Primary care
Primary care
Feature
Expanding fit note provision
Emma Borthwick and Catherine Atkinson look at the establishment of a vocational rehabilitation occupational therapy service in a London-based Primary Care Network and argue that occupational therapy assessment and intervention skills demonstrably improve return to work rates .
O
ccupational therapy-led vocational rehabilitation and the use of fit notes was shown to decrease sickness absence from work in a pilot project across a number of GP practices
( Drummond et al 2020 ; RCOT 2020 ).
Hackney Marshes Primary Care Network ( PCN ) and Homerton Healthcare NHS Foundation Trust adopted a similar approach , employing an occupational therapist to support the local population ’ s work and vocational needs , focusing on musculoskeletal and common mental health conditions .
The role was funded as part of the Additional Roles Reimbursement Scheme ( ARRS ) in England , aiming to employ wider range of professionals , including occupational therapists , to work in GP practices .
The Vocational Rehabilitation Occupational Therapy ( VROT ) service was set up in April 2022 , supporting patients across five GP practices in the Hackney Marshes PCN in East London . The service offers two pathways of support :
• Assessment and intervention for employed patients with common mental health and / or musculoskeletal conditions to return to and sustain their work role . Examples of intervention include increasing condition self-management , advice on adjustments to work role and environment , fitness for work reviews , return to work recommendations that can be shared with employers .
• Assessment and signposting for patients who are unemployed , providing guidance and signposting to suitable local vocational services .
Fit notes
The Allied Health Professionals ( AHP ) Health and Work report was used initially to provide guidance about fitness for work . This report took longer to complete and was less recognised by patients and employers , sometimes leading to additional requests for fit notes .
Fortunately , recent changes in legislation allowed more healthcare professionals to certify fit notes from 1 July 2022 , meaning the VROT service could now issue them . This reduced additional use of GP time , as they no longer needed to complete fit notes for patients seen in the VROT service .
Service outcomes
During the initial 10 months of the service , 164 patients were accepted for treatment ; 107 of those were in employment . The results were very positive ( see graphs opposite ):
• Sickness absence was reduced from 65 % to 3 % and use of ‘ not fit ’ notes was reduced from 68 % to 8 % ( collected at assessment and 12 weeks after discharge ).
• Patients in work , but with reported difficulty , reduced from 19 % to 5 % and patients accessing reasonable adjustments increased from 2 % to 31 % ( collected at assessment and discharge ).
• 23 % of all occupational therapy completed fit notes indicated ‘ may be fit with recommendations ’; this is significant in comparison with average GP practice use reported at 6.3 % ( Department for Work and Pensions 2022 ).
Patient example
A patient is booked to see the occupational therapist following a repeat fit note request at their GP practice . The patient , in their 30s , has been on sickness absence from their education-based role for the past two months , due to diagnosis of Long Covid . They present with symptoms of fatigue , breathlessness and anxiety , affecting activities of daily living and quality of life .
Following the assessment , the patient receives a fit note from the occupational therapist indicating as ‘ not fit for work ’. The occupational therapist and patient collaboratively agree goals and intervention that includes education , energy conservation , routine building and coping strategies .
They then agree a fit note indicating as ‘ may be fit for work ’, including recommendations of a returnto-work plan and adjustments .
The advice reads : ‘ Patient is experiencing fatigue , advise a phased return to work starting at reduced hours at three days per week , suggest regular reviews before increasing . Some supportive
38 OTnews October 2023