Rishi Sunak sets out plans to tackle 'sick note culture'

Rishi Sunak wants to strip GPs of their power to sign people off work as part of a plan to tackle what he calls the UK's "sick note culture".

The prime minister claims benefits have become a "lifestyle choice" for some, causing a "spiralling" welfare bill.

If the Tories win the general election, Mr Sunak wants to make it harder for some patients to obtain a sick note.

Disability charities reacted with anger, with Scope branding the plans "a full-on assault on disabled people".

They suggested the planned reforms were "driven by bringing costs down rather than how we support disabled people".

Labour says the government has "run out of ideas".

In his speech, Mr Sunak said a "worrying" proportion of younger potential workers were among a near-record high of 2.8m people "economically inactive" due to long term sickness as of February 2024.

"There's nothing compassionate about leaving a generation of young people to sit alone in the dark before a flickering screen watching as their dreams slip further from reach every single day," he said.

• Sunak: Strip GPs of power to sign people off work

• Listen: 5 Minutes On Sick Leave - What's behind the rise?

Mr Sunak also said, if the Conservatives win the general election, those who were still out of work after 12 months after support from a work coach will have "their benefits removed entirely".

He denied claims his plans lacked compassion, arguing that there would still be a "safety net" for "those who genuinely need it".

But he added: "We don't just need to change the sick note, we need to change the sick note culture so the default becomes what work you can do - not what you can't."

What is a sick note?

Sick notes are officially know as fitness to work notes. They are written evidence that your ill health is affecting your fitness for work. A "fit note" certifies a patient is sick, confirming a valid reason for staying off work and eligibility for sick pay.

Why would somebody need a sick note?

Employees can self-certify absence due to illness for seven days and in most cases, qualify for sick pay. But if their illness means they need to be absent for longer, they need a fit note to continue to receive sick pay and also to qualify for some welfare payments.

Who can sign-off a sick note?

GPs used to be the only healthcare professionals able to sign a sick note. In 2022, this was widened to include nurses, occupational therapists, pharmacists, and physiotherapists.

Mr Sunak said not acting would be "irresponsible" when he claimed the current £17.6bn personal independence payments (PIP) bill is forecast to rise by more than 50% over the next four years.

Part of that change would be more "objective assessment" by unspecified "specialist work and health professionals" rather than GPs, Mr Sunak said, claiming the system is currently being "undermined" by "subjective and unverifiable claims" about capability.

The government will launch a consultation on toughening up the eligibility criteria for PIP by demanding "greater medical evidence" about the type and severity of mental health conditions.

"All of which will make the system fairer and harder to exploit," said Mr Sunak, adding PIP bank transfers could be replaced by "access to treatment like talking therapies or respite care".

However, Mr Sunak was unable to provide any details about which "specialist professionals" would be given the job of issuing fit notes and whether they would have to be recruited.

'Ongoing onslaught'

Richard Kramer, chief executive at disability charity Sense, said the speech was "unbelievably damaging and unhelpful", and falsely portrayed disabled people "as shirkers" when many want to work but are prevented from doing so by negative attitudes, unfair recruiting practices and a lack of support and equipment.

He accused the government of carrying out an "ongoing onslaught" against disabled people that was "hard to watch".

Dan Scorer, of learning disability charity Mencap, said many people with a learning disability are already struggling to get by on current benefit rates, resulting in them taking extreme actions including skipping meals and not turning on lights or the heating.

"The government needs to stop demonising disabled people when it is the system that is failing, and ensure that those who need financial support get the right amount," he said.

NHS data showed almost 11m fit notes were issued last year in England, with 94% of those signed "not fit for work".

A call for evidence will be published on Friday seeking responses from healthcare professionals, employers, and those with lived experiences asking how the current process works and how it can be improved.

'Blaming people who are ill'

The British Medical Association (BMA) said people were struggling to get the treatment they need to be able to return to work because of delays and waiting lists in the NHS.

Dr Katie Bramall-Stainer, chairwoman of the BMA's GP committee, said that rather than "pushing hostile rhetoric" the prime minister should focus on what is stopping patients from receiving the healthcare they needed which in turn prevented them working.

Dr Chris Jacobs, a GP in Swindon, said it could benefit GPs by having others put in charge of issuing fit notes but said they would need to be trained to deal with physical and mental health.

"We are a diminishing work force on a full-time equivalent basis so I don't think our time is best spent [filling in fit notes]," he said.

Dr Mohit Mandiratta, a GP partner in Halesowen near Birmingham, said he saw people every day who needed fit notes for medical reasons, with the majority of those being "wholly appropriate".

"I certainly see people who, with more support, could do more work and most importantly they want to work," he said.

He said people needed a personalised approach and may need physical and medical support as well as help with things such as their confidence or interview technique.

"The reason people are off work is very specific. It's not always cut and straight," he added.

Labour leader Keir Starmer said the PM's announcement was a "reheated version" of something the government announced seven years ago, a reference to a policy announced by then-PM Theresa May in 2017.

This was in contrast to Labour's "laser-like focus" to deal with "the problem of people getting back into work", he added.

"The big problem here, frankly, is that the government has broken the NHS and waiting lists are up... so that's where the focus needs to be," he said, adding: "It's no good talking about the problem - what we need is action."

Liberal Democrat Leader Ed Davey said the speech was "desperate" when millions are unable to access NHS hospitals, GPs and mental health support.

Green Party co-leader Carla Denyer said the prime minister "should be fixing the NHS... not blaming people who are ill."

Correction 4 July 2024: An earlier version of this article suggested 2.8m people were out of work as of February 2024. It should have clarified that this was the number who were economically inactive due to long term sickness.