As a GP, here's how I feel about Britain's sick note culture

For short-term illnesses, the system makes sense. Someone with influenza, pneumonia, a fractured ankle or another acute condition may genuinely need a few weeks away from work. Most doctors are perfectly comfortable issuing a Fit Note in these circumstances.

The problem arises when temporary illness becomes a long-term discussion about employability, benefits and financial support.

Every GP will recognise the scenario. A patient attends requesting a long-term or even indefinite Fit Note. They may explain that their anxiety prevents them from working, that their back pain makes bricklaying impossible, or that a knee problem means they can no longer drive lorries for a living. These are often genuine problems causing genuine distress.

However, the question facing the doctor is not simply whether the patient has a medical condition. The question is whether they are incapable of all work, and often whether they should continue in the particular occupation they have chosen. That is a much more complicated judgement and difficult conversation.

In many cases, the medically appropriate advice may be uncomfortable. Work can be beneficial for some people with anxiety. A patient whose back can no longer tolerate heavy manual labour may need support to retrain rather than certification that they should never work again. Someone with a chronic knee condition may need to consider alternative employment rather than continuing in a physically demanding role.

Unfortunately, such conversations can be difficult. Increasingly, some patients approach Fit Notes not as a clinical assessment but as a service to which they are entitled and to which a GP has no right to say no.

If a doctor challenges the request, disagreement frequently follows. Patients may seek another GP who is willing to issue the certificate. Complaints are not uncommon. Even when ultimately dismissed, complaints consume many hours of administrative work and create significant stress for already overstretched clinicians.

The reality is that many GPs simply do not have the time to engage in prolonged disputes, nor the desire. Faced with ten-minute appointments, rising demand, workforce shortages and an ever-growing administrative burden transferred from secondary care, some conclude that resistance is futile. If the patient is likely to obtain a Fit Note eventually, why spend valuable consultation time fighting a battle that cannot be won?

This creates inconsistency and undermines confidence in the system. Many doctors have encountered situations where government assessors have declared an individual fit for work, have instructed the GP surgery to stop issuing Fit Notes, yet further Fit Notes continue to be issued. The GP has just decided that it is too hard to fight. We didn’t train for this, we trained to help people get well.

The result is confusion for patients, frustration for clinicians and a process that satisfies nobody.

The fundamental problem is that GPs are being asked to perform two incompatible roles. We are advocates for our patients, but we are also expected to act as objective assessors whose decisions carry significant financial consequences. Those roles inevitably conflict.

If society wishes to provide long term financial support to people unable or unwilling to work, it should do so through dedicated occupational health and benefits assessment services, not through family doctors. GPs should focus on diagnosing illness, treating disease and helping people recover. They should not be expected to act as arbiters of long-term welfare entitlement.

The Fit Note system may have been created with good intentions, but in its current form it places doctors in an unwinnable position. It is time to remove GPs from that role altogether.