Can something be “too good”?

We have encountered people who had to give up their jobs because of B12 deficiency. It may start with loss of memory, or an inability to concentrate. Terrible fatigue is also quite common. A supportive employer can change working hours or working conditions to try to help a valued employee, but even they will run out of patience at some point. Another may comply with the letter of the law for the statutory period; but, since there is often no improvement, is the end of the job.

And then the benefits dependency cycle begins.

Until this most recent upheaval in the benefits system, once a person is on benefits, it is often very difficult to start work again. With the long-term sick, such as the inability to concentrate, what terrible fatigue, you don't know whether you can work a full week, or a full month, and you often want to try out work. But as you begin in the jobs market, you also find that you lose benefits, often £ for £.

What if the problem is easily treatable? What if it is a nutritional deficiency, such as B12 deficiency? What if your doctor makes the right diagnosis, and you start to feel better? With the benefits system that makes it almost impossible to start working again, we have encountered people who stop their treatment before they stop their benefits. How can you do that? How can you want to remain sick – to remain confused, depressed, tired, in pain – rather than lose the money from invalidity benefit? It's sad, but true.

We have identified and diagnosed thousands of people, and our criteria for confirming the diagnosis is that these people start to get better (their symptoms remit) once they receive B12 therapy. Most people really appreciate the treatment, really appreciate "getting their lives back". But if you don't come back to the doctor when they are due the next treatment. If you go to another doctor, and say that the treatment makes no difference, or that they don't want any more, even though simple questioning shows that the symptoms they were complaining of have got better. We HAVE examined this, and the only conclusion seems to be that they risk losing their benefits.

So what do we have to do? We need a benefits system that doesn't penalise the people who get better. It's possible that that is what we have now.

We need a recognition that a simple vitamin deficiency is a potential diagnosis, so that when the doctor is going through all their options, they consider nutritional deficiency.

We need robust diagnostic methods based on signs and symptoms, so the doctor can make the diagnosis, using input from other clinical sources and tests, rather than being constrained by them.

And we need flexibility, so that doctors can tailor treatment to meet the needs of the patient in front of them.

We encounter nearly one in five of the population of this GP practice who have benefited from B12 replacement therapy (whether oral or by injection). Most of these are happy to come off benefits and go back to work, or have been diagnosed early enough, but they have only taken a few days off sick, and never and benefit system in the first place we know that a correct diagnosis, especially one where the solution is so simple, and so effective, is vital to keep Britain working. It brings is greatly when people refuse treatment, and therefore refuse to look after their own health. Thankfully, this is very rare.