Publisher Health

Rishi Sunak has announced plans to trial stripping GPs of their power to sign people off work, as he attacked the UK’s “sick note culture” in a speech about welfare.

Instead he wants specialist work and health professionals to issue fit notes as part of a broader aim to make sick notes harder to obtain.

Doctors’ union the British Medical Association (BMA) said fit notes were carefully considered before they are written and criticised Mr Sunak’s “hostile rhetoric” on the issue.

Meanwhile Professor Kamila Hawthorne, chair of the Royal College of GPs, told BBC Radio 4’s Today programme that “as a profession we are not against the idea” because of high workloads but pointed out that issuing fit notes often formed part of a wider consultation with a patient.

BBC News spoke to some GPs to see what they thought.

Halesowen-based GP Dr Mohit Mandiratta said he sees people in his clinic every day who need fit notes for medical reasons, and for the majority it’s “wholly appropriate”.

But he says he would support other professionals taking on fit notes as it would reduce their workload.

“It’s no secret that general practice is under huge pressure at the moment. I would support other people doing fit notes as long as they are trained,” he says.

“It’s important they are supportive to patients, understand their needs and take a personalised approach.

“The reason people are off work… often has many factors. I would hope it’s a personalised process.”

The partner at Feldon Practice explained any plans to get people back into work would need to be based on general practice and required conversations with employers.

Work is “good for health”, with people who work generally being happier and feeling more fulfilled, he added.

Dr Chris Jacobs says sick notes are a lot of work for GPs and have become a daily task. It is common for people to see him asking for a fit note at the request of their employer.

“We are not trained occupational health doctors, so it is an added workload that we take on,” he said.

The Swindon GP does not think passing the job on to other professionals is a bad idea, as long as they are trained to deal with physical and mental health.

“It could benefit primary care in my view, but primary care should still be involved in the discussion,” he says, explaining it would allow GPs to spend more time focusing on patients’ health needs.

“We are a diminishing workforce on a full-time equivalent basis so I don’t think our time is best spent [filling in fit notes].”

Anecdotally, he says, he has seen a rise in people suffering from bad mental health in the last five years.

One in four adults and one in 10 children experience mental illness, according to NHS England.

County Durham GP Dr Kas Hawes thinks sick notes can be a difficult part of the job. “We are too busy as GPs,” she says.

In particular, repetitive requests with little evidence of sickness or efforts to accept help and get better can be difficult to challenge she says, without impacting the relationship with the patient.

But the Day In The Life of a GP author says the risks of removing sick notes from GPs include issues with access to patient records, and whether the adoption of a one-size-fits-all approach to ill health and recovery penalises people already struggling with financial hardship.

“There is a role for more scrutiny earlier with repeat sick notes, but removing them all together for the financial benefit of the government purse is very worrying in how it could affect some of the most vulnerable people in our society,” she says.

Sick notes are officially known as fitness-to-work notes. They are written evidence that your ill health is affecting your fitness for work. A “fit note” certifies a patient is sick, confirming a valid reason for staying off work and eligibility for sick pay.

Employees can self-certify absence due to illness for seven days and in most cases, qualify for sick pay. But if their illness means they need to be absent for longer, they need a fit note to continue to receive sick pay and also to qualify for some welfare payments.

GPs used to be the only healthcare professionals able to sign a sick note. In 2022, this was widened to include nurses, occupational therapists, pharmacists, and physiotherapists.