The BBC has received responses from 752 GPs in England, with 540 stating they have never refused to sign a patient off work for mental health issues.
According to the GPs, the current system can be frustrating, with some patients becoming aggressive if they are not signed off work. The GPs also highlighted the challenges of providing fit notes, which are often used to access certain benefits and sick pay.
Of the responding GPs, 162 said they had turned down at least one request for a fit note, while 50 preferred not to say. The BBC sent a questionnaire to more than 5,000 GPs in England to gather information on their experiences with fit notes.
Fit Note Data
Fit note data shows that the number of fit notes being issued has been rising, with almost 850,000 more fit notes in the most recent year compared to six years earlier. More than 956,000 notes last year cited mental health and behavioural disorders as the underlying reason.
GPs sign the vast majority of fit notes, although nurses, pharmacists, physiotherapists, and occupational therapists are also able to issue them. The notes advise on how a patient's health problems impact their ability to work.
GP Concerns
Many GPs expressed concerns about the current system, stating that signing patients off work can be an unfair task and can threaten the doctor-patient relationship. Some GPs said they explain to patients that going to work can benefit their mental health, while others said they would only sign a fit note if they felt it was medically appropriate.
Alternative Approaches
The government has stated that it is testing new approaches to the fit note system, including so-called 'stay in/return to work' plans developed with businesses and occupational health professionals. Jaguar Land Rover is one of 60 companies working with officials to explore this approach.
Dr Richard Peters, JLR's chief medical officer, said firms have a part to play in supporting people with health conditions in work. However, there are concerns about how this kind of help could be scaled up, particularly for small businesses.
Reform Concerns
Tina McKenzie, from the Federation of Small Businesses, said proposals to make small businesses pay for a service to provide occupational health advice, as well as fit notes, would add to costs and bureaucracy. Tom Pollard, head of policy and campaigns at the mental health charity Mind, said any move towards an alternative system needs to be approached with caution and built around trusting and compassionate relationships.
