A recent BBC article has highlighted how the UK’s fit note system is under immense strain, and the pressure is falling heavily on GPs. Hundreds of family doctors told the BBC they have never refused a mental health-related fit note, and many openly admitted the system forces them into a role they were never designed to play.
For organisations, this is risky, particularly as day-one Statutory Sick Pay reforms arrive in April 2026. Without proper intervention and support that keeps people in work, this is going to be a costly expenditure.
GPs are overwhelmed
The responses shared with the BBC show a striking pattern:
• Many GPs feel stuck between being a patient advocate and a gatekeeper, leaving them “uncomfortable” and “conflicted”
• Some reported patients becoming aggressive if a sick note was questioned — in some cases, refusing to leave without one
• Several acknowledged that it was simply easier to sign someone off than risk confrontation or complaints
• Others described the process as “a dirty task” that risks damaging the doctor–patient relationship
Mental health adds further complexity. Unlike a physical illness with clear clinical evidence, practitioners told the BBC they often struggle with whether (or how) to refuse a request. Some deeply trust the people they see; others feel patients are “milking the system.” Some GPs have even said it’s not their job to "police the sick note system".
Fit notes are rising
The BBC’s report highlights growing reliance on fit notes for mental health, with GPs issuing most of them. Many explained that they rarely sign someone off for the duration requested and often issuing shorter notes instead. Some even encourage individuals to continue working where appropriate, knowing work can support recovery.
But the bigger issue is structural. When fit notes are easy to obtain, and difficult to challenge, organisations experience:
• Higher levels of short and medium-term absence
• Limited visibility of functional capability (as most fit notes lack a stated reason)
• Delayed return-to-work journeys
What GPs are telling the BBC is something organisations already know: the sick note system doesn’t support sustainable attendance or timely return to work.
Day one SSP reforms changes the equation for every organisation
Smaller organisations are already expressing concern about the upcoming requirement to pay SSP from the first day of absence. Combined with a system where GPs often feel they “have no choice” but to sign someone off, organisations face:
• Higher absence-related cost from day one
• Increased short-term mental health related absences
• Greater pressure to provide internal support
• Particularly as GPs are under time pressure, or lack the training or capacity to assess work capability in a meaningful way
This is exactly why fit note reform is being explored. So much so, the BBC reports that government officials are testing models where employers and occupational health professionals co design “stay in/return to work” plans.
What organisations should do now
The BBC’s reporting reinforces what we see every day: organisations cannot rely on GP-issued fit notes to manage absence, risk or return- to-work outcomes. But what they can do is remove the barriers to getting the help they need faster, to facilitate return-to-work and/or keep individuals in work altogether.
To prepare for day-one SSP and a likely redesign of the fit note system, organisations should:
1. Strengthen early, clinically guided intervention
GPs themselves say they are not resourced to assess workplace capability. Organisations need a rapid triage and support route that prevents long-term absences from occurring.
2. Equip managers with clarity and confidence
When sickness absence conversations come up - confrontation, uncertainty and tension often spills into the workplace. Clear processes and manager training reduces risk, inconsistency and unnecessary escalation.
3. Identify and reassess barriers with occupational health in mind
Whether an individual has an existing or newly acquired condition or health concern, what can you do as an organisation to facilitate keeping them at work?
4. Prepare for cost exposure under day-one SSP
The financial impact will become apparent once the new reforms take effect. Organisations that invest now in smarter absence management and early intervention will feel the benefit fastest.
