Many family doctors say they have never refused a patient’s request to be signed off work due to mental health concerns. In a survey of more than 5,000 GPs across England, 752 responded, with 540 saying they had never rejected such a request. A further 162 said they had turned down at least one request, while 50 preferred not to comment. Several doctors argued that deciding whether someone should be declared unfit for work should not be a core responsibility of general practitioners.

Some GPs described the role as challenging because it places them in the difficult position of both supporting patients and judging whether time off work is appropriate. Doctors warned this can damage the doctor–patient relationship, as people often visit their GP seeking support rather than assessment. A number of practitioners also reported tensions when requests are refused, with some patients becoming confrontational or refusing to leave until a fit note is issued.

The number of fit notes issued has risen steadily in recent years. Data shows that mental health and behavioural conditions are now the most common reason cited, accounting for more than 956,000 notes last year. However, in many cases the notes do not specify a particular cause. While fit notes can suggest adjustments that might allow someone to remain in work, most still sign individuals off completely.

There are growing calls to review how the system operates. Some experts believe GPs may not always have the time or occupational health expertise needed to assess a person’s ability to work long term. As a result, new approaches are being explored, including workplace support schemes and return-to-work plans developed jointly by employers and health professionals.