Development of an early intervention to prevent long-term incapacity for work: using an online RAND/UCLA appropriateness method to obtain the views of general practitioners

Aim: To explore the acceptability amongst general practitioners (GPs) of an early intervention to prevent long-term sickness absence from work and to identify the appropriate broad characteristics of such a service. Background: The effect of long-term sickness absence from work on individuals and society has been the subject of recent policy debate. In the United Kingdom, a number of return-to-work interventions have been piloted and plans to reform the incapacity benefit system are underway. Since GPs play a key role in the sickness certification process, their views on the appropriateness of an early return-to-work intervention were sought to help inform the development of a primary care-basedmodel. Methods: A panel of nine GPs fromeight practices in a mixed rural/urban area of the South West of England participated in a modified RAND/UCLA appropriateness method (RAM) study. Panellists completed two rounds of an online survey in which they were asked to read a summary of relevant research evidence and then rate the level of appropriateness of providing a return-to-work intervention in a series of clinical scenarios. Findings: There was general support for a return-to-work intervention. Panellists considered the intervention would be more appropriate for patients with mild-moderate rather than severe symptoms and for those with longer symptom duration. There was support for early intervention after approximately seven weeks of absence fromwork, but not before four weeks of absence. The return-to-work intervention was consideredmost appropriate for patients with repeat or recurrent patterns of sickness absence, rather than those on their first sickness absence period, and for those not already receiving specialist health input for their condition. Panellists considered that a multidisciplinary team providing a combination of biopsychosocial and vocational support would be the most appropriate model, with the service possibly being located outside of a general practice setting.