Sickness certification and the fitness for work consultation continues to pose challenges for general practitioners. The fitness for work consultation often requires GPs to make decisions that go beyond just the management of a medical condition. The challenge for the GP is to remain focused on the patient and the problem. The biopsychosocial model of illness and disability takes a patient centred view of ill health where individuals health concerns are considered within their social context. Illness, disability and incapacity are closely linked. Part of a GPs struggle when managing fitness for work and certification perhaps lies around using this model in everyday consultations. The patterns emerging from incapacity benefit statistics show a major shift from musculoskeletal to mental health problems as the major cause of incapacity benefit in Great Britain. It is also becoming clear is that there seems to be a 'window of opportunity' for effective clinical and occupational management that is between one and approximately six months off work. The changes in attitudes to mental health, with increasing numbers of people off work due to stress and distress however, seem to relate to the change in social acceptance of anxiety and stress as legitimate reasons for absence from work and disability. However, evidence seems to suggest that work may have a positive effect on health and well-being. So, if the management of common health problems particularly mental health problems are to change then this will need a concerted effort from all parties involved.