According to BBC News, of the 752 GPs who replied to a survey, 540 said they had never refused such a request, while 162 said they had turned at least one down, and 50 preferred not to say. Some GPs revealed instances of patients becoming aggressive if they were not signed off work, and one GP described how a patient had refused to leave the practice without a fit note.
NHS England data shows that more than 11.2 million fit notes were approved by GP practices in England last year. BBC analysis indicates the number of fit notes issued has increased by almost 850,000 in the past six years. According to NHS England, the number of fit notes issued in 2025 more than doubled since 2015, when 5.3 million were distributed. Mental health and behavioral disorders was the most common documented cause for fit notes, with more than 956,000 fit notes citing it as the underlying reason, according to BBC analysis. That figure was more than double the number attributed to 'diseases of the musculoskeletal system and connective tissue' (468,010 notes), according to NHS England. There was a small drop in mental health sick notes from the previous year by 41,395, NHS England reported.
According to BBC analysis, 72% of fit notes do not give a reason. NHS England reported that over eight million fit notes did not record a reason or diagnosis. There was a 124,140 rise in notes handed out with the cause 'not provided', marking a 10.8% change over three years since 2022, according to NHS England. The biggest increase in people being signed off work since 2022 was for 'congenital malformations, deformations and chromosomal abnormalities', which rose by more than 17% from 12,162 to 14,338, NHS England said. There were 156,422 cases in which people were signed off work with 'diseases of the respiratory system', a 14.53% rise since 2022, according to NHS England.
NHS North East London Integrated Care Board (ICB) provided 454,757 fit notes last year, the highest in England, according to NHS England. In a broader NHS context, 2.24 million people contacted the NHS needing mental health treatment in January, up from 2.04 million in January 2025 and 1.39 million in January 2020, NHS England reported. The overall NHS waiting list for planned care came down to 7.25 million appointments at the end of January, its lowest level since February 2023, according to NHS England.
Many GPs criticized the current system and say fit notes should not be part of their job, according to BBC News.