Further to the article in October 2010 BJGP,1 on the issue of fit notes, I would just like to point out the fact that it is not just GPs who are involved in the issuing of fit notes for patients. Your article appears to make this assumption. Accepting that GPs do not fully understand the working environment of patients, I do not believe we are the only group of clinicians that this is true of. If we are being true to the guidance sent out by both the Department of Work and Pensions (DWP), which was reiterated when fit notes were brought on line in April last year, supported by the Department of Health Cabinet Office document several years ago which also talked about the issuing of sick notes, that the responsibility of the provision of this document lies with the person who has clinical responsibility. That means a number of our secondary and tertiary care colleagues are responsible for that element of a patient's health that prevents them from attending work. I am, therefore, surprised that this is not mentioned at all, and your article basically says that it is all down to the GP. I don't believe it is and the article does not help in changing the culture that we are in and the ability to implement the DWP guidance.
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