Pharmacists working in general practice write just 1.5% of fit notes, despite reforms introduced in 2022 that allow them to do so.

The majority (90%) of fit notes are issued by GPs, and have been since the reforms were introduced.

Nurses issue just over 7% of fit notes with practice based pharmacists doing around 1.5%.

In total, 2.7 million fit notes that were issued in the second quarter of 2024/25, NHS Digital said – a rise of 2.3% on the previous three months.

Support for pharmacists writing fit notes but awareness low

An evaluation of changes to allow registered nurses, occupational therapists, physiotherapists, and pharmacists to sign fit notes found that while most GPs, patients and employers supported the move, the use of extended certification was ‘limited at present’.

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Awareness that healthcare professionals other than GPs could sign a fit note was low among the general public, an accompanying YouGov survey had shown.

But the reforms had been broadly welcomed, and it was likely that more healthcare professionals would take on fit notes over time, the report commissioned by the Department of Work and Pensions and the Department of Health and Social Care concluded.

HCPs can spend time discussing return to work with patients

Instead, the main benefits reported by GPs on the extended fit note regulations was improved patient experience and ‘more substantial discussions between healthcare professionals and patients on the potential for them to return to work’.

Nearly all GPs and other healthcare professionals agreed that GPs’ time was better spent dealing with other issues instead of issuing fit notes.

But most GPs did not think allowing other healthcare professionals to sign fit notes would make much difference to their own workload.

A number of doctors – mainly GP partners – who took part in the research were unconvinced that management and training costs of extended fit note certification to other members of the healthcare team would be justified by the long-term gains.

And the time spent having to supervise staff doing fit notes may partly explain why rate of uptake of extended certification had been relatively slow.

Fit note system 'open to misuse' by some patients

But healthcare professionals questioned for the report expressed some frustration with patients who felt they were entitled to a fit note with no medical justification.

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Patients and employers commonly felt that signing people off is ‘not always in their best long-term interest, particularly for their mental health’.

Many GPs ‘seem to accept’ that the fit note system is open to misuse by some patients, but some said it was not their job to check people are not abusing the system, the report noted.

Variation in fit note processes

Interviews with a range of GP staff, employers and patients found that the move to a digital fit note in 2022 was popular.

But the research identified considerable variation in how GP practices deal with fit notes, despite guidance and training being in place.

Some patients and employers said that it could be difficult for patients to get a GP appointment to obtain a fit note but there was also frustration with hospitals not issuing them which placed additional burdens on GP practices.

It follows a report last month which found the ability of GPs to issue fit notes and deal with work and health issues is ‘questionable’.

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In an independent review of what more the government and employers need to do to tackle ‘economic inactivity due to ill-health and disability’, Sir Charlie Mayfield found a disparity between the level of detail that employers might expect and what healthcare professionals offer.

The report pointed out issues with general practice staff not being qualified in occupational health, their lack of knowledge about a patient’s ‘workplace dynamics’, and the lack of time to ‘get to the bottom’ of any workplace barriers.

A version of this article was first published on our sister publication Pulse.