Sir, The Government is right to say that work is fundamentally good for health and that there are many health benefits of work ("The sick note that will tell the boss you’re fit enough to work”, Feb 18). However, making a judgment about the type of work that someone is well enough to do is a complex decision.

Occupational health doctors are specialists who are trained to work with employees and employers to rehabilitate people back into work. They fully understand the difficulties that GPs face when signing sick notes. It is difficult enough for GPs to know whether their patient are able to continue in their usual job, but to assess patients’ capacity for alternative work is much more difficult.

Redesigning the sick note might be part of the answer. However, the real issue is not getting GPs to do something “different”, but helping GPs to access support for their patients who can (and want to) return to some form of work. Both GPs and patients need access to the expertise that occupational health doctors and nurses offer and fast access to treatments such as physiotherapy and psychological support.

Employers also need to be inventive and flexible in finding alternative jobs or modified work.

Dr Gordon Parker
President, Society of Occupational Medicine

Sir, Alan Johnson’s “well-notes speech” is welcome news for chronic pain sufferers — it could open doors for employees to receive the right treatment to get back to work.

I have suffered from migraines for six years. In that time I have had to leave college, compromising my career prospects and lowering my confidence. Most employers view pain sufferers as malingerers. I’ve been luckier than most — with the help of a supportive boss and effective pain relief, I have been able to hold down my job at a high street bank and things are beginning to look up.

No one likes to be off work, especially knowing that you are letting colleagues down or fearing your job is in jeopardy. If this initiative will change perceptions and provide advice on how employees like me can get fit and back to work, it will be a very good thing.

Ellie Beattie
Taunton

Sir, Nine out of ten of those who claim incapacity benefit want and expect to return to work. Many start claiming incapacity benefit because of back and neck pain, depression or heart and circulatory problems. These are serious conditions, but with prompt intervention by physiotherapists and other primary care professionals long-term unemployment can be avoided.

Along with mental health problems, musculoskeletal disorders (MSDs) are the most commonly reported cause of work-related ill-health in the UK. Back pain alone costs employers £600 million a year, with sufferers of persistent back pain on average taking 17 days off sick every year.

The benefits of prompt access to physiotherapy for people with musculoskeletal disorders are well known. They can not only help to prevent MSDs, they can stop them recurring and help people to self-manage their health conditions. If the suggested strategies to help people return to work and stay there are to succeed, it is vital that such occupational health schemes are expanded.

Liz Cavan
Chair, the Chartered Society of Physiotherapy

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