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GPs to refer long-term sick to occupational health service under Government plans

The Government is pressing ahead with plans for GPs to refer patients heading for long-term sickness to a national occupational health service that it says will reduce the burden on practices.

The Department of Work and Pensions (DWP) says the scheme is on course to launch late next year, with GPs the main referral route for patients into the service.

The health and work advisory and assessment service is still being designed but will involve a ‘case managed approach’, the DWP said.

However, the developer of one of the successful pilots has urged the Government to involve GPs with relevant experience in the specialist centres themselves.

The £50 million project aims to boost access to occupational health services, to help prevent people on short-term sickness absence falling into long-term sickness or worklessness, and is expected to benefit the economy to the tune of £900 million a year.

The service should save practices by covering costs of referrals for physiotherapy or mental health services, the Government claims.

The DWP is basing the service design on results from seven so-called ‘Fit for Work Service pilots’ running around the country, with various models of case-managed and multidisciplinary services providing help with social concerns, such as financial and housing issues, as well as clinical problems.

A DWP spokesperson said: ‘GPs will be the main referral route into the Health and Work Service for employees who have reached, or are expected to reach four weeks sickness absence. Once referred , the employee will receive an assessment by an occupational health adviser. 

‘A case managed approach will be adopted by the service to deliver the service to employees.

‘We are currently working on the detailed design of the service, which we expect to launch late next year. The Fit for Work Service pilots have provided valuable insight that has helped inform the service’s design.’

The DWP said the service would involve occupational health nurses, occupational therapists, physiotherapists and occupational physicians ‘amongst others’.

The GP who led a successful pilot in Leicestershire urged the Government to involve GPs with relevant experience.

Dr Rob Hampton’s pilot Fit For Work Service employed a case manager for every patient and was unique in being GP-led.

Dr Hampton, a GP in Wigston and an occupational health specialist, told Pulse having a GP on hand to manage the more complex cases was critical to its success.

He said: ‘Certainly we’re hoping the new national service will have a GP involved in the delivery.

‘[Having] a GP with experience in chronic pain and occupational 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.’

The Leicestershire pilot employed a case manager for each patient, with an occupational health nurse employed to support them with medical problems, while the GP’s direct involvement was needed for around one in 20 cases.

Dr Hampton said: ‘These were often people with chronic pain disorders who were fearful of going back to work – so having the GP to manage the process of rehabilitation helped to get them over that.’

Dr Hampton also called for adequate case management as the majority of people referred had complex problems, particularly mental health issues.

The DWP’s plans involve a mixture of telephone advice, face-to-face sessions with an occupation health specialist and more intensive case management of complex cases, but Dr Hampton said it remains unclear what the ‘mix’ of services would be.

He said: ‘Our service was very intensive and my concern is there is much more complexity out there than is realised, particularly around the mental health problems, which were the majority of referrals.

‘The question is how realistic is it for most people to have telephone advice and what is the quality of the service from the face-to-face advice? It could just be an advice service rather than something that solves the problem.’

Dr Richard Vautrey, GPC deputy chair and a GP in Leeds, said GPs would welcome the new service, although it would not necessarily have much impact in reducing workloads.

‘GPs will welcome the opportunity to have the patient assessed by a trained occupational specialist. For some selected patients it will be beneficial to look at the particular aspects that prevent them working and what could be modified to help them to return to work.’

He added: ‘It shouldn’t change what change what GPs do, it will give them another opportunity to seek support people to get back into a working environment, which we recognise in the vast majority of cases is good for people’s health.’

‘The potential savings would be modest in terms of the number of patients who would no longer need to return for a fit note. For most people who use fit notes they’re only using them for a short period of time.’

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