Dame Carol Black, the architect of Britain’s “fit note” system, has raised concerns about the inadequacy of sick notes issued by General Practitioners (GPs), suggesting that the country’s overstretched healthcare system is inadvertently pushing millions towards a life reliant on benefits.

Dame Carol, who spearheaded the establishment of the current sick note system, highlighted its shortcomings, asserting that it is no longer “fit for purpose.”

She expressed apprehension that the failure of the system could result in millions of individuals with manageable health conditions being consigned to a life dependent on benefits.

The former president of the Royal College of Physicians emphasised that the increasing fragility of the National Health Service (NHS) has compelled doctors to issue repeated sick notes, inadvertently leaving individuals who could potentially work stranded outside the labor force.

Millions signed off work

According to Dame Carol, nearly 94 percent of the 7.5 million individuals who consulted a GP or qualified medic for a fit note last year were signed off work. Many of these individuals were excused from work for up to 12 weeks or even longer, exacerbating the risk of prolonged worklessness.

She criticised successive governments for failing to create a robust safety net that facilitates individuals in remaining in or returning to work, accusing them of abandoning key policies mid-way. Despite the introduction of flagship schemes aimed at assisting individuals with health conditions, Dame Carol described the implementation as “little more than a call centre.”

Dame Carol emphasised the urgent need for reform, particularly in light of the current sickness crisis gripping the nation. The number of economically inactive individuals due to long-term sickness has surged, reaching 2.8 million, the highest level in a decade. This alarming trend, fuelled by a mental health crisis and a rise in musculoskeletal issues, underscores the pressing need for effective intervention.

While acknowledging the challenges, Dame Carol remains hopeful. She cited the success of programs like Individual Placement and Support in assisting individuals with serious mental health issues back into the workforce, emphasising the importance of finding ways to support those grappling with anxiety, stress, and depression to prevent long-term worklessness.

As the government pledges to overhaul existing policies to create a fairer benefits system and tackle what Chancellor Rishi Sunak has termed a “sick-note culture,” Dame Carol’s warnings underscore the urgency of addressing the shortcomings of the current system to prevent millions from being condemned to a life on benefits.





Amelia Brand is the Editor for HRreview, and host of the HR in Review podcast series. With a Master’s degree in Legal and Political Theory, her particular interests within HR include employment law, DE&I, and wellbeing within the workplace. Prior to working with HRreview, Amelia was Sub-Editor of a magazine, and Editor of the Environmental Justice Project at University College London, writing and overseeing articles into UCL’s weekly newsletter. Her previous academic work has focused on philosophy, politics and law, with a special focus on how artificial intelligence will feature in the future.