GPs to refer only a third of eligible employees to Fit for Work service


GPs expect to refer just a third of eligible patients to the incoming Fit for Work (FfW) service and want it to be extended to people not working.

In some practices this referral rate was as low as one in ten (11%) while in others it was as high as three-quarters (72%).

Doctors were reluctant to refer those patients who had a negative attitude to work, while understanding of the service's eligibility criteria was also mixed.

The findings came from research conducted by the Institute for Employment Studies (IES) and the University of Liverpool and underlined the need for clearly understood and accepted eligibility criteria, so that GPs knew whom to refer and why.

The report also recommended:

  • a clear specification of the services on offer, so GPs could see to whom it would apply and that patients could understand what they may be signing up to;
  • an easily accessible service, with low or no waiting times;
  • high service standards; and
  • available evidence of the benefits that patients could enjoy from using the service, to reassure both GPs and patients that a referral would be worthwhile.

Last week COVER's sister title WSB revealed that the project, which was previously known as the Health and Work Service (HWS), was being renamed for a second time.

The service will offer occupational health related assessments and support to employees who have been, or are expected to be, absent from work for at least four weeks.

The aim of this study was to provide an estimate of the likely rate of referral by GPs to the assessment element of the new service, and identify the factors affecting referrals.

Data was collected from 3,000 fit notes issued by 13 GP practices across the country alongside an online survey of GP attitudes to health and work.

Just over 70% of all patients receiving fit notes were reported as being employed with 53% of these (39% of all patients) receiving a fit note lasting for three or more weeks making them eligible for the service.

GPs said they would refer 36% of these nominally eligible patients to the new service, varying between practices from 11% to 72%.T

The research raises concerns about GPs' understanding of the service; despite being briefed on the eligibility criteria only 63% of all nominally eligible patients were deemed suitable for referral.

GPs then said they would refer just over half (54%) of those they deemed suitable.

Encouragingly, GPs generally thought work was beneficial for people's health, but were a little less clear about whether it was their role to get people back to work and whether patients needed to have fully recovered before they recommended a return.

GPs were also generally positive about the prospect of the new service - two-thirds agreed that the new service would be helpful to their patients and it was noticeable that referral rates were higher among those with the most positive attitudes to health and work.

The timing of the survey coincides with the further delay to the FfW service, which WSB revealed last month was due to concerns over GP referrals.

This GP survey was carried out between October 2013 and January 2014.

WSB understands that potential operators were then told during the tendering process in the spring that the launch of the service would be pushed back from October until December.

It also coincides with the DWP's decision, which WSB revealed in April, to slash the number of expected patients the service would deal with by a third from between 350,000 and 700,000 employees each year to between 229,000 and 457,000.

This study estimates that GPs would refer around 310,000 and 450,000 patients.

WSB has contacted DWP for a response to the results but has not yet received a reply.

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