Hundreds of GPs Admit Never Refusing Mental Health Sick Notes in BBC Survey
A recent BBC investigation has uncovered that hundreds of general practitioners in England have confessed they have never refused to sign a patient off work for mental health issues. The survey, which questioned over 5,000 GPs about their practices regarding fit notes, more commonly known as sick notes, received responses from 752 participants. Among these, a significant 540 GPs stated they had never denied a patient requesting a sick note linked to mental health concerns.
Survey Findings and GP Responses
In contrast, 162 GPs reported having refused at least one patient a fit note, while 50 chose not to disclose their response. This revelation comes at a time when the issuance of fit notes has surged dramatically. Data indicates that nearly 850,000 more fit notes were distributed in the most recent year compared to six years prior, highlighting a growing trend in medical absences from work.
A damning Government study further exacerbated concerns by revealing that millions of sick notes are being handed out without patients ever seeing a GP or nurse in person. Fit notes serve as official medical evidence, approved when an individual is too ill or unable to work for more than seven days. Notably, these notes do not require disclosure of the specific reason for absence, with NHS data showing that 72 percent of slips provide no underlying cause.
Underlying Reasons and System Criticisms
Last year, over 956,000 fit notes mentioned behavioural disorders and mental health as primary reasons. While GPs are the primary issuers, other healthcare professionals such as pharmacists, physiotherapists, nurses, and occupational therapists can also provide them. Fit notes offer guidance on how a patient's health issues may impact their work ability and can assist with eligibility for sick pay and certain benefits.
Some fit notes categorise patients as 'not fit for work' or 'maybe fit for work,' rather than signing them off entirely. However, it remains unclear if the GPs who responded to the BBC's questionnaire represent the entire profession. Many respondents expressed frustration with the current system, arguing that issuing sick notes should not fall within their role. One GP lamented, 'It is hard to be patient's advocate and a judge,' reflecting a common sentiment among colleagues.
GP Experiences and Patient Interactions
Another GP told the BBC, 'Patients come for support - not to be dismissed,' while one noted they 'should not be gatekeepers of fitness to work.' Most GPs pointed out that they often issue sick notes for shorter periods than requested and do not always comply with patient demands for extended leave. Instances of patient aggression were also reported, with one GP describing a situation where a patient refused to leave without a fit note.
While some GPs trust their patients' honesty, others feel it is 'not worth the grief' or 'hassle' to dispute requests, opting instead to provide a note to avoid complaints. Several noted that issuing a sick note is quicker and easier than dealing with potential conflicts. A government-commissioned report last year labelled fit notes as 'often problematic,' citing GPs' lack of occupational health training and time constraints in evaluating work capability.
Broader Implications and Policy Responses
The report, titled Keep Britain Working, found that the longer an individual is signed off, the less likely they are to return to work. The Royal College of GPs echoed this, stating that GPs are not always the most appropriate professionals for facilitating return-to-work or providing long-term support. In response, the Government acknowledged the need for change and is assessing new approaches to the sick note system.
Tina McKenzie, Policy Chair of the Federation of Small Businesses, highlighted the economic impact, noting that sickness absence costs small businesses billions annually, with costs set to rise due to new Statutory Sick Pay rules. She criticised proposals that would require small businesses to pay for occupational health services and fit notes, arguing it adds bureaucracy and financial strain. The Government is funding 5,000 occupational health training places for small businesses through a partnership with the FSB, aiming to improve staff health and resilience.
McKenzie called for making this scheme permanent and reintroducing a small business rebate for Statutory Sick Pay to mitigate costs. The Daily Mail has approached NHS England for comment on these developments, underscoring the ongoing debate over the fit note system's efficiency and fairness.
