Most GPs say they have never refused a sick note for a patient citing mental health concerns, raising questions about how the current system supports employers managing absence and workplace wellbeing.
An investigation by the BBC found that 540 of 752 GPs never turned down a request for a fit note, as they are now more commonly known, linked to mental health issues. A further 162 said they had refused at least one request, while 50 preferred not to say.
The findings come from a BBC News questionnaire sent to more than 5,000 GPs in England and suggest that many doctors face difficult decisions when assessing whether patients should be signed off work.
Mental health now leading reason for sick notes
Official data show that more than 11.2 million fit notes were issued by GP practices in England last year, a figure that has risen by almost 850,000 in the past six years.
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Mental health and behavioural disorders accounted for more than 956,000 of those notes, making them the most commonly recorded reason for employees being signed off work.
Fit notes are issued when someone is unable to work for more than seven days. Doctors can declare someone “not fit for work” or say they “may be fit for work” with adjustments, although most notes currently sign employees off entirely.
While GPs issue most fit notes, other healthcare professionals such as nurses, pharmacists, physiotherapists and occupational therapists can also provide them.
Doctors say current system puts them in difficult position
Many of the doctors who responded to the BBC probe described frustration with their role in deciding whether someone should be signed off work. Some said the system placed them in an uncomfortable position between supporting patients and acting as gatekeepers to sick leave.
One GP said it was difficult to balance those roles, describing the process as “hard to be patient’s advocate and a judge”.
Others argued that signing people off work should not be part of their responsibilities, saying GPs should not be required to “police the sick note system”.
Several doctors said refusing requests could lead to confrontation. Some described patients becoming aggressive when a fit note was denied, with one GP reporting that a patient refused to leave the practice without one.
Others said time pressures at clinics meant it was often quicker to issue a sick note than risk complaints or disputes.
Employers raise concerns
Bertrand Stern-Gillet, chief executive of HA Wisdom Wellbeing, a workplace wellbeing and mental health consultancy, said the BBC investigation showed the current fit note system was placing pressure on GPs and highlighted the need for employers to strengthen workplace mental health support.
“This report confirms what many businesses already know: the UK’s fit note system is under huge strain, and GPs are carrying the weight. Many GPs have never refused a fit note for mental health reasons, not because the need isn’t real, but because the system forces them into a role they were never designed to play,” he told HRreview.
“Employers should look to remove the barriers to employees getting the help they need faster, rather than relying on GP-issued fit notes. Give managers the clarity and confidence they need to manage conversations around mental health in the workplace.
“Identify and reassess the barriers to mental health support by involving occupational health at an early stage. That way you can help support the employee to remain in work while also accessing the support they need.”
Gemma O’Connor, head of HR advisory at software provider BrightHR, said rising sickness absence linked to mental health was creating growing pressure for employers.
“Employers have always had to deal with sickness absence, but the impact that the increased volume of people being signed off for mental health conditions has on the workplace is significant, not just financially but also in terms of employee morale and productivity,” she said in comments provided to HRreview.
She said upcoming changes to statutory sick pay could lead to more short-term absences because workers will receive payment from the first day of sickness.
“Implement robust absence management policies, including return-to-work interviews and trigger points so you can find out more about the reasons for absence and look at ways to offer support,” she said.
O’Connor said employers should also consider wellbeing measures such as employee assistance programmes, counselling services, mental health first aiders and flexible working arrangements to help support staff and reduce absenteeism.
Managing absence in the workplace
It comes as employers face growing pressure to manage long-term sickness absence, particularly where mental health conditions are involved. Fit notes are intended to help employers understand how a health problem affects an employee’s ability to work and whether adjustments could support an earlier return.
But the BBC reported that 72 percent of fit notes do not specify a reason for the absence, limiting the information available to employers.
Previous government-commissioned research has also raised concerns about the current system. The Keep Britain Working review concluded that fit notes are “often problematic”, noting that many GPs lack occupational health training or sufficient time to assess someone’s ability to work.
The report warned that the longer someone remains absent from work, the less likely they are to return. It found that employees absent for four to six weeks have a 96 percent chance of returning to work, but it falls to around 50 percent after a year.
