Department for Work and Pensions is trying to address challenges

EDITOR—Hussey et al produce similar findings to other recent studies about general practitioners' advice on fitness for work,1^–3 but in his editor's choice Smith concludes that much of this work is philosophically untenable. General practitioners have been poorly trained in this important and undoubtedly difficult aspect of their day to day work, a challenge that the Department for Work and Pensions is anxious to address.

Smith also perpetuates the myth that general practitioners are acting solely as agents for the department, presumably in the same way that they are agents of the NHS when they issue a prescription?

Advice on fitness to work is an integral part of the clinical management of patients of working age. The obligation to record the advice on a statement (such as Form Med 3) does not detract from the doctor's overriding concern for the best clinical outcome for the patient. Good professional practice may sometimes mean challenging the patient's view, much as a general practitioner may do when requested to prescribe a drug. But it is an extremely narrow view of advocacy to believe that a skilled professional should simply accede to the patient's wishes without any negotiation.

The government has recognised the need for reforms in the area of incapacity for work, including many of the changes called for by Hussey et al.4 5 Employers need to take greater ownership of managing absence and avoiding inappropriate medicalisation. But general practitioners' position in frontline health care inevitably means that they will remain a key source of advice and influence for working patients for the foreseeable future.

General practitioners' educators should urgently recognise the need for a change in thinking about this aspect of vocational training and continuing professional development. To support them in this task, the Department of Work and Pensions already provides a range of relevant training resources, evidence based guidance, online training, and a national network of medical officers (www.dwp.gov.uk/medical)