More than 11 million sick notes were issued by NHS staff in England last year, with GPs failing to disclose the reason for the vast majority of them, according to newly released figures. The data from NHS England shows that over eight million of the certificates distributed by medical professionals did not include a diagnosis or reason for the absence.
The leading documented cause was 'mental and behavioural disorders' such as anxiety and depression, which accounted for 932,100 notes. The number of notes issued in 2025 more than doubled since 2015, when 5.3 million were distributed. In the last three years since 2022, the number issued has risen by nearly 500,000.
Also known as 'fit notes', these certificates are provided when someone is deemed unfit to work after being off for more than seven days. Doctors, nurses, pharmacists, physiotherapists, and GPs can all issue them, informing employers that the person cannot carry out their job or that adjustments should be made to support their return to work.
Earlier this year, hundreds of GPs admitted they had never denied a patient a mental health-related sick note. A survey by the BBC found that of over 5,000 GPs questioned, only 752 responded, with 540 saying they had never refused a request for a sick note related to mental health. Meanwhile, 162 said they had refused at least one such request, and 50 did not disclose their response.
Sick notes for mental health conditions were more than double the number attributed to 'diseases of the musculoskeletal system and connective tissue'—including osteoarthritis, arthritis, gout, lupus, and fibromyalgia—which accounted for 468,010 notes. There was a slight decrease from the previous year, with the figure down by 41,395, but a significant rise of 124,140 in notes issued without a recorded cause, marking a 10.8% change over three years since 2022.
The largest increase in people being signed off work since 2022 was for 'congenital malformations, deformations and chromosomal abnormalities', which rose by over 17% from 12,162 to 14,338. This category includes inherited conditions such as Down syndrome and other disorders potentially linked to consanguineous relationships. Additionally, 156,422 cases involved 'diseases of the respiratory system' such as pneumonia and chronic obstructive pulmonary disease (COPD), a 14.53% rise since 2022.
The region with the highest number of sick notes was NHS North East London Integrated Care Board (ICB), which issued 454,757 notes, an increase of nearly 20% since 2022. NHS North West London ICB followed with 390,467 notes (up over 18%), while NHS Birmingham and Solihull ICB issued 369,300 notes, and NHS South East London ICB provided 343,803. NHS Central East ICB saw the biggest percentage increase, with a rise of over 20% from January 2022 to December 2025.
Overall, the number of sick notes issued last year was 11,171,899, a slight decrease from 11,181,103 in 2024. However, more than eight million of these certificates lacked a recorded diagnosis, suggesting the true number of cases linked to specific conditions could be significantly higher.
Last July, Health Secretary Wes Streeting vowed to tackle the 'sick note epidemic', stating: 'Some 2.8 million people are out of work due to health conditions—this is bad for patients, bad for the NHS, and bad for the economy.' Official forecasts earlier this year predicted that the annual bill for Personal Independence Payment (PIP) would jump from £25.9 billion when Labour came to office to £44.9 billion by the end of the decade, with the increase alone costing the equivalent of a 2p rise on all income tax rates. Last year, Prime Minister Keir Starmer abandoned plans to curb PIP payments following a revolt by Labour backbenchers. Government sources confirmed that no legislation on welfare reform would be included in the next King's Speech in May, raising concerns that Labour is unable to control rising welfare spending.
A Department for Work and Pensions spokesperson said: 'There was little change in the number of fit notes issued in 2024 and 2025, and comparisons with 2015 are ill-advised due to significant differences in data collection. That being said, we have been clear the current fit note system needs reforming to work better for patients, employers, and our health system. We are already testing new approaches as part of our wider plan to get Britain working, but we know we need to do more to build a system that works for everyone.' NHS England and the Department of Health and Social Care declined to comment.
