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GPs’ motivation to refer their patients into Health and Work Service (HWS) may play a key role in its success

Dr Tyna Taskila

16 October 2013

Macmillan Cancer Support held a workshop yesterday (15 October) on the Health and Work Service (HWS) for chronic conditions – the tweets from which you can view by searching Twitter for #healthandwork. Key healthcare charities and patient groups attended to discuss how the new service could best take account of the needs of people with long-term conditions.     

The service, which will be introduced next year, is designed to support people who have been on sick leave for more than four weeks, back into work. GPs will play a key role in introducing the service to their eligible patients and motivate them to ‘take up’ an offer. GPs and other healthcare professionals are in an important position to identify the patients who need additional support and further referring them into vocational support.

Although the significant majority of GPs and other clinicians recognise their increasing part in supporting their patients back to work, there is considerable research evidence that some groups of patients, such as those with certain chronic conditions, do not get referred to vocational rehabilitation as expected. The reason for this remains largely unclear, but it’s likely that GPs’ attitudes and lack of knowledge on ‘return to work’ issues may play a major role. GPs, as with other healthcare professionals, often have low expectations of their patients’ work capability most importantly, they rarely see work as a key priority for their patients.  This is particularly true in people with certain chronic illnesses, such as cancer and severe mental health conditions, to whom employment has not traditionally been seen as a priority or even as a realistic outcome among healthcare professionals.

Another key issue is the patient’s initial motivation to return to work. Due to low expectations of others, many patients may lack confidence in their own work capability and they may be reluctant to return, for example due to experiencing a difficult work environment. Thus different negative factors could make a patient less motivated to seek help to return to work; however, a positive attitude from their GP about returning to work could help to change that. Unfortunately, low recognition of employment as an important outcome for people with chronic conditions among GPs may have an opposite impact on patients’ motivation to receive support to return to work; despite employment being an outcome in a number of health related indicator sets, it is not currently included in the CCG indicators, and is therefore not a priority for GPs.

GPs are trained to protect a patient’s best interests. If GPs do not see return to work as in their patients’ best interests or important for their wellbeing then they are unlikely to motivate them to take up an offer of the HWS or any other type of vocational support. The success of the WHS depends heavily on the patient’s motivation to take up an offer to attend but also on the GPs motivation to refer their patients into the service.