Patients refuse sick notes as they cannot afford not to work, says leading GP

Patients have refused sick notes in recent times because they feel they cannot afford to take time off work, the chairwoman of the Royal College of GPs has said.

Professor Kamila Hawthorne also said the cost of living crisis has “suddenly got a lot worse in the last couple of months” and she has seen patients who are worried about fuel costs this winter.

She told the Guardian of her surprise that people she has tried to sign off work due to illness have refused, saying they must keep working to provide for their families.

She said: “Recently I’ve had patients refusing sick notes because they can’t afford not to work. Quite often, when it’s clear that somebody needs some time off, they won’t take it.

“These are people who ideally, medically, should not be at work (because) they have a chronic condition such as asthma or diabetes, but quite often mental health problems, quite severe mental health problems, I (see) some cases that really do require a bit of sick note peace and quiet to try and help them get better.

“I’ve been really surprised in the last year that when I’ve offered a sick note they’ve said ‘Oh no, no, I can’t take time off. I need the money from work’. They’ve refused.

“They say ‘I need to keep working to earn and to feed myself and my family.’

“I don’t take it personally, of course, but I feel sad for people because for a few minutes you enter their lives and see that it’s really tough.”

She said people are “very anxious” about what is in store as the weather gets worse, and described the “moral distress” for GPs who want to be able to help their patients.

She said: “The cost-of-living crisis has been there for a long time. But it’s suddenly got a lot worse in the last couple of months.

“I’ve now got patients who are worried about fuel costs this winter, who’ve not turned on their heating yet and are keeping their windows shut.

“People are very, very anxious about what’s to come and whether they’re going to have to choose between heating and eating.

“The moral distress among GPs comes from not being able to do more (to help people with complex problems).

“We can help most people who come to see us as they have, for example, a skin rash, period problems or anxiety and depression.

“More and more, however, we’re seeing people with intractable social and psychological problems that are very difficult to solve.”

Prime Minister Rishi Sunak has warned that soaring inflation and spiralling NHS waiting lists are among the issues that will cause a “challenging” winter.