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Independents' Day

Med 3 system casts GPs in impossible role

I am very grateful for your article raising the issue of Med 3 certification (News, 14 September). This matter urgently needs discussion with a wide audience as vast sums of public money are spent each year on sickness benefit (currently in excess of £12 billion).

In my experience doctors do not fulfil the responsibility that society assumes they should. The current system is a disaster for everyone concerned. Patients are not adequately encouraged to return to work, the Department for Work and Pensions pays out vast sums of public money (much of it, I am sure, inappropriately) and GPs' surgery appointments and time are wasted.

During my 20-plus years as a GP, I have asked hundreds of GPs: 'How often have you insisted a patient returns to work when they would prefer not to, if you felt that by doing so you might jeopardise your relationship?' Almost invariably the reply is: 'Maybe once or twice in my career.' To the converse question, 'How often have you insisted someone doesn't go to work, when they would prefer to return?', the answer is usually: 'Occasionally, such as a cook with diarrhoea, or a surgeon with a septic finger.'

Yet GPs are signing 10 to 20 Med 3 certificates a week (or on average over 20,000 in a career) to make an impact on just a handful of cases.

Most GPs do not have a genuine interest in occupational medicine. Most of us can only make an educated guess about the conditions our patients

experience at work. I had no training in this area either at medical school or in my postgraduate training. Like most GPs, although I would encourage my patients to be at work, I do not feel I can police a benefit system for the state at the same time as empathising with my patient, particularly if they are having difficulties at work or with their employer.

GPs' primary responsibility is to their patients, so their

ability to give an unbiased opinion on their capacity for work is seriously compromised. Of course, we make every effort to encourage our patients to be at work, but sadly the answer is not that simple. One of the main reasons the amount spent on sickness benefit has trebled in the past 30 years is that the whole process of certification is flawed. The GP's role should be to to provide an

independent health adviser with a factual report.

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