More fit notes have been handed out to patients in Wigan than in other parts of the country, new figures have revealed.
A total of 41,172 fit notes - previously known as sick notes - were issued by GPs in the borough between April 2017 and March this year.
That was an average of 113 every day, according to data from the NHS, with more women being signed off sick more than men. They received 57 per cent of the fit notes in the 12 months.
It equates to 2,493 notes per 100,000 people aged 18 to 65 registered with a GP, compared to 1,940 per 100,000 patients across England.
Doctors in NHS Wigan Borough Clinical Commissioning Group (CCG) did issue fewer fit notes in 2017-18 than the previous year, according to the data.
However, the NHS said a technical error for February this year meant they were under recorded - only 110 were said to have been issued in Wigan, compared to 3,698 in February 2017.
The most common reason for doctors signing people off work was mental and behavioural disorders, such as stress.
Others included diseases of the musculoskeletal system and connective tissue, respiratory diseases, and injury, poisoning and other external causes.
Dr Tim Dalton, a GP and CCG chairman, said: “Fit notes are given by GPs to people who for medical reasons need to take some time off work or need to have a change to their working pattern. They are an important tool to help people manage ill health and get back to work in a safe and supported manner.
“In our borough, we give out more fit notes per thousand of the population than the national average, but we give out the same number as the north of England average.
“Local initiatives like the Deal for Health and Wellness will have an impact and, thanks to the collective hard work of the health and care partners, Wigan borough residents are already living longer with more years of good health.”
People in work need a fit note if they are off work for more than seven days and their doctor assesses their health affects their fitness for work. Up to that point they can self-certify that they are unwell.
Across England, 5.3m fit notes were handed out in the 12 months.
The most recent monthly data, for March this year, shows the highest rate of notes given to working-age patients was in Halton, Cheshire. The lowest rate was in Camden, London.
Despite being called fit notes, most of those issued classify people as unfit for work. This was the case for 94 per cent of the notes.
However, fit notes are also used to advise patients and their employers on getting back to work. This includes recommendations for an employee to make a phased return or work reduced hours or with limited duties.