Work, fit notes, and occupational health

Morrison, Jillian

doi:10.3399/bjgp10x515647

Cited by 6 publications

(3 citation statements)

References 4 publications

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“…These include clinical knowledge which was not found to be a key requirement in either a systematic review or focus groups with vocational advisors [26,27]. It has been suggested that interpersonal skills may be more important than a health background when defining the VA role [29,30]. The level of clinical knowledge required for the VA role is centred on understanding the potential for disability or functional limitations that a condition leads to, and hence the likely impact on work participation [24].…”

Section: Discussionmentioning

confidence: 99%

Acceptability of a vocational advice service for patients consulting in primary care with musculoskeletal pain: A qualitative exploration of the experiences of general practitioners, vocational advisers and patients

Sanders

Wynne‐Jones

Ong

et al. 2017

Scand J Public Health

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Aims: To explore the experiences of GPs, vocational advisors and patients towards a new vocational advice (VA) service in primary care, using qualitative interviews. Methods This study was nested within the Study of Work And Pain (SWAP) cluster randomised controlled trial. The SWAP trial located a VA service within three general practices in Staffordshire.Interviews took place with 10 GPs 12 months after the introduction of the VA service, 4 vocational advisors whilst the VA service was running and 20 patients on discharge from the VA service. The data were analysed using the 'constant comparative' method, which is a variation of grounded theory. Results: The key factors determining the acceptability and perceived effectiveness of the VA service from the perspective of the three groups of stakeholders were 1) the timing of referrals to the VA, 2) the perceived lack of patient demand for the service, and 3) role uncertainty experienced by VAs. Conclusions Early vocational intervention may not be appropriate for all musculoskeletal patients with work difficulties. Indeed, many patients felt they did not require the support of a VA, either because they had self-limiting work difficulties and/or already had support mechanisms in place to return to work. Future VA interventions may be better implemented in a targeted way so that appropriate patients are identified with characteristics which can best be addressed by the VA service.

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Section: Discussionmentioning

confidence: 99%

Acceptability of a vocational advice service for patients consulting in primary care with musculoskeletal pain: A qualitative exploration of the experiences of general practitioners, vocational advisers and patients

Sanders

Wynne‐Jones

Ong

et al. 2017

Scand J Public Health

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“…The aim of the fit note, however, is to challenge the assumption that illness and work are incompatible and that work is an impediment to recovery [ 9 ]. The focussed advice that GPs are able to provide should stimulate a more in-depth discussion with the patient around their health and their specific work role, with the proviso that the GP is fully reliant on information from the patient [ 10 ]. Evidence suggests that GPs find the fit note a useful tool and that it is helpful in initiating and negotiating discussions around health and work [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Perceptions of health professionals towards the management of back pain in the context of work: a qualitative study

Wynne‐Jones

Windt

Ong

et al. 2014

BMC Musculoskelet Disord

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BackgroundMusculoskeletal complaints have a significant impact on work in terms of reduced productivity, sickness absence and long term incapacity for work. This study sought to explore GPs’ and physiotherapists’ perceptions of sickness certification in patients with musculoskeletal problems.MethodsEleven (11) GPs were sampled from an existing general practice survey, and six (6) physiotherapists were selected randomly using ‘snowball’ sampling techniques, through established contacts in local physiotherapy departments. Semi-structured qualitative interviews were conducted with respondents lasting up to 30 minutes. The interviews were audio recorded and transcribed verbatim, following which they were coded using N-Vivo qualitative software and analysed thematically using the constant comparative methodology, where themes were identified and contrasted between and within both groups of respondents.ResultsThree themes were identified from the analysis: 1) Approaches to evaluating patients’ work problems 2) Perceived ability to manage ‘work and pain’, and 3) Policies and penalties in the work-place. First, physiotherapists routinely asked patients about their job and work difficulties using a structured (protocol-driven) approach, whilst GPs rarely used such structured measures and were less likely to enquire about patients’ work situation. Second, return to work assessments revealed a tension between GPs’ gatekeeper and patient advocacy roles, often resolved in favour of patients’ concerns and needs. Some physiotherapists perceived that GPs’ decisions could be influenced by patients’ demand for a sick certificate and their close relationship with patients made them vulnerable to manipulation. Third, the workplace was considered to be a specific source of strain for patients acting as a barrier to work resumption, and over which GPs and physiotherapists could exercise only limited control.ConclusionWe conclude that healthcare professionals need to take account of patients’ work difficulties, their own perceived ability to offer effective guidance, and consider the ‘receptivity’ of employment contexts to patients’ work problems, in order to ensure a smooth transition back to work.

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“…42 One of the main implications of the fit note for GPs is the need to spend more time with their patient to find out what their work involves and what workplace adjustments may be possible. 43 During this process, the GP is completely reliant on what the patient tells him or her about their working environment and practices, and neither GP nor patient are likely to know what adjustments are possible or reasonable from the employer's perspective. How GPs make their assessments of fitness to work, what information they use in coming to their decisions, how accurate they are, and how employers use the recommendations made on the fit note are key questions for evaluation.…”

Section: Commonly-reported Difficultiesmentioning

confidence: 99%