I was crying in my doctor’s office when she gave me the choice. Struggling to breathe, my heart racing and taking small sips of water to calm my nauseated stomach, I knew I couldn’t go on like this. I was close to burnout, a breakdown or worse, and I knew I needed help.

“I know you’re working from home right now, but is that enough?” she asked gently. It was the question I’d been too scared to ask, whether I could get a sick note to take some time off work and focus on bringing my anxiety back into balance. Taking in my tearful state, I was given the note – also called a fit note – and signed off work for two weeks. 

For me, the break was a huge relief and helped me get through one of the worst periods of anxiety I’d experienced, a time when I couldn’t exercise, socialise or take proper care of myself. But in a new policy announced last week, Rishi Sunak, the prime minister, states his intention to strip GPs of their ability to provide fit notes in an effort to tackle what he calls the country’s “sick note culture”.

In a speech on welfare reform, Sunak claimed that the country is in danger of “over-medicalising the everyday challenges and worries of life”, a situation he says puts “unsustainable” pressure on the welfare budget.

“‘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,” he continued, adding that for people who are “feeling anxious or depressed… that shouldn’t mean we should assume you can’t engage in work”.

While Sunak didn’t lay out detailed plans for how this would be rolled out, he spoke about “shifting the responsibility for assessment from GPs … to specialist work and health professionals who have the dedicated time to provide an objective assessment”. But at a time when waiting lists for NHS talking therapies range from a few weeks to over a year, I worry this will make vital support much more difficult to access for those most in need.

NHS data shows that 11 million fit notes were issued in 2023, with research indicating that poor mental health accounts for more than half of all work-related illnesses. While there’s currently no data broken down by gender, it seems safe to assume women were some of the most affected. In 2022 women had some of the highest rates of sickness absence, while reports of anxiety and depression have increased in young women. Women are also more likely to experience symptoms of anxiety and depression compared to men in their age group.

In fact, keeping women in work could further affect their state of mind, with a 2023 study showing that almost half of the women surveyed cited work as a cause of harm for their mental health, a figure that’s amplified for marginalised women who face additional pressures such as racism, ableism and homophobia. Add on the trauma of a pandemic and cost of living crisis and it’s easy to see how life can get on top of you. It’s important to note though that generalised anxiety disorder and clinical depression need no trigger to set in, and whatever the reasons behind the way you feel, everyone deserves access to professional help within an appropriate timeframe – not after spending a year on a waiting list.  

As psychotherapist Sharnade George, founder of Culture Minds Therapy, explains: “Paid leave from work is a crucial opportunity for individuals to cultivate mental clarity. When life gets overwhelming, causing stress and burnout, stepping back from work – if that’s the trigger – can help people take that time for themselves, understand their pressure points and figure out the next steps to work on this.”

So is this announcement a reason for women to worry? Dr Zoe Watson, a GP based in east London and founder of Wellgood Wellbeing, considers Sunak’s statements “insulting”. “Who will that job be given to? You can’t unilaterally say ‘No one is allowed any time off work.’ That goes against absolutely everything I stand for. Until he announces his alternative plan, it’s hard to say what will happen,” she says.

Dr Watson doesn’t think the move will ease overstretched GPs either: “There are far greater problems facing us in general practice. Taking sick notes away from us won’t make a bit of difference.” In fact, she worries the change will upset her patients, making them feel like they have nowhere to turn at a time when they need support.

As with all GPs, Dr Watson will only offer a short-term leave sick note if she feels it’s appropriate or she’ll discuss adaptations that might make a patient able to continue to work. “In all honesty, most people want to continue working unless they’re in a toxic environment. It’s very rare, I think, for someone who doesn’t need time off to ask for it,” she adds. “Humans crave purpose and connection, which work provides. But the desire to work doesn’t always exist alongside the ability to work.”

George adds: “It’s important not to generalise that individuals with anxiety and depression cannot work. The severity of these conditions varies widely. For some clients I’ve worked with, being pushed into work could cause more harm than good. Others could benefit from working as a boost for their mental wellbeing. Ultimately, it’s a case-by-case assessment to determine what’s best for each individual,” she says.

So will Sunak’s policy hinder essential mental health support? It’s too soon to say, but the evidence isn’t looking good. A focus on improving NHS waiting times and creating a system that supports, rather than demonises, its most vulnerable people might be a better idea, but until then, doctors will shoulder the burden of a country that pushes people to breaking point. I don’t think there’s a prescription strong enough to fix that.

Images: Isabella Silvers