Incapacity, work, and benefits

Incapacity benefit should not be seen as a payment for being unable to carry out any work at all owing to illness.¹ Instead it is seen by most claimants as a form of income support and as a gateway benefit to other state support such as housing and council tax benefits. This package can typically amount to over £700 each month. It is easy to claim and requires only a medical certificate to allow payment by direct bank transfer. No further evidence is initially required, and recipients do not need to sign on at regular intervals. There are powerful incentives to continuing the claim as benefit levels increase after one year, and returning to paid work may entail a drop in income or at best a small increase as all benefits are lost.

It is extremely difficult for a general practitioner to refuse a sick note request for incapacity benefit and to be impartial when giving advice. Certificates for incapacity benefit are not statements of incapacity for all work but really just confirmation that the patient has consulted a doctor and requested a certificate. In my experience more than 90% of claimants are able to do some type of work, and in fact many do so unofficially.

From this, the single most important way to help recipients of incapacity benefits and new claimants is to take GPs out of the requirement to provide long term certification, and payment should not be dependent on them. A GP may be asked to provide an initial certificate to a patient, so that he or she can access the system, but payment should be made only after assessment by an independent doctor and confirmation that the claimant is unable to work in any way at all.

The patient should then be assessed regularly before further payments are made. Assessments should be functional, and if some type of work is possible then further help and advice about finding work can be given. Other considerations are secondary but may be important. I have concerns about benefits increasing after 12 months as this may contribute to long term claims. The linkage to other benefits may also need to be addressed to reduce the “poverty trap.” But fundamentally the most important measure is to remove the link between GP certification and benefit payments.