‘Getting patients back to work is not the responsibility of GPs alone’

GP and chief medical officer of the Department for Work and Pensions Dr Gail Allsopp on how primary care can support patients in getting back to work, and what Government initiatives are in place to help

As GPs, we are passionate about reducing health inequalities. It is part of our role. To do this though, we must look beyond the consulting room and do what we can to ensure the social determinants of health are also addressed. One such determinant that we can easily influence is work.

Professor Sir Michael Marmot and many others have documented well the evidence that ‘good work’ is good for health. Whilst I agree that work is important, it is also essential to consider the journey towards work. Meaningful activity of any sort can give people a sense of belonging, a reason to get up and a sense of purpose. If we get this right, we improve our sense of wellbeing and impact our health. Our social prescribers in practice already help us with this when they link patients to community projects, voluntary organisations or informal groups and we must not underestimate the impact this intervention has.

With one in three people diagnosed with a long term condition and one in four self-reporting living with a disability, the issue of work and health has never been more important. The Academy of Medical Royal Colleges (AoMRC), supported by the Royal College of General Practitioners (RCGP) released their updated Statement for Action on Work and Health earlier this year which gives five clear statements for all healthcare professionals to consider:

• Ask the work question – what do you do for work, how are you managing in work, and what may help you get back to work?
• Understand through training the importance of work as a health outcome, how health may be promoted through good work, and where to signpost their patients who need further support.
• Be able to advise their patients through easy access to up to date guidance from Government, professional bodies, and work and health professionals on the impact of health conditions and treatment on their work, and on adjustments to assist those with disabilities.
• Derive most value from the ‘Fit Note’ in primary care, hospitals and in the community, through training for health professionals, and utilising updated easy to use guidance.
• Recognise their own role to support healthy and safe working environments, looking after their own health and wellbeing, and promoting the health and wellbeing of their colleagues within the organisations in which they work.

It is important to note that this is not the responsibility of primary care alone. We are not occupational physicians and we do not have the time to undertake hour long consultations with people who are out of work, or at risk of falling out of work. To help us, there are now services being set up with significant investment (see Box 1) from the Government, and if we use them and refer in to them, we stand more chance of building the evidence base on what works, which will then enable further funding to sustain or expand the projects.

WorkWell pilots aim to devolve power to local areas to lead, design and deliver integrated work and health support. NHS Accelerators aim to improve population health outcomes whilst helping build the evidence base related to targeted action to better prevent, treat and manage the health conditions most associated with economic inactivity (mental health, musculoskeletal and cardiovascular disease), and Trailblazers aim to increase engagement and tailored approaches that bring together and streamline work, health, and skills support.

On top of this, 15 WorkWell sites have just each been offered a share of an additional £1.5M as part of the WorkWell Primary Care Innovation Fund to facilitate proactive approaches to fit note innovation, reduce pressure on GPs and improve patient work and health outcomes. One of the key objectives of the funding is to build the evidence base for the role that the fit note process can play as part of joined up, locally led work, health and skills systems, led by GPs.

By making simple changes today, you and your practice could further improve health inequalities, simply by looking beyond the consulting room. As the AoMRC suggests, you could ask the work question and aim to derive the most value from the fit note, but what does this mean in practice? Firstly, you could consider your default position as ‘may be fit for work’ rather than ‘not fit for work’ when asked for a fit note. By doing so, you could enable people to have an earlier conversation with employers which may lead to an earlier supported return to work, preventing deconditioning or further health harms associated with a prolonged absence.

And secondly, don’t forget to use the services being set up to help people have work and health supported conversations (see Box 1). If we collectively aim to keep people in work, stop people falling out of work, and support those who need it on their first steps of meaningful activity, it might just be the difference needed to improve their social determinant of health and help reduce overall health inequalities.

Dr Gail Allsopp is a GP in Derbyshire, a nationally elected member of RCGP council, and Chief Medical Advisor to the Department for Work and Pensions

Box 1: