FocalPoint
Research type
Research Study
Full title
What helps people with musculoskeletal pain stay in the labour market, if they are self-employed, flexible or portfolio workers? Patients’ and First Contact Practitioners’ views (the FocalPoint study)
IRAS ID
320093
Contact name
Elaine Wainwright
Contact email
Sponsor organisation
University of Aberdeen
Clinicaltrials.gov Identifier
21/014, Funder Project No.
Duration of Study in the UK
0 years, 6 months, 30 days
Research summary
Research Summary:
Musculoskeletal (MSK) pain is a major health problem, leading to poorer physical and psychological outcomes. For people with MSK pain safe, appropriate work can be protective, and healthcare professionals including First Contact Practitioners (FCPs) are increasingly asked to consider work as a health outcome in its own right. However, most return-to-work research concerns organisational full and part-time contracts; we currently know little about supporting people living with MSK pain to stay in work if they are in a flexible working pattern, such as being self-employed or in irregular ‘portfolio’ working arrangements such as freelance or contract work, or under a zero-hours contract of employment. This represents an important knowledge gap, as these working practices are becoming more prevalent. In addition, at present we know little about how FCPs can support people in pain with their working lives, especially those working under more flexible or ‘precariat’ working practices. This is important as the FCP might often be the person who sees a patient first in their healthcare journey.
In this study, we will interview workers living with MSK pain to explore their experiences of using the above working practices, and of their experience of FCP consultations. We will also interview FCPs to investigate their experiences of supporting those in a flexible working pattern or environment. Data analyses will consider what patients and FCPs think works to keep people in pain in modern labour market patterns, and what supports the FCP role when discussing work and health.
Summary of results:
First Contact Practitioners (FCPs) are trained to work with patients living with musculoskeletal (MSK) pain, including helping patients with work support. However, the FCP role is still developing, and research into supporting people with MSK pain with work focuses full-or-part-time work for organisations.
We originally aimed to ask what patients and FCPs think supports people living with MSK pain to stay in work when they are self-employed, or in flexible or ‘non-traditional’ work.
Unfortunately, we found recruiting patients for this study very difficult, possibly due to the precise group of workers we aimed to investigate. We faced challenges easily describing this group in our advertising materials, and had difficulty sourcing and accessing communications channels which these people are likely to utilise. We had also intended to recruit people during clinical consultations, however continued pressures on NHS services likely meant that recruiting participants was a low priority for busy clinicians to keep in mind, particularly with such a narrow target group.
We were much more successful in recruiting FCPs to our study, eventually interviewing 13 FCPs (5 in Grampian) to explore what FCPs think supports people living with MSK pain to stay in work when they are self-employed, or in flexible or ‘non-traditional’ work. This enabled us to complete an analysis based on FCPs’ experiences, while noting that further research still needs to be done to explore the patient perspective.
Key themes from our interviews with FCPs included:
• FCPs need to know which kind of working patterns people have to support them, and feel more confident supporting mainstream workers as they have more experience here, with better workplace support structures in place.
• Higher levels of deprivation tend to indicate more prevalent ‘precarious’ jobs, which bring additional support complexity. It can be difficult to advise people do not have to be 100% fit to return to work, though people might also be afraid to take time off work even when this is needed.
• The fit note is complex to use for non-traditional jobs and FCPs want more training on how to use it.
• Some elements of consultations are key no matter what kind of job people are in, such as building patient rapport.To improve health and work conversations, we need to ensure FCPs know where to find information for patients in these types of jobs and roles. The fit note may be more effective with FCPs than GPs due to their being able to see patients faster, and more experience over time may help FCPs manage the complexity of using the fit note with patients in these working roles. However, fundamental elements of the clinical consultation still remain no matter what kind of work a patient does.
https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.pstmrk.it%2F3ts%2Fosf.io%252Fa9fe2%252Fwiki%252Fhome%252F%2FNBTI%2FCpW8AQ%2FAQ%2Faabe3777-49cc-4c7a-b466-0a32a7667052%2F2%2FicQ4k1Z2tg&data=05%7C02%7Charrow.rec%40hra.nhs.uk%7C7ef67d06323a4c9ef3dc08dd7818e833%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638798770562485573%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=GaGt623Nh78zgioQjjcEdRKvZ%2BEz%2F%2F4uU2Uzzpqt7oU%3D&reserved=0
REC name
London - Harrow Research Ethics Committee
REC reference
23/LO/0133
Date of REC Opinion
26 Jan 2023
REC opinion
Favourable Opinion