish needs”

Scotland’s approach to health and social care has historically been more GP‑centred and less privatised than England’s

Given the political climate, it is unlikely Scotland will mirror England’s reforms quickly — if at all.

But Scotland could review the system in future, especially if GP workload becomes unsustainable.

Why the difference matters for the Highlands
For rural areas like Caithness, the English model would be extremely difficult to implement:

No local assessment hubs

Long travel distances

GP shortages already stretching services

Digital access issues in remote communities

Scotland’s GP‑based system, while under pressure, is more practical for rural regions.

This is one of those cases where devolution genuinely protects rural Scotland from a policy designed around urban England.

The UK Government’s Fit Note overhaul does not apply to Scotland.
Scotland continues with the existing GP‑based system, and any future changes would be made by the Scottish Government — not Westminster.

For Caithness and the Highlands, this means no immediate disruption, no travel to assessment hubs, and no change in how people get signed off work.