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Mental health/behavioural issues account for nearly 1 in 3 fit notes

We need greater access to mental health therapists, say GP leaders

Caroline White

Friday, 01 September 2017

Nearly one in three fit notes issued by GPs in England is for mental health/behavioural issues, reveal provisional figures from NHS Digital.

The figures, which cover the period from December 2014 to March 2017, are based on anonymised data collected from up to 62.5% of all 18- to 65-year-olds registered with a GP in England. 

They show that the most common reason for issuing a fit note were mental health/behavioural issues, with this category accounting for 31% of all those written where the diagnosis was known.

In all, more than 12 million fit notes were issued during this period, of which around 5.8 million had a known diagnosis.

Almost 1.8 million of these concerned mental health and behavioural conditions.

Around one in five were issued for a period of absence of more than 12 weeks.

Around 1.1 million fit notes related to diseases of the musculoskeletal system and connective tissue, the second most common known reason for which a fit note was issued.

The number of fit notes written for anxiety and stress-related conditions increased by around 14% from 503,000 to 573,000 between 2015-16 and 2016-17.

And the issuing of fit notes peaked in January 2017 at 556,000.

Among those CCGs where at least two GP practices returned information, the data showed that Knowsley CCG recorded the highest number of fit notes written for working age registered patients in March 2017 (4,123 fit notes/100,000 people), while Richmond CCG recorded the fewest (977/100,000 people).

Women consistently accounted for more than half of the total number of fit notes issued in the reporting period, from a low of 53.8% in August 2015 to a high of 57.8% in January 2017.

Commenting on the figures, Dr Steve Mowle, honorary treasurer for the Royal College of GPs, said the figures were not surprising because mental-health-related issues made up an increasing amount of the GP caseload.

“They might possibly indicate a positive move towards greater awareness and reduced stigma of mental health in society – with people being more open and willing to discuss their mental health conditions,” he suggested.

But he said: "We know that working is beneficial for our patients' long-term physical and mental health and wellbeing, and we need a society-wide approach, including involvement from employers, to put measures in place to get people back into work, where possible, safely and appropriately.”

And there was still a long way to go before mental health achieved parity of esteem with physical illness — a clinical priority for the College.

“We are pushing for GPs to have easier, better access to more, and a greater variety of, mental health therapies in the community for their patients to reduce waiting times and ensure they get the care they need,” he said.

And he added: "NHS England's GP Forward View includes a pledge for every GP practice to have access to at least one of 3,000 more dedicated mental health therapists in the community. We need this and its other commitments– including 5,000 more GPs – to be delivered as a matter of urgency."

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