Conditions in new return to work service may stop it being fully effective
The Fit for Work service is launching this month. It stems from a review conducted by Dame Carol Black in 2011, aimed at identifying ways of minimising sickness absence and improving systems for managing it.
The report identified that a lack of access to occupational health services, particularly for small and medium-sized businesses, was a significant issue in preventing employees returning to work. Consequently, a key recommendation in the report was the setting up of a state-funded health and work assessment and advisory service.
Referrals
The advice aspect of Fit for Work will be available before the assessment service is on stream. Employers, employees and GPs will be able to access a telephone helpline and website which are due to go live this month. The primary route to the assessment aspect of the service will be through GPs’ referrals, and will be subject to the employee’s consent. GPs can refer employees for assessment once their patient has reached, or is expected to reach, four weeks of sickness absence. This part of the service will be rolled out probably on a regional basis; it is expected to be completed nationally by May 2015.
Employers can refer employees with the employee’s consent if the GP has not done so after four weeks' absence. Following the assessment, a plan will be prepared containing advice and recommendations on assisting the employee’s return to work.
Concerns
But how effective will the service be in achieving its aims in practice? Awareness of it seems low and although guidance for employers has been promised, there is no indication when this will be published.
Crucially, this is a consent-based service, entirely voluntary on both the employee's and employer’s part, which could seriously limit its effectiveness. Contrary to original expectations, there is no mandatory element. If the employee refuses to consent to the GP’s referral, that is the end of the process; employees cannot be compelled to attend the assessment. Similarly, the employee may refuse to consent to disclosing the return to work plan to the employer and, even if it is disclosed, the employer could disregard any recommendations made in it.
Another potential problem is that GPs will have to exercise their clinical judgment about whether or not to refer an employee for assessment (subject to the issue of consent). A Department for Work and Pensions survey of GPs in October 2014 showed that the proportion of likely referrals varied considerably from 11 per cent to 72 per cent.
Some of the reasons given by GPs for non-referral were the nature of the health problem; whether the employee was already receiving sufficient support; and concerns about the employee’s motivation regarding returning to work. Guidance for GPs will be prepared but there is no indication when this will be available. If GPs are unsure how the service will operate, this may affect the level of referrals, especially in the early stages.
Phone assessments
Although in certain circumstances a face-to-face assessment may be recommended, generally the assessment will be over the telephone. This will take place within two working days of the referral and last between 45 minutes and an hour.
The assessment will look at employees’ non-health and non-work issues, described as a ‘biopsychosocial’ approach. Individuals may be reluctant to discuss their health or personal problems with a stranger over the telephone and, as it is not anticipated that the assessor will have access to the employee’s medical records, the effectiveness of the assessment could be limited. Similarly, how effective will the return to work plan be if employers are not involved in the discussions? They are likely to be the best people to know what adjustments are going to work in their organisation.
The service is intended to complement, rather than replace, employers’ existing occupational health provision. Large organisations with access to established occupational health services may not need to use it while SMEs could find that, in practice, the new service may not work as effectively as they had hoped.
Debra Gers is a senior practice support lawyer in the employment team at Blake Morgan
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