Our Occupational Therapy Service and QI (Quality Improvement) team has supported Rosebank Primary Care Network (PCN) to establish a pioneering service for working age adults; a Vocational Rehabilitation Service with the aim of providing their patients with the tools, skills and adjustments needed to return to work using quality improvement methodology.
The UK is the only major economy that has seen its employment rate fall over the last five years, reversing the previous long-run trend of declining rates of economic inactivity. This has been driven predominantly by a rise in the number of people who are economically inactive due to long-term sickness – a trend that triggered the Government white paper ‘Get Britain Working’.
Proposals detailed in this paper included scaling up and deepening the contribution of the NHS and wider health system to improve employment outcomes as well as a focus on treatment and care pathways for those who are in long term sickness, in particular mental health and musculoskeletal services.
Rosebank PCN Business Manager Cheryl Lawrence explains:
“We are proud to be the first in the country to offer this service to working-age adults. The idea stemmed from a significant rise in Med3 sick note requests following the pandemic. We wanted to explore innovative ways to manage this increasing demand while ensuring our patients receive the right support to help them return to work.”
Rosebank hoped to enable their patients to reap the benefits of Vocational Rehabilitation by supporting patients to remain in or regain permanent employment, to overcome barriers to this, to provide advice on reasonable adjustments or suitable duties as part of an individualised treatment plan, to improve long-term physical and mental health, enable access to wider support services and, for those with complex vocational needs, to find a way to support GPs to help with this.
GHC Quality Improvement (QI) Manager Jenny Smith explains how the QI tools and techniques helped to create an opportunity for patient representatives, colleagues from the practice and occupational therapy leads to come together and design a service in response to the problems Rosebank GPs were facing in supporting individuals to remain in or return to work.:
“We used QI tools and methodologies to understand the needs of this population, the challenges people were facing in managing their health at work and to measure the impact that our Occupational therapist was having on their lives through vocational rehabilitation”.
Together the team established a referral and exclusion criteria and a structured tiered approach to the level of treatment each individual needed based on that criteria.
Consideration is given to reasonable adjustments that may be made such as alterations to work patterns timings or workload. Environmental adjustments may be made, such as working from home, parking arrangements or supportive equipment – as well as further support that may be offered such as time off for medical appointments, temporary flexible working or additional breaks, a review of job objectives and clarity over expectations, as well as access to regular support and Access to Work.
The service was introduced on 8 May 2024, and Rosebank has been impressed by the success of the service. Over the first ten months they recruited an occupational therapist and received 325 referrals over this time.
With the support of the Quality improvement methodology, the service is able to monitor standardised outcome measures for occupational therapy treatment by recording patient outcomes and are able to demonstrate the quantitative and qualitative measures of success as Cheryl explains:
“We are among the first nationally to offer this service and respond to the government agenda on sickness absence from work and, with the support of GHC’s Occupational Therapy and QI teams, we are at the forefront of innovation in Primary Care. Being able to demonstrate the value of this service has been essential, not only in securing continued support but also in highlighting the real difference it makes to our patients’ lives. By tracking outcomes, we can show how vocational rehabilitation is helping individuals regain confidence, return to work, and improve their overall well-being.
“For the surgery, this has meant a more efficient way of managing Med3 requests and long-term sickness, freeing up GP time for other clinical needs. Instead of repeated consultations for sick notes, patients now receive tailored support that helps them take proactive steps toward employment.
“One example that stands out is a patient who had been struggling with their mental health following a bereavement. Through our vocational rehabilitation service, they received structured guidance, workplace adjustments, and the confidence to gradually reintegrate into employment. Within a few months, they were able to return to work on a phased basis, significantly improving their mental health and quality of life.
“This service is not just about helping people get back to work; it’s about empowering them to sustain employment in a way that supports their long-term health. We’re incredibly proud to be leading the way in this area and hope to see this model replicated more widely in primary care.”
The demonstrable benefits of the service so far include a reduction in patients returning to their GP for the same issues time and again. Patients are able to get back to work quicker, and in a more sustainable way, with Vocational Rehab than other traditional approaches which frees up GP time for other patients.
There is no requirement for onward referral outside the practice or a separate service for physical and mental ill health – a one-stop shop.
Gloucestershire Health and Care NHS Foundation Trust Specialist Occupational Therapist Kelly McLaughlin says the service is making a real difference for patients:
“Providing support to people with physical and/or mental health conditions within the vocational rehabilitation service has been incredibly rewarding.
“Many people experience a loss of identity when they are unable to work due to their health condition and want to return to work as soon as they can. My role involves supporting these people to explore strategies to help manage symptoms and to consider reasonable adjustments in the workplace which might support their return to work.
“We have regular reviews to monitor progress and address any barriers/challenges they may be facing when returning to work. The majority of the people I work with are able to successfully return to work and remain at work with support from their employer.
“Overall, the service has been extremely valuable to patients to help identity strategies to manage their health conditions within the workplace and to sustain their employment”.
