A meeting of 200 doctors was implored to think twice before signing patients off sick because of evidence that a lay-off was worse for their wellbeing; and that of the taxpayer.

Alan Johnson, the Work and Pensions Secretary, called on GPs not to give in to those demanding a sicknote but to become a “critical friend” inspiring them to go back to work.

Doctors’ leaders later said that if a patient insisted that work was making them genuinely sick, then GPs had a duty to sign them off while the problem was sorted out.

They added that they would always act in the best interests of the patient and called for an overhaul of the present system of sickness certification which relied too much on doctors as gatekeepers.

Mr Blair insisted last week that the black hole in pension provision could be plugged by reducing the bill for the 2.7 million who claim incapacity benefit.

GPs sign an average of ten to fifteen sicknotes a week and Mr Johnson feels that more should be done to promote work as a route to rehabilitation.

Speaking at the Royal College of Medicine, Mr Johnson set out a win-win scenario of improved health and a cut in the £7 billion-a-year incapacity benefit bill. He said: “Often a patient will think that they want a sicknote, when the best advice a critical friend can give might not meet their initial expectations. You have a powerful opportunity to help us end the sicknote culture.

“People wrongly assume that an early return to work is bad for them and will cause their condition to deteriorate. There was general surprise at how quickly Tony Blair returned to work with just a weekend break after his heart operation.

“In fact, thanks to modern surgical techniques, evidence-based recovery times are often a lot shorter than people expect.”

But a spokesman for the British Medical Association was reluctant to accept the Prime Minister’s example as a general case study for GPs.

She said: “Some people can tolerate pain better than others. Some find it easier to work through it, while others find pain so intolerable that they cannot work properly. It is very subjective and each case needs to be managed differently.”

GPs were “reluctant” gatekeepers of the benefits system through sicknotes, she added.

“GPs have always found this position difficult because quite often it concerns things that the GP is no better at judging than any other person, for example, stress at work or back pain. Only the employee can say whether they are well enough to come back to work.

“What is needed is a more holistic approach because it may be important to look at the workplace, what they are doing and what their working environment is like. We need a complete overhaul of the way the system is managed.”

Mr Johnson, however, insisted that family doctors had “a powerful opportunity to help us end the sicknote culture”.

He said that the act of signing a sicknote sent a powerful message from a trusted figure that they cannot work — and work brought benefits such as money, dignity, purpose and activity. All helped to boost confidence and self-esteem.

Mr Johnson added: “We know that nine out of ten people who come on to incapacity benefit want and expect to get back to work . . . It is our job to ensure that they have every opportunity to realise this ambition.

“For people who are able to work again, a job can itself be an important step in the road to recovery and rehabilitation.”

Mr Johnson believes that periods of inactivity damage mental and physical health, with suicide rates of the long-term unemployed 35 times those of the employed.

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