Most people who ask for a note have already been coping in a way that does not look like coping from the inside. Sleep has gone. Sunday evening has become a thing they dread. Work still thinks they are fine, because the work is still being done, just at 1am, and with a version of themselves that is getting thinner.
A GP can issue a fit note after a proper look at that picture. A sick note mental health request is ordinary medicine. It is not a moral judgement about whether you are trying hard enough. It is also not issued automatically because the word stress was used on the way in.
Chest pain, signs of a stroke, severe breathlessness, heavy bleeding, a severe allergic reaction or symptoms of sepsis need 999 or A&E immediately. If you are not safe, or you have thoughts of ending your life, that is 999 or A&E as well, not a note.
What a sick note mental health appointment involves
The short version is this. For the first 7 days you can usually self certify. Your employer should have a form for that. You do not need a GP for those days in most jobs. After 7 days, if you still cannot work, you need to be seen, and the note follows the assessment if the assessment supports it.
Here is the longer version. The fit note is about fitness for this work, in this job, with these hours and these demands. It is not a diagnosis competition. Two people with the same label can have opposite work pictures. One can do a desk job with adjustments. One cannot currently leave the house. The note should describe function, not just name a condition.
I can say you are not fit for work. I can also say you may be fit for work with changes: fewer hours, no nights, a quieter room, a phased return, a pause on customer facing duties. That second version is often more useful, and it is often harder to write honestly, because it requires me to understand the job, not just the mood. Bring the job. Tell me what a Tuesday actually contains.
I cannot promise your employer will accept it. I cannot promise occupational health will agree. I cannot promise how long this will last. I can write what today’s examination supports, for a defined period, with a plan for when we look again. A note without a review date is how people drift.
It is worth saying plainly. I will not write a backdated novel covering 3 months I did not see. I will not write that you are unfit because a relative asked me to. I will not write a diagnosis you do not have because a workplace policy pays more for some words than for others. I will write what I can stand behind if someone later asks me why.
What I look at before I issue a note
What I look at in clinic is the pattern of the days, not the single bad morning. Sleep. Appetite. Concentration. Whether you are still washing, still leaving the house, still answering messages. Whether there is panic on the way in, or a flattening that has taken the colour out of everything. Whether alcohol has increased. Whether you are using work as the only structure you have left, which is a reason to be careful about stopping it abruptly, not a reason to be sentimental about it.
I ask what happened. Not because I need a cinematic trigger. Because sometimes there is a specific occupational problem: bullying, a complaint, a shift pattern that has become impossible, a bereavement, a court date, money. Sometimes there is no event, only a slope. Both are valid. They lead to different letters and different next steps.
I ask what you have already tried. Time off you self certified. A conversation with a manager. A GP on the NHS. Talking therapy you are waiting for. Things you have bought that have not helped. I am not here to collect a shopping list of treatments. I am here to see whether the next move is time off, adjustments, a referral, a physical look at thyroid and iron and blood count because those impersonate depression, or all of those.
The examination is still an examination. Pulse. Blood pressure. Thyroid if the picture fits. Weight if it has changed. I look at the person in the chair, not only at the story. Low mood behind back pain is a pattern I was trained to notice. The reverse is also true: a thyroid, an anaemia, a long covid hangover, a steroid you were given for something else. If we need bloods, the draw is £20 plus the test. Treating a number that is actually a gland is kinder than writing a note that misses it.
The second layer, when this comes up, is shame. People apologise for being here. They offer to go back tomorrow. They ask whether this “counts”. It counts if function has gone. It does not count more if you cry in the room, and it does not count less if you sit very still and speak in bullet points. I am interested in whether you can do the job safely, for you and for other people, not in whether the performance of distress was convincing.
Risk sits in this conversation whether we like it or not. If you are not safe, the note is not the product. Getting you to A&E or to a crisis team is the product. I will say that without drama if it is true. If you are low and tired and still safe, we make a plan that includes sleep, work, who knows at home, and when we review. I do not know yet, let us look again in 2 weeks, is allowed. So is: you are not fit for this role for the next 4 weeks, and here is what we do in between.
If a specialist letter or a longer report is what the workplace or a solicitor actually asked for, that is a different product. A fit note is a fitness statement. A report is evidence. The medical reports page is the right door for the second. Do not try to squeeze a tribunal document into a sick note. It will fail both jobs.
When to come in sooner
Some of this should not wait for a convenient slot.
- If you are not safe, or you have thoughts of ending your life, or you cannot care for yourself or a child: 999 or A&E now.
- Chest pain, severe breathlessness, signs of a stroke, heavy bleeding, a severe allergic reaction, or symptoms of sepsis: the same door.
- You have already used your 7 days of self certification and work has asked for a note this week.
- You are still at work and you are making mistakes that could harm someone, including you.
- Sleep has gone for days, or you have not eaten, or you have not left the house, and there is no adult watching this with you.
- A workplace process, a hearing, or an occupational health deadline is close, and they have asked for medical evidence rather than a short note.
If none of that is true and you are in the first 7 days, self certify, tell someone at home, and book to be seen before day 7 ends if you will not be ready to go back.
How notes are issued here
You are seen face to face at Clinique Alpa, 466 Green Lanes, Palmers Green. A 30 minute appointment is £100. We do not issue a note without that assessment. If you cannot get to the clinic, a home visit is £250 in the day and £450 at night, up to an hour. Fees for particular certificates sit on the fees page and are agreed before we write.
Bring what your employer actually asked for, including dates, and whether they want a fit note or a longer letter. Vague requests make weak notes. If they want adjustments listed, tell me which adjustments are even possible in that workplace. I cannot invent a role they do not have.
With your consent we can copy the fact of the consultation to your NHS GP. Mental health care that lives in two unconnected files is how people fall through a gap the next time they are unwell.
If the assessment does not support a note, I will say so, and I will say what it would support instead: a conversation with work, a short review, bloods, a referral. You are entitled to an honest answer. You are not entitled to a document the examination does not bear.
If we write the note, we also write the next look. A date. Not a shrug.
Get the note written after someone has actually assessed you. Read our fees page, or call 020 8882 8088. 30 minutes £100. Home visits £250 in the day, £450 at night, published in full. In an emergency call 999. Subject to availability.
Written by Dr Mitesh Parmar, MBBS MRCGP, GP and founder of Clinique Alpa, 466 Green Lanes, Palmers Green, London N13 5PA. This article is general information, not personal medical advice. In an emergency call 999. For NHS advice call 111 or visit nhs.uk.