BBC poll: 752 England GPs on mental health fit notes

You’ve probably heard them called sick notes. Officially they’re fit notes, and they shape whether you get sick pay, what support you can ask for at work, and when it’s reasonable to return. A BBC News questionnaire of GPs in England suggests that, among those who responded, most have never refused a mental‑health‑related request. Here’s what the system does, where it strains, and why reform is on the table.

BBC News contacted more than 5,000 family doctors. Of the 752 who replied, 540 said they had never refused a mental‑health fit note, 162 said they had turned at least one down, and 50 preferred not to say. As BBC News makes clear, we can’t assume these respondents represent every GP in England, but their replies offer a useful window into daily pressures.

Demand has been rising. GP practices in England approved more than 11.2 million fit notes in the most recent year of data, according to BBC analysis-almost 850,000 more than six years earlier. Most certificates, around 72%, don’t list a reason at all, yet where a cause is recorded, mental health and behavioural disorders top the list with more than 956,000 notes-far exceeding any other condition.

So what is a fit note? If you’re unwell for more than seven days, a fit note provides evidence for your employer and, where relevant, the benefits system. It can record that you are ‘not fit for work’ or ‘maybe fit for work’ if certain changes are made-such as phased hours, amended duties or short‑term home‑working. You do not have to disclose your diagnosis on the note itself.

GPs sign most fit notes, but nurses, pharmacists, physiotherapists and occupational therapists can issue them too. That matters because the decision focuses on how your symptoms affect your ability to work, not just the diagnosis, and several health professionals are authorised to assess this within their scope of practice.

In written comments to the BBC, many doctors described a difficult balancing act-supporting their patient while also acting as a gatekeeper for employers and the state. Several said they often issue shorter notes than requested, and some admitted it can be quicker, and at times safer, to sign a certificate than risk confrontation or a complaint. A few reported instances of aggressive behaviour when refusing to sign someone off.

Attitudes towards patients varied. Many GPs emphasised trust and compassion, noting that mental health difficulties are rarely visible in the way a chest infection might be. Others were more sceptical about motives. Some felt younger adults ask for time off more often, but national fit‑note data aren’t broken down by age, so those impressions shouldn’t be treated as evidence.

Policymakers are looking again at who should make these decisions. A government‑commissioned Keep Britain Working review called fit notes ‘often problematic’, pointing out that many GPs lack the time and occupational‑health training to judge work capacity in depth. The review also highlighted a clear pattern: returning becomes harder the longer someone is away-roughly a 96% chance after four to six weeks, dropping to about 50% after a year.

The Royal College of GPs says family doctors may not always be the best people to provide long‑term, work‑focused support. Its chair, Professor Victoria Tzortziou Brown, has argued GPs should continue to sign short‑term notes-around three weeks-while the NHS explores moving longer‑term decisions to services designed for workplace assessment and rehabilitation.

Ministers say the current system needs reform and are testing alternatives. Officials are exploring ‘stay in/return to work’ plans co‑created by employers and occupational‑health professionals. Jaguar Land Rover is among about 60 firms involved and points to six UK ‘centres of wellbeing’ offering prevention such as exercise classes and NHS health checks, plus support like physiotherapy, counselling and on‑site occupational‑health advice.

Small businesses worry about costs and capacity. The Federation of Small Businesses warns that paying statutory sick pay from day one, alongside any requirement to fund occupational‑health advice or fit‑note services, could add expense and bureaucracy. Any change will have to balance early, humane support with what smaller employers can realistically deliver.

Mental health charities urge caution. Mind’s Tom Pollard says any alternative must be built on trusting, compassionate relationships and mustn’t force people to work before they feel able. What this means for you: if you’re struggling, talk to your GP or another authorised clinician early, ask whether a ‘maybe fit’ note with adjustments could help, and request an occupational‑health referral where possible. Keep your employer informed at a pace you choose, and use trusted support-Mind, your union if you have one, or the NHS-if you’re unsure about your rights and options.