Fit notes are issued by GPs to provide evidence of a patient’s condition and their ability to work, and usually required if they have been away from work for more than seven days.
Introduced in 2010 to replace the traditional sick note, the fit note was intended to help people return to work by describing possible workplace adjustments, instead of only stating that the person is not well enough to work.
NHS Digital has now analysed information on the fit notes issued by GP practices for the first time. The data covers approximately two thirds of working age patients registered with a GP in England, for the period between December 2014 and March 2017.
Rise in anxiety
Although 12 million fit notes were analysed by NHS Digital, just under half included a known diagnosis. Of these, almost a third were due to mental health and behavioural conditions. One in five of these were issued for an absence of more than three months.
Anxiety was particularly common. Over 570,000 notes were written for stress and anxiety-related conditions in 2016/17, which is an increase of 14% compared to the previous year.
Responding to the figures, Honorary Treasurer for the Royal College of GPs Dr Steve Mowle said mental health is contributing an increasing amount of GP workload: ‘These figures are not surprising. They might possibly indicate a positive move towards greater awareness and reduced stigma of mental health in society – with people being more open and willing to discuss their mental health.’
The College called for society-wide approach: ‘We know that working is beneficial for our patients’ long-term physical and mental health and wellbeing, and we need a society-wide approach, including involvement from employers, to put measures in place to get people back into work, where possible, safely and appropriately. However, we still have a long way to go before mental health has parity of esteem with physical illness. Achieving this is a clinical priority for the RCGP, and we are pushing for GPs to have easier, better access to more, and a greater variety of, mental health therapies in the community for their patients to reduce waiting times and ensure they get the care they need.’
The highest number of fit notes (4,123 per 100,000 working age patients in March 2017) were recorded by NHS Knowsley CCG in Merseyside, while Richmond CCG recorded the fewest (just 977 notes per 100,000 patients in March 2017). This compares to a national average of 2,334 fit notes per 100,000 patients for the same period.
Women consistently accounted for more than half of fit notes, from a low of 53.8% in August 2015 to a high of 57.8% in January 2017.
Action on mental health
This data reflects the growing burden of mental health difficulties in the UK. We know that one in four adults will experience a mental health problem, and this comes at a cost to the UK economy of over £100 billion each year (almost the cost of the entire NHS).
In an attempt to tackle this, the Five Year Forward View for Mental Health was released by the government in 2016. Historically underfunded, the Five Year Forward View aimed to get an extra 1 million people treated by mental health services by 2021.
To provide the workforce for this, Health Education England has now released its own action plan to train public health staff in mental health. The plan includes developing a new curriculum, encouraging people to take mental health courses and commissioning new public mental health programmes.
Professor Ian Cumming, Chief Executive of Health Education England, said the plan will be important for mental health: ‘We will endeavour to build the capacity and capability across our workforce to help prevent mental health problems and promote good mental health. We are committed to supporting local authorities, policy makers, NHS CCGs and other commissioners, service providers, employers and the voluntary and community sector to adopt this Concordat and its approach.’