GPs Admit Rarely Refusing Sick Notes as Mental Health Services Face Unprecedented Demand
General practitioners across England have revealed that they almost never deny requests for sick notes, even as new NHS data shows record-breaking demand for mental health services. This disclosure comes amid growing concerns about the sustainability of the healthcare system and the role of GPs as gatekeepers for workplace absence.
Record Mental Health Referrals Overwhelm Services
The latest NHS England figures reveal a staggering 2.24 million people contacted the health service seeking mental health treatment in January 2026. This represents a significant increase from the 2.04 million recorded in January 2025 and a dramatic 61% rise compared to the 1.39 million reported in January 2020, before the COVID-19 pandemic began.
Experts remain uncertain about the precise drivers behind this unprecedented surge in demand, which has placed immense strain on mental health services already struggling with extensive waiting times for care. The situation has created a perfect storm where patients urgently need support while services struggle to keep pace.
GP Survey Reveals Sick Note Practices
A comprehensive BBC investigation involving 752 general practitioners has uncovered that the overwhelming majority never refuse requests for sick notes, now officially termed "fit notes." Of those surveyed, 540 GPs admitted they had never turned down such a request, while 162 reported having refused at least one. A further 50 preferred not to disclose their practices.
Many participating doctors expressed frustration with the current system, arguing that issuing fit notes should not fall within their professional responsibilities. They reported facing difficult situations, including patients becoming aggressive when denied workplace absence certification. One GP described an incident where a patient refused to leave the practice without obtaining a fit note.
Mixed Picture on NHS Waiting Lists
While mental health services face unprecedented pressure, today's data reveals some positive developments regarding overall NHS waiting lists. The backlog for planned care has decreased for the third consecutive month, dropping to 7.25 million appointments by the end of January. This represents the lowest level since February 2023, when the figure stood at 7.22 million.
The waiting list reached its peak in September 2023, with 7.77 million treatments pending for 6.50 million patients. The current reduction brings the total to 7.25 million treatments awaiting 6.13 million patients, down from December's figures of 7.29 million treatments and 6.17 million patients.
Expert Analysis and Political Response
Brett Hill, employment expert at consultancy Broadstone, offered a sobering perspective: "While the referral to treatment waiting list may be at its lowest level in three years, this positive trend is masking a troubling reality. Mental health services are in record demand, with overstretched NHS services grappling to meet it."
Health Secretary Wes Streeting acknowledged the improvements: "After years of rising waiting times, patients are finally starting to see things move in the right direction - with waiting lists at their lowest level for almost three years and more people getting treated within 18 weeks. Despite record demand this winter, A&E and ambulance services improved - meaning patients are getting help faster when they need it most."
Sarah Scobie, deputy director at the Nuffield Trust, cautioned against premature celebration: "Seeing the waiting list fall substantially for a few months in a row is a relief, but the NHS is still some way off hitting the March goal of 65% of patients treated within 18 weeks. Even if they get close to this through short bursts of improvement, it remains incredibly difficult to sustain this trend over longer periods."
Tim Gardner, assistant director of policy at the Health Foundation, added: "Today's data shows tentative signs of improvement across the health service after a gruelling winter, which should provide some relief for patients and staff. Achieving lasting improvements will require a concerted focus on addressing the root causes of delays."
The combination of record mental health demand and GPs' reluctance to refuse sick notes highlights systemic challenges facing the NHS. As services strain under unprecedented pressure, questions remain about sustainable solutions for both patient care and workplace absence management.
