Some 40,000 people were signed off with fit notes each working day last year, according to analysis by a policy thinktank, as it called to move the responsibility away from GPs.
Based on NHS Digital figures from the first quarter of 2025/26, the Centre for Social Justice (CSJ) estimated 11 million fit notes were issued in 2025 – the majority by GPs.
In all, 2.6 million fit notes were issued between April and June last year – equivalent to 2,256 per 100,000 GP practice population of working age adults. The vast majority (89.8%) were issued by a doctor.
The CSJ recommended fit note responsibility be moved away from ‘overstretched’ GPs and into a new Work and Health Service and ‘embed employment and occupational health support at the point of sign-off’.
It argued that once a fit note is issued, particularly for mental health conditions, an individual’s ‘chances of returning to sustained employment fall sharply, especially for young adults, despite overwhelming evidence that worklessness only exacerbates mental ill-health.’
To address this, the thinktank recommended the Government should: ‘move fit note responsibility out of GP surgeries and into a new Work and Health Service focused on maintaining work attachment; embed employment and occupational health support at the point of sign-off to stop the flow of people moving onto benefits; (and) treat good work as a health outcome, particularly for common mental health conditions.’
Centre for Social Justice recommendations
- Move fit note responsibility out of GP surgeries and into a new Work and Health Service focused on maintaining work attachment.
- Embed employment and occupational health support at the point of sign-off to stop the flow of people moving onto benefits.
- Treat good work as a health outcome, particularly for common mental health conditions.
Source: Centre for Social Justice
CSJ policy director Joe Shalam said: ‘Thousands being nudged every day along a conveyor belt to worklessness is a scandal, but overstretched GPs are being asked to manage a crisis they are not equipped to solve.
‘We need a dedicated Work and Health Service that helps people recover and return to work, rather than a system that risks wasting the potential of millions.’
It comes after a Government-commissioned review published in November advocated replacing fit notes with a ‘non-clinical case management service’ funded by employers to ‘take pressure off GPs’.
The Mayfield report argued that this ‘would not replace the GP’s role’ when it comes to clinical support, but it would focus on how best to support a disabled employee or employee with a health condition ‘to thrive in work’.
It said the fit note process was ‘problematic’, with GPs being asked to assess both treatment needs and work capacity, despite ‘most lacking occupational health training’ and time to get into ‘sufficient detail’.
This is despite the Government introducing legislation in 2022 that expanded fit note certification to other professionals, such as nurses, physiotherapists, and occupational therapists. Last year, Government-commissioned research found limited take-up of healthcare professionals other than GPs writing fit notes since the 2022 reforms.
Responding to the Mayfield report at the time of publication, the RCGP said GPs should still have the option to continue to issue short-term (up to 3 weeks) fit notes and retain some involvement in longer-term care and oversight of patients’ overall health ‘where appropriate’, as this would avoid associated bureaucracy and duplication.
The Government has also announced it is extending its scheme to embed job coaches in GP practices to provide intensive employment advice to 40,000 more sick or disabled people. Nine more areas in England will be putting specialist employment advisers in GP surgeries through the Connect to Work scheme.
A Government spokesperson said the figures quoted by CSJ were ‘misleading’ because they are based on the number of fit notes issued as opposed to the number of individual patients signed off – a person may be issued with one or more fit notes during the same period of sickness absence. They also said the total includes fit notes signed off as ‘may be fit for work’ as well as ‘not fit for work’.
They said: ‘We already know that the fit note process has not been working effectively for patients, employers, or the health system for many years now. That’s why we’re trialling new ways to provide better support for people signed off – getting them back to work when they’re ready while reducing pressure on GPs.’
A version of this story first appeared on our sister title Pulse.
