Hundreds of GPs say they have never refused a fit note for mental health

A BBC questionnaire sent to more than 5,000 GPs in England received 752 replies; 540 respondents said they had never refused a fit note requested for mental health reasons, while 162 said they had refused at least one. The story comes as fit note issuance has risen and officials and professional bodies debate whether GPs are the right professionals to assess longer-term fitness for work.

Hundreds of general practitioners told the BBC they have never refused to issue a fit note when a patient requested one for mental health reasons. The BBC sent a questionnaire to more than 5,000 GPs in England and 752 replied. Of those respondents, 540 said they had never refused such a request, 162 said they had refused at least one, and 50 preferred not to say. The topic has gained attention because the number of fit notes issued has been rising and officials are considering changes to how fitness for work is assessed. Key findings: - Of 752 GP respondents, 540 reported never refusing a fit note requested for mental health, 162 reported refusing at least one, and 50 preferred not to say. - NHS data analysed by the BBC shows nearly 846,795 more fit notes in the most recent year compared with six years earlier, and 72% of fit notes do not record a reason. - More than 956,000 fit notes in the last year cited mental health and behavioural disorders as the underlying reason, higher than for any other condition. - GPs issue most fit notes, though other professionals such as nurses, pharmacists, physiotherapists and occupational therapists can also do so. - Many responding GPs described the task as difficult for the doctor–patient relationship and reported that some patients became confrontational when a fit note was refused. Summary: The responses underline a strain between the advocacy and gatekeeping roles GPs face when issuing fit notes and reflect wider rises in fit note use, particularly for mental health. Professional bodies and the government say the system needs reform, with the Royal College of GPs open to exploring whether longer-term responsibility should sit elsewhere and officials testing options including employer-led "stay in/return to work" plans with occupational health input; the outcome of these discussions and pilots is undetermined at this time.