The integration of Work Coaches (WCs) & Disability Employment Advisors (DEAs) into UK General Practice (GP) provides an innovative approach to bridging the gap between health & employment services. We now reflect on the findings of our recent study led by Shriti Patani, Lara Shemtob & Kabir Varghese in collaboration with colleagues from the Department of Primary Care and Public Health at Imperial College London. The study explored the benefits & challenges of integrating emplyment support services in primary care from the perspectives of GPs & work coaches.
What’s the context?
Employment is a critical social
determinant of health, with unemployment linked to poorer physical & mental
wellbeing & reduced quality of life. Traditionally, individuals seeking
employment support access services through Jobcentres. However, barriers including
stigma or lack of awareness - especially in people with disabilities or
long-term health conditions - could limit engagement with support services leaving people underserved. This could have a significant impact on mental health & the lived experience of people who are out of work & therefore cannot earn an income to live & thrive on.
Embedding work coaches within GP practices can help address these barriers whilst providing accessible, holistic support in a familiar healthcare setting. This streamlined integration allows patients to receive tailored employment advice alongside their medical care, and particularly where their presentation involved health & psychosocial factors.
The aim of our study was to qualitatively evaluate the effectiveness of this integration of work coaches in primary care & to characterise barriers & enablers to scale up this service for patient benefit. Primary data collection involved a series of semi-structured interviews with four GPs & eight work coaches/ disability employment advisors that were placed within NHS GP practices between May and July 2023. Discussions centred around the perceived benefits, challenges & strategies related to the integration of employment support within primary care.
“This work evaluates a novel approach of integrating work advice in the healthcare setting as a route to address the current challenge of economic inactivity in the UK. The work demonstrates positive experiences for the service, users, work coaches and healthcare professions”
Dr Shriti Pattani, National Clinical Expert, Occupational Health & Wellbeing, NHSE & Clinical Director Occupational Health, London North West Hospitals Trust.
Key findings
· Enhanced collaboration & patient openness: The physical presence of job centre staff in GP practices facilitated direct communication between healthcare providers & employment advisors. This enabled a more coordinated approach to care. Service users were more comfortable discussing employment concerns in the GP setting, leading to more meaningful interactions.
· Clear benefits to patients & providers: A series of case studies highlighted how support could be tailored to optimise person-centredness & outcomes. Service users benefited from the holistic support they received from work coaches, also reducing the need to see their GP for non-medical work-related episodes. This has the added value of reducing the non-medical workload of clinicians allowing them to focus on clinical care.
· Challenges & barriers: Resource constraints, coupled to lower awareness about this new pathway among healthcare professionals could limit the rate at which this model could be scaled up so that WCs & DEAs are routinely embedded in GP practices.
The future of integrating employment support pathways in general practices
The significant focus by the Department for Work & Pensions (DWP) on helping people remain economically active has led to a number of innovations including the WorkWell programme & approaches including embedding WCs & DEAs in general practices.
Our research showed the integration of Work Coaches & Disability Employment Advisors into GP practices is a promising strategy to address the intertwined issues of health and employment. Crucially, by providing, this model which streamlines access to holistic support has the potential to improve patient outcomes, reduce the burden on primary care & contribute to a more inclusive workforce.
“Work like this which interrogates how to better support service users at the interface of work and health is increasingly important in finding ways to better support both the health and productivity of the population”
Dr Lara Shemtob, Academic Clinical Fellow, Imperial College London
Policymakers should consider supporting
the rapid scale up of this approach whilst also addressing resource constraints.
Raising awareness & enhancing interprofessional collaboration can also maximise
the benefits of this approach. Future research should also consider patient
perspectives to fully assess the impact & identify areas for improvement. This work is crucial now more than ever given the recent launch of the WorkWell Programme vanguards across 15 Inegrated Care Systems in the UK to help people remain eocnomically active.
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