In October 2008 incapacity benefit in the United Kingdom will be replaced, for new but not existing claimants, by the employment support allowance.1 This radical change has been largely ignored by health professionals, despite the role of general practitioners in the diagnosis and certification of long term sickness absence,2 the involvement of the NHS (usually via primary care) in interventions for getting incapacity benefit claimants back to work (notably the condition management programme and Pathways to Work),2 and the importance of income maintenance policies for the health of individuals and the population.3 But the reform of incapacity benefit signifies a dangerous political shift in how chronically ill and disabled patients are seen as either “deserving” or “undeserving” of state support.4 Such a shift will have important implications for the health professionals involved.

Incapacity benefit, the main social security cash benefit that isn’t means tested, is paid to 2.7 million people in the UK. Recipients, who need to have contributed sufficient national insurance payments, are assessed …