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Case study: How we enabled potential long-term sick patients to get back to work

What happened at our referral centres?

Our pilot was the only one that had a GP leading on the delivery team and the only one that focused on referrals into the service.

Patients had a case manager who spent time assessing their reasons for being off work and offered support in mediating with employers and signposting them to other services. We had an occupational nurse who provided clinical support for the case manager on medical problems.

The GP was involved in about one in 20 cases. That was often for people with chronic pain disorders who were fearful of going back to work – having the GP to manage the process of rehabilitation helped to get them over that.

Having a GP with experience in chronic pain and occupation health is important, because that time with the doctor is often what can make a real difference in changing the patient’s beliefs about a health problem. We had success with some quite complicated cases and the case managers recognised the impact of the GP consultation and how it really changed the agenda.

How many GPs and patients were involved?

We had good buy-in from GPs – 94% of practices (of which there are about 150) referred patients to the service and 63% referred five or more patients.

Over the three-year study, 1,655 patients were referred, 1,406 patients met the criteria for the programme and a total of 1,026 completed the intervention.

The average duration of the intervention was about six weeks. By the end of the study period, 67% of the patients who completed their interaction with us remained in the same workplace, while a significant number left work but went into training or some other form of work. We also followed patients up at one and three months and the retention rate was very good.

What will happen now

We hope the DWP will ensure any provider of the national service is closely involved with GPs. If it is given to a large national provider, it is unclear how locally responsive to GPs it will be and whether CCGs and health and wellbeing boards will have a say in how it’s delivered and be able to define the quality of the service they want locally.   

Another uncertainty is that DWP plans to involve a mixture of telephone advice, face-to-face sessions with an occupation health specialist and more intensive case management of complex cases, but it is not clear what ‘mix’ of services will be available.

Our service was very intensive for those who needed that and there may be much more complexity out there than is realised, particularly around the mental health problems, which made up the majority of referrals.

Dr Rob Hampton is a GP in Wigston and clinical director of the Leicestershire Fit For Work Service

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