Management of post-acute covid-19 in primary care

Dear Editor

I welcome the authoritative review of post-covid-19 problems by Greenhalgh et al and in particular that those in employment may need help in returning to work (RTW). [1] Strangely the assistance offered by Acas [2] to which Greenhalgh referred makes little reference to this issue, but it is more complex than negotiating a phased RTW, helpful though that facility is. As work is known to be of great importance to individuals, their families, employers and society at large, [3] RTW is now seen to be an important outcome of health interventions. [4]

In order to minimise worry about possible job difficulties or loss, patients need to be informed early in the course of the disease that there are many ways of helping them to RTW and that it is most important that they remain in contact with their employer, [5-6] as not all employers have, or practice, good absence management. It is also helpful at an early stage to comment on the fact that RTW usually precedes full recovery by utilising such techniques as:-

• working from home
• part-time working
• adjusting working tasks and responsibilities
• allowing time off work for health-related activities e.g. appointments, physiotherapy or mental health support
• access to a quiet room for those with fatigue
• utilising the Access to Work Scheme or other advice from the Department for Work and Pensions (https://www.gov.uk/access-to-work).

Primary care teams can be very helpful when completing a fit note [7] which assists employers in understanding their employees' potential needs when they RTW. For those with difficulties in talking about work to their patients, advice is now available. [8] Early involvement of occupational health departments can also greatly facilitate a successful RTW when available.

When the clinical condition has improved sufficiently to consider when and how to effect a RTW, these issues can be reviewed and often a meeting between the employer and employee can construct a RTW plan. When conditions are complicated, a vocational rehabilitation professional should be consulted when one is not available as part of the rehabilitation available. [9]

The views expressed are those of the author and not necessarily those of the Vocational Rehabilitation Association.

References

1. Greenhalgh, T., et al., Management of post-acute covid-19 in primary care. BMJ (Clinical research ed.), 2020. 370: p. m3026.
2. Acas, Coronavirus (COVID-19): advice for employers and employees. Acas: London, 2020,
3. Black, Dame Carol. Working for a healthier tomorrow. London: TSO, 2008,
4. Academy of Medical Royal Colleges, Royal College of Nursing, Allied Health Professions Federation. Healthcare Professionals' Consensus Statement for Action, London: 2019 - https://www.aomrc.org.uk/news-and-views/healthcare-professionals-consens...
5. NICE. Managing long-term sickness absence and capability to work overview. 2019 [cited 2020 18/06/20]; Available from: https://pathways.nice.org.uk/pathways/managing-long-term-sickness-absenc...
6. Mikkelsen, M and Rosholm, M. Systematic review and meta-analysis of interventions aimed at enhancing return to work for sick-listed workers with common mental disorders, stress-related disorders, somatoform disorders and personality disorders. Occupational and Environmental Medicine, 2018. 75(9): p. 675-686.
7. Hampton, J. How to support patients in getting back to work. Pulse; , 2020(January):41-42
8. Council for Work and Health. Talking Work: A guide for Doctors discussing work and work modifications with patients. London: Council for Work and Health, 2019:
9. Frank, A. Vocational rehabilitation: supporting ill or disabled individuals in(to) work: a UK perspective. Healthcare, 2016. 4(46). doi:10.3390/healthcare4030046