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GPs' no-win situation on benefits

Incapacity benefit forms are the bane of GPs' lives – but how can the current system be improved?

From Dr JS Caithness, Florencecourt, Co Fermanagh

As a GP who has been doing incapacity benefit medicals for 13 years, I entirely agree with Dr Lal Mandal's assessment of the problems (Letters, 9 November).

We have, in a generation or so, created a truly enormous problem of abnormal illness behaviour.

So often people think we are dealing with malingerers, but it is far more subtle than that.

The overwhelming majority of people I see have come to believe themselves as ill; but it is a wonderful flexible illness, adapting itself to day-to-day requirements; always hugely worse when any assessment occurs!

And objectively there is usually little sign of genuine disability.

It worries me what this vast scale of 'illness' is doing to the population.

We have here whole extended families where work is quite unknown; where everybody is 'sick'. What kind of dreadful upbringing can it be for children in such environments?

It is going to be very hard to turn this around. The Government would much rather have these people 'sick' than unemployed, which is where they should be.

And of course this huge population of 'disabled' people all have votes and pressure groups to stand up for them, and will resist very much any reduction in their benefits.

• From Dr RP Yadava, Longton, Stoke-on-Trent

I can understand the feelings of Dr Lal Mandal when some disgruntled person complained after being turned down for disability benefits.

It is a no-win situation. I worked for the disability agency and had a heavy workload for many years.

Then the management changed and wanted to cut the benefit budget. My workload reduced and I was sent for retraining on the basis that I was rather too soft. Then all the work ceased.

If a patient doesn't get benefit then they complain. If the doctor is less stringent then the department complains, so it is difficult indeed.

But remember that nobody depends on income from disability benefits anyway.

• Name and address supplied

Some patients are truly disabled and deserve financial help from taxpayers. Others can't be bothered to find paid employment because the system makes it more profitable for them to 'get benefits'.

Some exaggerate symptoms and others exaggerate what the consultant said in hospital/ outpatients because they want time off work. We have argued with consultants over this, because they refuse to issue sicknotes when they should, so we are unable to tell when patients have genuinely been advised to avoid work by the consultant, and when they are fibbing.

In one case the consultant was astonished to hear the patient had been off work for a year as there was 'nothing wrong with them'.

Sending Med3/5 to our local office with written comment that the patient needs a BAMS assessment has no effect. Sending RM7 to the local office indicating that the patient is fibbing and needs urgent BAMS assessment usually has no effect either.

I have taken to occasionally writing 'specific work inhibition' as the cause of absence on notes, since I discovered it is a Read code term.

This has resulted in one BAMS doctor phoning me to ask if it was intended to mean what it might appear to mean – I confirmed that it was.

The Job Centre frequently sends people to get a sicknote in extremely inappropriate circumstances, such as normal uncomplicated pregnancy or having been housed so far out of town that they cannot access transport to work.

They are actually surprised when we point out that it does not make them unsuitable for their usual employment.

I am also appalled to find that a Med3 indicating that a patient need not refrain from work, but should avoid specified tasks, is 'not accepted' by the Job Centre, which insists the patient come back 'for a proper sicknote with time off'.

Is anyone going to do anything about this disreputable state of affairs?

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