I’m a GP – and these are the reasons why I log a hundred people off work every month, without even talking to most of them

Every morning when I log on to my computer, I am greeted with a familiar message. It goes something like this: “Depression, one month please.”

This short message is a request for what we GPs call a ‘fit note’ – what most people call a ‘sick note’. I receive four or five a day.

I check their notes to make sure the symptoms they describe are not new. If it is a recently developed condition, I will call them into the practice for assessment.

However, this is rarely the case. The majority of people who request sick notes have requested them in the past due to an existing health problem and will want them again in the future.

I pull up a pre-generated form, enter the patient’s personal information, their medical problem, and how much time they want to take off work.

I click Enter and it’s done. The patient has received the document by e-mail that he can give to his employer. This allows them to take a month off from work and still get paid.

I don’t talk to the patient. In many cases, I haven’t seen them lately, and probably won’t for a while. But I approve almost all fitness notes I receive this way.

Last week, Prime Minister Rishi Sunak announced plans to strip GPs of the power to dismiss people.

The move is in response to the record 2.8 million people who are ‘economically inactive’ due to ill health, the majority of whom live with chronic pain or mental health problems.

Shortly afterwards, MailOnline revealed that many GPs were routinely writing good notes for patients they had not seen, and the news was met with outrage. But it didn’t surprise me.

The truth is that, in my own experience and from conversations with colleagues, waving requests this way has been routine for years.

We rarely refuse a request for a medical certificate for several reasons: GPs are burdened by the weight of unprecedented demand for appointments, a new digital system that allows patients to email medical questions and requests and a mountain of administration and paperwork.

Of course, it would be ideal to see every person requesting sick leave or at least have a telephone appointment, but given the sheer number of such requests we receive, that would not be physically possible.

Occasionally, if I suspect malingering is occurring and the sick note does not match what I know about the patient’s health, I will contact them. But these cases are very rare.

I just don’t have the time to research them all.

Moreover, we do not sign these notes because we cannot prevent a confrontational situation from arising.

And so, unlike many of my colleagues who, bizarrely in my view, rushed to claim that GPs were ‘best placed’ to issue health certificates, I support Mr Sunak’s plan.

I am not alone. When the new policy was announced, my WhatsApp group chat at the GP was lit up with messages from colleagues who were overjoyed to hear they no longer had to fill in these forms.

Because although GPs endlessly approve fitness notes, few are happy with the arrangement.

One of the main reasons for this is that they are afraid that patients will complain if they refuse to sign them off work.

Since 2013, the performance of GPs has depended heavily on how well they perform on the so-called friends and family test: an anonymous survey that patients can complete to determine whether or not they would recommend their GP to friends and family.

GPs fear poor scores because it can affect the number of patients registering with the practice – and this affects the amount of money we get.

Upsetting patients by denying their request for a fitness note can mean a negative score for friends and family.

It can also damage the relationship between patient and doctor, meaning that if they become seriously ill in the future, they may not want to talk about their problems until it is too late.

Many doctors also worry that denying sick leave could put them in physical danger.

Sometimes I get requests for a fit bill from patients trying to get out of court-ordered community service, and I will always call them into the practice for assessment.

When they realize that I am skeptical of their statement, these patients may become aggressive, raise their voices, and turn on me.

In this situation, it’s hard not to think about the fact that this person knows where I work and that my kids go to the local school down the street.

Is it worth taking the moral stand and rejecting their good comment, putting you and your family in danger?

But perhaps the simplest reason why GPs regularly forward sick notes is that we simply don’t have the time to assess every patient.

GPs see more patients than ever. On average, there are four million more GP appointments every month than before the Covid pandemic.

It is a huge workload that we are struggling to cope with.

And even after we see them, patients can still wait months for an appointment with a mental health professional or pain specialist.

The uncomfortable reality is that simply approving fit notes on the spot reduces the GP’s workload while satisfying the patient.

That is why I – and the majority of my colleagues – think that the decision not to allow GPs to take proper notes is a good move.

Of course, there are still unanswered questions about how the scheme will work.

We currently do not know who will process the applications instead of the general practitioners. All the government has said is that they will be the responsibility of ‘specialist employment and healthcare professionals’.

It is also crucial that the move is accompanied by increased funding for mental health and pain services to ensure patients can receive treatment that will allow them to return to work within weeks, not months.

But I am hopeful that the change will free up GPs to help even more patients while ensuring that patients who are well enough to continue working do so.