More than 11 million sick notes were issued by NHS staff in England last year, with a significant majority—over eight million—lacking a recorded reason or diagnosis, according to new figures from NHS England. This marks a substantial increase, more than doubling the 5.3 million notes distributed in 2015, and rising by nearly 500,000 in the last three years since 2022. Despite this overall increase over time, there was a slight decrease in the total number of notes issued from 11,181,103 in 2024 to 11,171,899 in 2025.

Known as 'fit notes', these certificates are provided to individuals deemed unfit to work after more than seven days off. Doctors, nurses, pharmacists, physiotherapists, and GPs are all authorized to issue them, informing employers that an individual cannot perform their job or requires adjustments to facilitate a return to the workplace.

The leading documented cause for sick notes was 'mental and behavioural disorders,' including anxiety and depression, accounting for 932,100 notes. This figure is more than double the number attributed to 'diseases of the musculoskeletal system and connective tissue' (such as osteoarthritis, arthritis, gout, lupus, and fibromyalgia), which totaled 468,010 notes. There was a small drop in musculoskeletal-related notes from the previous year, but a 124,140-figure rise in notes where the cause was 'not provided', marking a 10.8 percent change over three years. Other significant categories included 'diseases of the respiratory system,' with 156,422 cases (a 14.53 percent rise since 2022), and the biggest percentage increase for 'congenital malformations, deformations, and chromosomal abnormalities,' which rose over 17 percent from 12,162 to 14,338.

A recent survey highlighted concerns regarding the issuance of these notes, particularly for mental health conditions. Out of more than 5,000 GPs questioned, only 752 responded to the BBC, with 540 admitting they had never denied a patient a mental health-related sick note. In contrast, 162 stated they had refused at least one fit note, and 50 declined to disclose their response.

Geographically, NHS North East London Integrated Care Board (ICB) led the nation in sick note issuance last year, providing 454,757 notes, a nearly 20 percent increase since 2022. Following were NHS North West London ICB (390,467 notes, up over 18 percent since 2022), NHS Birmingham and Solihull ICB (369,300), and NHS South East London ICB (343,803). NHS Central East ICB recorded the largest increase, with notes rising by over 20 percent from January 2022 to December 2025.

The high volume of sick notes, particularly those without recorded diagnoses, has fueled broader concerns about welfare spending. Healthy Secretary Wes Streeting vowed to address the 'sick note epidemic,' noting that 2.8 million people are out of work due to health conditions, which he described as detrimental to patients, the NHS, and the economy. Official forecasts predicted the annual bill for Personal Independence Payment (PIP) could jump from £25.9 billion to £44.9 billion by the end of the decade, equivalent to a 2p increase on all income tax rates. Labour leader Keir Starmer reportedly abandoned plans to curb PIP payment growth after a backbencher revolt, and government sources indicated no legislation on welfare reform would be included in the next King's Speech.

A Department for Work and Pensions (DWP) spokesperson stated that comparisons to 2015 are ill-advised due to data collection differences, but acknowledged the need for reform in the current fit note system to better serve patients, employers, and the health system. The DWP confirmed that new approaches are being tested as part of a wider plan to get Britain working. NHS England and the Department of Health and Social Care declined to respond to these figures.