Views & Reviews

Why the health secretary’s “well note” is not so swell

BMJ 2008; 336 doi: (Published 28 February 2008) Cite this as: BMJ 2008;336:508
  1. George Moncrieff, general practitioner, Oxfordshire
  1. georgemoncrieff{at}

    Everyone agrees that the United Kingdom’s state benefit system is in a mess. The cost to the taxpayer has escalated out of control, and the annual bill is now in excess of £13bn (€17bn; $26bn). The public are outraged by stories of malingering and inappropriate claims, and the government has appointed Carol Black, as national director for health and work, to investigate alternatives to the current flawed system.

    Most GPs would like to be removed from their current central role in signing patients off work—not because we are lazy, but because we recognise that it is impossible to be the patient’s advocate on health matters at the same time as being responsible for deciding whether they are entitled to incapacity benefit. Furthermore, most of us have no experience of occupational health and really know little more about our patients’ work environments than anyone else. Instead of policing the system effectively, honest GPs admit that they nearly always simply ask their patients whether they think they should be at work and how long they think they should be off work. At most we may suggest that work is generally good for health and that usually you …

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