Sick notes for mental health: what a GP can and cannot do

A GP can issue a fit note for a mental health problem when an assessment shows your symptoms genuinely affect your fitness for work, and this is common, routine and nothing to be embarrassed about. What a GP cannot do is issue a note automatically just because stress, anxiety or low mood is mentioned, because a fit note follows an assessment, not a request.

Mental health and fitness for work

Mental health problems are among the most common reasons for sickness absence in the UK, and the rules are exactly the same as for physical illness. For the first 7 calendar days of absence you self certify, and those days include weekends and bank holidays. After that, a fit note is the usual evidence.

A fit note records 1 of 2 opinions: that you are not fit for work, or that you may be fit for work with support. For mental health, the second option is often the most useful. It lets the GP suggest adjustments such as altered hours, amended duties, a phased return or changes to your working environment, which you and your employer then discuss. The GP suggests; your employer decides what is workable, and if nothing can be agreed you are treated as not fit for work.

A note does not have to name a diagnosis. It can describe the problem in general terms, such as a stress related problem or an anxiety related disorder, where a more general description is appropriate. What goes on the note is something to discuss with the GP during the assessment.

What the assessment covers

The GP’s job is to understand how your symptoms affect your ability to work, not simply to hear a label. Expect questions about when things changed, what you are experiencing day to day, your sleep, your concentration, and which parts of your job you can and cannot currently manage.

The GP will also ask about your health more broadly, what support you already have, and how you are coping outside work. Where it is relevant and proportionate, they will ask about your safety too, because that is part of good care rather than a judgement.

From there, 2 things can happen together. The first is the fit note decision itself, including how long a period off or adjusted work might sensibly cover before review. The second is a conversation about what might actually help: talking therapies, lifestyle measures, a review of any current treatment, or a referral. Nothing is prescribed or arranged without discussing it with you first.

What helps the GP help you

You do not need to prepare a speech, but a few things make the assessment more useful.

Think about specific examples. Saying my concentration has gone and I cannot get through a report I used to write in an hour tells the GP far more than saying you feel stressed. Note roughly when things started to change and whether anything specific triggered it. If your employer has asked for particular wording or has its own absence process, have that to hand. And be honest about how things really are, because a note written from an accurate picture protects you far better than one written from a watered down one.

What we cannot do or promise

We cannot promise a note before we have assessed you. Stress, anxiety and low mood are real, but they do not automatically lead to a fit note or a diagnosis, and the consultation fee pays for the GP’s assessment rather than a particular outcome.

We cannot backdate a note beyond what the evidence supports. If your absence began before your appointment, tell the GP, and bring anything that helps evidence it, such as messages to your manager or earlier consultations.

We cannot tell your employer what to do. A GP can recommend adjustments, but cannot order an employer to make them, and cannot override an occupational health opinion or an employer’s decision.

And a GP consultation is not the right route for a crisis. If you feel at risk of harming yourself, or you cannot keep yourself safe, call 999 or go to A&E. You can also contact NHS 111 for urgent mental health help, or the Samaritans on 116 123 at any time. For anything that is not an emergency, an assessment is a sensible first step.

Frequently asked questions

Can a GP give a sick note for stress?

Yes, where an assessment supports it. Stress itself is a description of pressure rather than a diagnosis, so the GP will assess what is actually happening, for example anxiety, depression or an adjustment reaction, and how it affects your work. A note follows where the clinical picture justifies it.

How long can a mental health sick note last?

There is no fixed maximum. The GP certifies a period that makes clinical sense, often 1 to 2 weeks to start with, then reviews you before any extension. Longer periods are possible where the situation warrants them, but they are normally reviewed rather than written far ahead.

Can I get a sick note for anxiety without an appointment?

No. A legitimate fit note always follows a genuine assessment, because the note is a doctor’s professional opinion. An online video or telephone consultation counts as a proper assessment for this purpose, so you do not need to travel to a clinic, but you do need to speak to a clinician. Where the anxiety is tied to one situation rather than to work, we have described how a GP assesses anxiety about flying.

What should I tell my employer about my mental health absence?

Only what you are comfortable with. You are not obliged to share a diagnosis, and a fit note can describe the problem in general terms. It is usually enough to say you are unwell and being signed off, and to share the practical adjustments the note suggests when you are ready.

Will a mental health sick note affect my job?

A fit note is medical evidence of your fitness for work, and employers are expected to treat it the same as any other absence evidence. If your condition amounts to a disability under the Equality Act 2010, your employer also has duties around reasonable adjustments. If you run into difficulty, Acas and Citizens Advice can advise on your rights.

How to arrange an assessment

Clinique Alpa is currently a virtual first clinic, so mental health assessments take place by secure video or telephone, which many patients find easier for this kind of conversation. A 15 minute consultation is £65, and 30 minutes is £79.99 if you would like longer. Dr Mitesh Parmar, our Principal GP, has a special interest in psychological medicine.

Where the assessment supports it, your fit note follows promptly by email, and with your consent a short summary goes to your NHS GP. Book through our sick notes and medical letters page or arrange an online GP consultation directly, or call 020 8882 8088.

Dr Mitesh Parmar, Principal GP and Clinical Director at Clinique Alpa. MBBS MRCGP, GMC number 6113670.