Fit notes are increasing across UK workplaces but so is long-term absence. But the real issue is not whether doctors are issuing them too easily. The real risk sits in how organisations respond to them.

There is a growing narrative that GPs are “signing people off too easily.” In reality, this reflects a misunderstanding of how the system works. GPs assess medical symptoms, not workplace environments.  They do not have visibility of job demands, organisational pressures, or internal capability processes.

When an employee presents with stress, anxiety, burnout, menopause-related symptoms or neurodivergent overwhelm, the safest clinical decision is often to sign them off as unfit for work. Not because work is impossible, but because returning without appropriate support presents a greater risk.

GPs are also operating in a system that is time-pressured and risk-averse. If a fit note is refused and the employee deteriorates or raises a complaint against the GP, the accountability sits with the clinician. The decision is therefore shaped by risk management, not convenience.

What is a Fit Note??

Fit notes themselves are brief, general and non-directive. They were never designed to manage workplace capability or long-term absence. Yet many organisations treat them as if they are definitive evidence of incapacity or a long-term plan.

This is where the problem begins.

When employers rely on fit notes alone, they are making decisions without the level of medical clarity required to manage risk effectively. There is no detailed understanding of functional capability, no structured view of what adjustments may support a return, and no clear plan for progression. The cheaper options are a telephone chat and a tick boxing exercise.  I recently saw a Fit Note where the individual was clearly suffering from the menopause but on the OH assessment there was no mention of it on the report just the isolated illness and not taking a holistic view and the proability of that person was in the menopause. 

How is an employer meant to put in place procedures if they are kept in the dark? Look out for tell tale signs and if you do not know what they are then it’s a good time to get the knowledge you need to support that member of staff.

Fit notes are not a decision. They are a signal.

UK tribunal decisions reinforce this point consistently. Employers are not losing cases because employees are unwell. They are losing because they fail to properly investigate and evidence their decisions.

In O’Brien v Bolton St Catherine’s Academy, an employee was dismissed following long-term sickness linked to stress and depression. The employer relied on outdated medical evidence and assumed there was no realistic prospect of return. The dismissal was ultimately found to be unfair because the organisation failed to reassess the situation properly.

Similarly, in BS v Dundee City Council, the court confirmed that employers must take reasonable steps to understand prognosis. Absence alone was not sufficient justification for dismissal. Employers are expected to explore whether a return is possible and what support might enable it.

In McMillan v Airedale NHS Foundation Trust, the issue was the rigid application of absence policies. The failure to adjust triggers for disability-related absence highlighted a key risk — treating all absence the same, regardless of underlying conditions.

The pattern across these cases is clear.

Employers lose when decisions are made without evidence, without adjustment, and without proper medical insight.

The impact of this is not just legal. It is operational and financial.

For employees, time away from work can quickly shift from relief to difficulty. Loss of routine, reduced confidence, and increased anxiety about returning can make re-engagement harder the longer absence continues. What begins as a short period of absence can gradually become a barrier to returning at all.

For employers, short-term absence extends into months without a structured plan. Costs increase through sick pay, lost productivity, and temporary resourcing. At the same time, the longer a case continues without clarity, the harder it becomes to make a defensible decision.

This is where organisations lose control. Effective management of long-term sickness requires early and structured intervention. Waiting several months before taking action is one of the most common and costly mistakes.

Early Occupational Health involvement provides clarity on functional capability, not just diagnosis. It allows employers to understand what an employee can do, what adjustments may be required, and how a return-to-work plan can be structured.

It is also essential to maintain a clear distinction between medical advice and workplace responsibility. GPs advise on health, but employers are responsible for determining what adjustments are reasonable and how work is structured.

When this distinction is blurred, decision making becomes unclear and risk increases.

The focus must shift from absence to capability. The key question is not “Are they fit for work?” It is “What can they do, with the right support?”

In many cases, the underlying issue is not illness alone. It is influenced by job design, lack of adjustments, management capability, and organisational culture. Addressing these factors is critical to achieving sustainable outcomes. Fit notes are increasing because the system is under pressure.

But the greater risk lies in how organisations respond. If fit notes continue to be treated as endpoints rather than starting points, absence will increase, costs will rise, and tribunal exposure will follow.

Fit notes are not the problem. Your response to them is.

If you’re dealing with long-term sickness or fit note challenges right now, Join our mailing list for more updates  I’ll send you a short guide Or DM me for a quick risk sense check and how we can support your organisation.