A BBC questionnaire has highlighted frustration among some GPs who issue fit notes for patients reporting mental-health problems. The result describes the doctors who chose to respond; it does not establish how every GP in England handles a request or whether any individual note was clinically justified.
BBC News sent the questionnaire to more than 5,000 GPs in England and received 752 responses. Of those respondents, 540 said they had never refused a mental-health fit note requested by a patient. Another 162 said they had refused at least one request, while 50 preferred not to answer.
The distinction matters. A self-selected questionnaire can document experiences and recurring concerns, but it cannot produce a representative national refusal rate unless the respondents reflect the wider GP population. The BBC explicitly said that representativeness was unknown.
The Survey Records Decisions, Not Motives
Several responding GPs said fit-note requests created conflict or took time away from other care. Some argued that assessing work capacity should sit with occupational-health professionals rather than general practice. One doctor reported that a patient would not leave without a note.
Those accounts show pressure inside consultations. They do not show that mental-health symptoms were fabricated. Nor does saying that a request was not refused reveal the length of the note, the advice provided or the patient's clinical history.
The BBC reported that some doctors issued a note for a shorter period than the patient requested. Others discussed how work might support recovery. A yes-or-no question about refusal cannot capture those decisions, so treating every non-refusal as automatic approval would distort the survey.
Eleven Million Notes Are Not Eleven Million People
More than 11.2 million electronic fit notes were recorded in GP practices in England in the most recent year cited by the BBC. The total was 846,795 higher than six years earlier. About 956,000 notes listed mental and behavioural disorders as the underlying reason.
That last figure was the largest named diagnostic category, but it was not a majority of all notes. NHS data showed that 72% did not state a reason. Claims that psychiatric conditions accounted for most fit notes therefore go beyond the published data.
NHS England Digital also warns that note counts are not patient counts because one person can receive more than one note. The dataset covers electronic notes issued by GP practices and excludes handwritten notes, certificates from hospitals or private doctors, people who objected to extraction and absences of seven days or less. It cannot be used as a complete measure of days lost to illness.
A Fit Note Can Recommend Adjustments
Under NHS guidance, a clinician can record that a person is either "not fit for work" or "may be fit for work" if the employer can provide support. Recommendations can include a phased return, altered hours, amended duties or an adapted workplace.
Doctors are not the only professionals permitted to issue notes. Nurses, pharmacists working in relevant clinical settings, physiotherapists and occupational therapists can also certify them when they are supporting the person's care.
The practical limitation is that a recommendation depends on what the workplace can provide. If an employer cannot implement the suggested support, NHS guidance says the same note is treated as evidence that the person is not fit for work. The decision therefore reflects health, job demands and available adjustments rather than a diagnosis alone.
Reform Needs Better Evidence Than Suspicion
The BBC's responses support a legitimate policy question: whether GPs have enough time and occupational-health information to assess work capacity and design a safe return. They also show why moving the signature elsewhere would not automatically solve the problem. Another professional would still need reliable clinical information, knowledge of the job and access to realistic adjustments.
Any evaluation should separate short and long notes, first and repeat certificates, "not fit" and "may be fit" decisions, diagnostic categories and whether employers adopted recommended changes. Without those measures, a falling note count could reflect improved support, unmet need or a new administrative barrier.
The survey is evidence of professional strain, not evidence that patients reporting mental-health problems are dishonest or that GPs have abandoned clinical judgment. Using it to police symptoms would convert an acknowledged sampling limitation into a national accusation. A credible reform must test whether people receive timely care and workable job support, not merely whether fewer forms are signed.