Authors' objectives: Accessible occupational health advice is only available to approximately half the United Kingdom population. With rising sickness absence new models for delivering occupational health are required to support employees with health conditions to manage their condition at work. People’s health often impacts their ability to work, but most people do not have access to occupational health.

Authors' results and conclusions: A vocational advice intervention and training package designed for delivery in primary care using case management and stepped care to support patients absent from work for 2 weeks to 6 months. The feasibility study recruited 19 participants demonstrating the vocational advice intervention could be delivered and was acceptable to participants. Recommendations around automated recruitment and data collection were made which were implemented in the trial. The randomised controlled trial sample size was 720; 130 participants were recruited (66 intervention/64 control) before closing early due to recruitment difficulties. There was no statistically significant difference in days absent over 6 months with a mean of 37 (standard deviation 48) days absence (vocational advice intervention) compared to a mean of 42 (standard deviation 57) days absence (usual primary care alone) and an adjusted incidence rate ratio of 0.913 (80% confidence interval 0.653 to 1.276). Health economic analysis found that productivity losses were also lower in the intervention arm at £5513.84 (standard deviation £7101.43) compared to the control arm at £6146.21 (standard deviation 8431.88). At 6 weeks, the intervention arm had lower mean absenteeism, presenteeism, work productivity loss and activity impairment on the work productivity activity impairment scale than the control arm; again this was not significant. This study resulted in a vocational advice intervention suitable for all health conditions and a training package to support delivery of the intervention. In primary care, delivery was feasible and acceptable to patients. Exploratory analysis indicated some signals of benefit in terms of days absent from work, costs and most other secondary outcome measures. Future work should focus on the delivery of a fully powered randomised controlled trial evaluating an early vocational advice intervention compared to usual primary care to determine the effectiveness and cost-effectiveness of this approach. A vocational advice intervention and training package was designed to support patients with any health condition, absent from work for 2 weeks to 6 months. The feasibility study recruited 19 participants demonstrating the vocational advice intervention could be delivered and was acceptable. The randomised controlled trial recruited 130 participants (66 to the vocational advice intervention/64 to usual primary care alone), before closing early. There was a non-significant difference in days absent over 6 months with the intervention arm reporting 4.8 fewer days absence compared to the control arm. Health economic analysis reported productivity losses were lower in the intervention arm at £5513.84 (standard deviation £7101.43) compared to the control arm at £6146.21 (standard deviation 8431.88). We developed a vocational advice intervention and training to support delivery of the intervention. The feasibility study found delivery was feasible and acceptable, but recruitment needed improvement. Exploratory analysis found signals of benefit in days absent from work, costs and most other measures. Future work should deliver of a fully powered randomised controlled trial evaluating an early vocational advice intervention compared to usual primary care to be sure of the effectiveness and cost-effectiveness.

Authors' methods: Intervention development: Training development using mixed methods and the theoretical framework the Behaviour Change Wheel. Feasibility study: Mixed methods, single-arm feasibility study, with stop/go criteria to assist decision making about progression to full trial. Trial: Multi-centre, two-parallel arm, superiority, randomised controlled trial with health economic analysis and nested qualitative study. General practices in three geographic areas in England: West Midlands, South London and Wessex. Patients aged ≥ 18 years, currently in paid employment (full or part-time), current absence from work of at least 2 weeks but not more than 6 consecutive months, with a fit note for any health condition. Vocational advice delivered by trained vocational support workers plus usual primary care (intervention arm), compared to usual primary care alone (control arm). The outcome of intervention development was a vocational advice intervention and training package. Feasibility study outcomes were ability to recruit and acceptability of the vocational advice intervention to participants. The trial primary outcome was number of days absent from work over 6 months. Three phases of research were carried out: intervention development: designing the vocational advice intervention feasibility study: testing the plans for the trial methods ted randomised controlled trial, patients were randomly assigned to the vocational advice intervention plus usual primary care or usual primary care alone. The outcome was number of days absence over 6 months.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hta/NIHR135994

Year Published: 2026

URL for published report: https://www.journalslibrary.nihr.ac.uk/hta/published-articles/DSRW9113

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/DSRW9113

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk