What is the role of Vocational Support Workers in supporting patients’ return-to-work planning?

Problem

Over 2.6 million people in the UK are absent from work due to ill-health with detrimental effects for the economy and the individual in terms of mental and physical wellbeing, as well direct financial impacts, and is thus a key policy priority. Accessing vocational support during sickness absence to facilitate return-to-work (RTW) is challenging for many people, and there is a paucity of evidence about what makes effective vocational support delivered in primary care settings. As part of the Work And Vocational advicE (WAVE) trial, we aimed to explore the delivery of vocational support by trained Vocational Support Workers (VSWs), from the perspectives of patients, VSWs, employers and GPs.

Approach

Semi-structured interviews were conducted with 10 patients who had received fit notes, two employers, two VSWs and one GP. Interviews were audio-recorded, transcribed and analysed using an inductive thematic approach. Patients have been involved throughout the study through a Research User Group (RUG) who influenced the development and implementation of the study. The lay co-applicant attended regular team meetings which included discussions of the initial findings and analysis of the qualitative study.

Findings

Our findings show that RTW planning was an individualised process, which incorporated how the patient felt about their health condition and workplace. By taking a holistic approach, the VSWs were able to identify and work with the patient to mitigate their barriers to RTW, and support an expedient return to the workplace. The independence of the VSW from their employers and other organisations was an important aspect of providing vocational support, as it engendered trust and provided the opportunity for patients to discuss potential workplace adaptations without fear of adverse consequences from their employer or any statutory benefits they may receive. Additionally, patients could disengage from RTW planning when contact with employers was sporadic or minimal. VSWs mitigated this through building patients’ self-efficacy and empowered them to negotiate their RTW proactively with their employer. Whilst employers perceived direct contact with VSWs positively, patients were concerned of the potential implications of such interaction. To provide effective vocational support, VSWs required training and ongoing mentoring support through multi-disciplinary supervision. Regular supervision offered a valuable opportunity to draw on the experiences of the multi-disciplinary team and provided access to peer support, an important aspect of ongoing professional development.

Consequences

Enhancing sustainable primary care which facilitates healthy people and healthy systems necessitates attention paid to the role of vocational support and the ways in which patients can be supported in their RTW planning. These findings point to the need for vocational support to be initiated and delivered within primary care, and could inform future vocational support interventions to support people to RTW more efficiently.