Rishi Sunak wants to strip GPs of their power to sign people off work as part of a plan to tackle what he calls the UK's "sick note culture".
The prime minister claims benefits have become a "lifestyle choice" for some, causing a "spiralling" welfare bill.
If the Tories win the general election, unspecified "specialist work and health professionals" would be given the job of issuing sick notes in England.
Labour says the government has "run out of ideas".
In a speech, Mr Sunak said a "worrying" proportion of younger potential workers were among a record high of 2.8m people out of work as of February 2024.
"There's nothing compassionate about leaving a generation of young people to sit alone in the dark before a flickering screen watching as their dreams slip further from reach every single day," he said.
Mr Sunak also said, if the Conservatives win the general election, those who were still out of work after 12 months after support from a work coach will have "their benefits removed entirely".
He denied claims his plans lacked compassion, arguing that there would still be a "safety net" for "those who genuinely need it".
But he added: "We don't just need to change the sick note, we need to change the sick note culture so the default becomes what work you can do - not what you can't."
Mr Sunak said not acting would be "irresponsible" when he claimed the current £69bn welfare bill is forecast to rise by more than 50% over the next four years.
Part of that change would be more "objective assessment", Mr Sunak said, claiming the system is currently being "undermined" by "subjective and unverifiable claims" about capability.
The government will launch a consultation on toughening up the eligibility criteria for personal independence payments (PIP) by demanding "greater medical evidence" about the type and severity of mental health conditions.
'Ongoing onslaught'
"All of which will make the system fairer and harder to exploit," said Mr Sunak, adding PIP bank transfers could be replaced by "access to treatment like talking therapies or respite care".
However, Mr Sunak was unable to provide any details about which "specialist professionals" would be given the job of issuing fit notes and whether they would have to be recruited.
Richard Kramer, chief executive at disability charity Sense, said the speech was "unbelievably damaging and unhelpful" and falsely portrayed disabled people "as shirkers" when many want to work but are prevented from doing so by negative attitudes, unfair recruiting practices and a lack of support and equipment.
"The government's ongoing onslaught on disabled people is hard to watch, with the prime minister today taking aim at people who are long-term sick in a cruel speech demonising people with 'sick notes'," he added.
NHS data showed almost 11m fit notes were issued last year in England, with 94% of those signed "not fit for work".
A call for evidence will be published on Friday seeking responses from healthcare professionals, employers, and those with lived experiences asking how the current process works and how it can be improved.
'Locked out of work'
Ahead of Mr Sunak's speech on Friday, Alison McGovern, Labour's acting shadow work and pensions secretary, attacked the PM for re-announcing a policy when, she claimed, his government had left a record number of people "locked out of work because they are sick".
She said: "A healthy nation is critical to a healthy economy, but the Tories have completely failed on both."
Liberal Democrat Leader Ed Davey said the speech was "desperate" when millions are unable to access NHS hospitals, GPs and mental health support.
He said: "Rishi Sunak is attempting to blame the British people for his own government's failures on the economy and the NHS and it simply won't wash."
Green Party co-leader Carla Denyer said the prime minister "should be fixing the NHS... not blaming people who are ill."
She added: "We would invest in mending the health and social care system, not denying people the right to see a GP when they need it."
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2024-04-19 10:09:51Z
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