Guidance

Promoting work as a health outcome: guidance for AHP leaders

Published 14 October 2025

Applies to England

Work has long been recognised to be a core determinant of health, which has an impact on the individual, their family and community. It is an important factor which can influence health and wellbeing and therefore needs to be a priority for clinical leaders.

Health and care professionals, including allied health professionals (AHPs), play a crucial role in preventing worklessness and promoting return to work through holistic, person-centred approaches. It is important for clinical leaders to:

• link healthcare provision to the work and health agenda
• contribute to integrated services
• ensure that their workforce is confident and proactive in this area

AHP skills in vocational rehabilitation, occupational health, and workplace health promotion are vital in supporting individuals to manage health conditions and maintain meaningful roles. Legislative changes introduced in 2022 allow a broader range of professionals to certify fit notes, enabling timely work and health conversations and support. Collaboration with local and regional networks, sharing impact examples, and championing co-production with underserved groups are all important strategies.

Senior leaders should champion the creation of good working environments, recognising that inclusive, flexible policies and a focus on wellbeing support are protective factors against economic inactivity due to health conditions.

This guidance has been co-developed with AHPs, professional bodies and expert advisers for use by AHP leaders in organisations, systems and regions. It is intended to support AHP leaders to confidently advise, advocate and take action on the topic of work and health. It has been structured as an introductory document for AHP leaders who may not have worked clinically in this area previously. This guide focuses on 3 aspects where leaders can support change:

• understanding and influencing the wider system related to work and health
• supporting the whole workforce to understand their role in work and health
• optimising AHP input to work and health specific services

Understanding and influencing the wider system related to work and health

Introduction

In this guidance, work includes paid employment, voluntary roles and any meaningful activity relevant to the individual. Good quality work is characterised by:

• fair pay and conditions
• opportunities for development
• autonomy
• work-life balance
• equity
• supportive management
• safe work conditions

Good quality work is an important determinant of good health. It directly and indirectly affects individuals, families and communities, and contributes to:

• economic wellbeing
• financial security
• improved living standards
• healthier lifestyles
• social connectedness
• skills development
• self-efficacy
• a sense of purpose

It can have a therapeutic role and promote recovery.

People living in areas with high employment rates are more likely to live for longer in good health. Conversely, poverty and unemployment are linked to adverse health outcomes, such as increased risk of cardiovascular disease, increased risk of mental health issues, restricted life opportunities, and early mortality.

Supporting the work and health agenda will mean different things for people across the life course, and AHP professions contribute at different points: from early opportunities to access education, through to maintaining the ability to work in later life.

Case for action

Office for National Statistics data for March to May 2025 showed there were 2.8 million people who were economically inactive due to long-term sickness in the UK. The percentage of people whose main reason for being economically inactive is long-term sickness has generally been increasing since before the pandemic.

In January to March 2025 there were 10.3 million people with a long-term health condition who were employed, of which 5.6 million were disabled.

As the population of the UK ages, there will be an increase in the number of people with one or multiple long-term conditions. Many of these people will still wish to remain in work and will benefit from the positive associated health outcomes if they are supported to do so. It is increasingly important for organisations to proactively consider and take action to support the employment of people with health conditions and disabilities.

Addressing this is a societal challenge. We need to ensure people have access to more holistic support, when and where it is needed, to reduce health disparities and avoid the negative health impacts associated with being unemployed. This not only benefits individuals, their families and communities, but also supports economic growth which can be reinvested into public services.

What AHP leaders need to know

Work as a health outcome

Clinicians should recognise that work is a primary determinant of health and that they have a duty to both focus their attention on and take action to reduce inequalities that exist in relation to this.

This is supported by evidence from numerous studies and reports, including:

• Waddle and Burton’s findings that work is generally good for physical and mental health and wellbeing

• the Marmot Review, published in 2010, in which employment was identified as one of the 6 key policy objectives to reduce health inequalities in England

The Marmot report called for “fair employment and good work for all”, emphasising that good work is protective of health, while unemployment and poor-quality jobs contribute significantly to poor health outcomes. The principle has since been reinforced in follow-up reports and local Marmot initiatives, including the Institute of Health Equity’s guidance. Fifteen years from this initial report, work as a health outcome remains a foundational public health principle, linking directly to prevention, recovery and population wellbeing.

In 2019 Public Health England (PHE) released Work as a Health Outcome, which was a programme aimed to facilitate conversations in all settings between healthcare professionals and people about work and health. This approach was evaluated and highlighted that the separation of work and health services meant establishing and maintaining connections between them was a challenge.

Recent policy has responded to this, recognising that co-ordination is needed between strategic partners to bring together a more integrated work and health skilled workforce to deliver tailored support in local communities.

The healthcare professionals’ consensus statement for action on health and work was refreshed by the Academy of Medical Royal Colleges, Royal College of Nursing and Allied Health Professionals Federation in 2025. This consensus recognises that AHPs have a responsibility to include work and health in whatever role they occupy.

Current policies and frameworks governing work and health

The government’s 10 Year Health Plan for England: fit for the future recognises the important role of employment and good work in supporting people’s health and the government’s ambition to shift from sickness to prevention. It identifies neighbourhood health hubs as locations where support about work and health should be available. It also recognises the NHS’s own role as an anchor institution and employer. An anchor institution refers to a large organisation rooted in a place, and involves the organisation making business decisions around recruitment, purchasing and investing that consider the impact on the health of the local community.

The Get Britain Working White Paper sets out the important role the health and social care system can play in supporting people to remain in work or return to work quicker where it is appropriate for them to do so. It builds on existing programmes to better integrate health with employment support, such as employment advisers in NHS talking therapies and the WorkWell pilots.

All areas in England have been asked to produce local Get Britain Working plans. These plans, led by local government and co-developed with Jobcentre Plus, integrated care boards (ICBs) and in partnership with wider local stakeholders, are intended to support the integration of work, health and skills support.

The white paper also announced the Keep Britain Working review, which is considering recommendations to support and enable employers to promote healthy and inclusive workplaces, support more people to stay in or return to work from periods of sickness absence, and recruit and retain more disabled people and people with health conditions.

This, alongside other measures to create good jobs, such as the UK modern industrial strategy, and to improve the quality and security of work, such as the plan to Make Work Pay, are essential in supporting more people with health conditions to access or remain in work.

Actions AHP leaders can take

AHP leaders and teams will have a unique and valuable perspective of the wider work and health system given their presence in multiple settings and stages of a person’s work and health journey. From the range of different clinical perspectives and understanding about what works and what does not, they are essential in shaping the design and implementation of a seamless, effective offer at a system level.

AHPs should:

• dedicate time to keep up to date with national and local policy and changes being discussed

• identify a champion or lead for this topic to ensure capacity is available to influence and contribute to this rapidly changing policy area

• encourage discussions on work and health within professional networks and communities

• establish and maintain strong relationships with key stakeholders within their system, including peers, policymakers, employers, social care and healthcare providers, education, economy, and voluntary sector. A list of potential stakeholders who may be in AHPs’ local networks includes:
  • commissioners: NHS, local authority or commissioning boards
  • public health teams who may commission or advise on workplace wellbeing interventions
  • providers of employment support services, work skills or health coaching
  • the voluntary, community and social enterprises sector, which may have local provisions to support people to return to work alongside activities that can help to build skills and confidence
  • ICBs, who may commission vocational rehabilitation or work aspects into health provisions, such as individual placement and support (IPS), or may be running WorkWell pilots or trailblazers in AHPs’ locality
  • Department for Work and Pensions or alternative department, including Jobcentres and personal independence payment assessment centres
  • economic development teams in local government, combined authorities or chambers of commerce
  • education teams in local government, and skills partnerships which operate over wider geographical footprints
  • independent providers of occupational health and other therapeutic services
  • general practice, often arranged as primary care networks
  • acute and community health and social care services
  • housing associations with support provision
  • criminal justice, including probation services
  • substance use and or mental health providers and IPS pathways
  • local and regional employers
  • people with lived experience
  • benefits advice services

• identify best practice examples to see if they are relevant to their community

• ensure the AHP voice is included in relevant discussions within their system and identify opportunities to influence the work and health agenda

• consider how long a patient waits for treatment may impact on their ability to work

Supporting the AHP workforce to understand their role in work and health

All AHPs have an opportunity to promote a culture where good work is seen as a benefit to people. By asking about what people do for work, and how they are managing it, AHPs can support people in their work as an integral part of patient care pathways. The role of all AHPs in public health also contributes to the prevention of ill health and injury. This in turn reduces the risk of people falling out of work, and supports people to enter, remain in or return to work.

 What AHP leaders need to know

The following resources will support AHP leaders to help their teams to confidently integrate work-focused conversations and interventions into the remit of their roles.

Consensus statement for action on health and work

The healthcare professionals’ consensus statement for action on health and work (linked above) was refreshed by the Academy of Medical Royal Colleges, Royal College of Nursing and Allied Health Professionals Federation in 2025. It sets out that:

• work is considered a health outcome
• there is a clear role for all health and care professionals to include understanding the person’s work role in their assessments

This may be a goal in their treatment, but there should also be a broader preventative conversation around healthy lifestyle, promoting a culture of seeing work as beneficial to health and wellbeing and offering advice which may help the person to remain in work.

The 5 principles set out within the consensus statement are as follows:

1. Ask the work question - what you do for work, how you are managing in work, and what may help you get back to work?
2. Understand through training the importance of work as a health outcome, how health may be promoted through good work, and where to signpost their patients who need further support.
3. Be able to advise their patients through easy access to up-to-date guidance from government, professional bodies, and work and health professionals on the impact of health conditions and treatment on their work, and on adjustments to assist with these conditions.
4. Derive most value from the fit note, in primary care, hospitals and in the community, through training for health professionals, and utilising updated, easy to use guidance.
5. Recognise their own role to support healthy and safe working environments, looking after their own health and wellbeing, and promoting the health and wellbeing of their colleagues within their organisations.

Making every contact count (MECC)

Each AHP interaction is an opportunity to enable the person to maintain or improve their circumstances. Whether it is a one-off or regular conversation, as part of a planned or unplanned intervention, AHPs can collectively support the people they see to make positive changes in their own lives. MECC remains a familiar approach with many practitioners, and the format lends itself well to a work and health conversation.

Having a strengths-based conversation about what individuals might be able to do in relation to work, or make adjustments to remain in work, can be supportive in the person’s decisions about whether they can work.

Integrating very brief interventions, along with signposting to information or referring forward to relevant services is an important social prescribing action that AHPs are well placed to deliver within existing services.

The ‘5 Rs’ approach is a helpful way to structure brief interventions about work and health:

• recognise the risk factors of being out of work
• raise work issues early in the intervention in a sensitive and acceptable manner
• respond effectively to the straightforward work problems that people identify
• refer people with more complex difficulties to the most relevant specialist service
• revisit work issues at regular intervals during the intervention

MECC regional networks remain available for support.

The fit note (Med 3)

Healthcare professionals issue fit notes (also known as the Med 3) to people to provide medical evidence needed to facilitate access to Statutory Sick Pay or health related welfare benefits. Fit notes also give people advice about the impact of their condition on their ability to work and the time they need to recover.

Fit notes can either be issued as ‘not fit for work’ or ‘may be fit for work’. They should record information about the functional effects of a person’s condition so the person and their employer can consider ways to help them to return to work. The fit note is an opportunity to provide support to the person and their employer to understand what reasonable adjustments (such as altered hours or amended duties) might be needed to support a return to work. Fit notes can be issued in primary or secondary care settings and should be issued by the clinician closest to the patient at that point in their healthcare journey.

Fit notes were introduced in 2010 (replacing the sick note), but in 2022 legislation was amended to extend the ability to issue fit notes from just GPs to other healthcare professionals, including:

• registered nurses
• physiotherapists
• occupational therapists
• pharmacists working in GP surgeries or hospitals

However, there has been relatively little change in practice despite this amendment, with 90% of fit notes in 2024 still being issued by a GP. An evaluation of the fit note reforms was published in April 2025 and found widespread support for the reforms, while identifying some barriers to the uptake of extended certification.

Fit notes remain an important opportunity to provide people with work and health advice that supports participation in work. AHPs can undertake training on issuing fit notes, and conducting high quality work and health conversations, at NHS England’s fit note elearning for healthcare.

The AHP health and work report

Depending on whether the AHP is permitted to certify a fit note, the AHP health and work report can offer specific advice that can support the certifying colleague’s decision and reduce duplication for the person and practitioner.

This report can be used to support fitness to work and return to work conversations and support discussions between employer and employee in relation to specific adjustments to enable the person to work.

AHPs offering the health and work report as part of their practice could support more people to remain in or return to work. This tool is available to facilitate AHPs to make detailed recommendations to:

• support employees to remain in work
• support employees to return to work with some modifications
• recommend a period of absence with Statutory Sick Pay

It is similar to the fit note, but it offers:

• more detail about functional impact of a person’s health condition
• specific advice on how a person may be supported to remain at work or return

It is still unusual for the fit note to offer this level of detail or advise that a person could remain in work but with adjustments.

The AHP health and work report is not sufficient on its own to provide the medical evidence needed to access ill health benefits or Statutory Sick Pay. In that situation the fit note would need to be issued by the relevant eligible healthcare professional. Further guidance on documentation needed to support benefits applications is available.

Wellbeing principles in the Care Act 2014

For AHPs who work within local authorities or in delegated services where the Care Act 2014 is relevant, it is important to be clear about how work is included as part of the principles of prevention and protection within the act.

The Care Act 2014 places a duty on local authorities to promote an individual’s wellbeing, meaning this should always be in mind when making decisions about them or planning services.

The wellbeing principles specifically include work, education, training and recreation alongside social economic wellbeing. Work should therefore be included in a holistic approach.

Actions AHP leaders can take

To promote work as a health outcome, AHP leaders can:

• implement the 5 principles set out within the health and work 2025 consensus statement
• embed the 5 Rs model into clinical practice
• raise awareness of the work and health agenda with AHPs in their organisation
• create an environment where there is permission and expectation to act on the work and health agenda
• champion the proven benefits to workforce wellbeing through promoting a culture that supports inclusion and diversity in their teams
• implement evidence-based practices and relevant National Institute for Health and Care Excellence (NICE) guidelines at the earliest opportunity. NICE guidelines relevant to workplace health include:
  • mental wellbeing at work
  • tobacco: preventing uptake, promoting quitting and treating dependence
  • physical activity in the workplace
  • workplace health: management practices
• disseminate educational materials and training programmes focused on work as a health outcome. The elearning for health modules available include:
  • one specifically on work and health
  • supporting people back to work after a stroke
• highlight the connections between the work and health agenda and reducing health inequalities
• encourage interprofessional collaboration and knowledge-sharing within the workforce
• start a conversation with local AHP leads to understand current levels of confidence, competence and motivation in this topic. AHP leaders should listen to what will help their workforce to progress this agenda in their roles and service areas and help overcome barriers. To offer an insight on how AHPs consider their practice supports health and wellbeing in work and opportunities for extending this, read the 2022 RSPH report
• audit current practice, seek insights into effectiveness of pathways and where improvements can be made
• facilitate or prioritise quality improvement or research projects that explore the interface between work and health and how AHPs can contribute to improved outcomes
• create opportunities within student placements, return to practice and preceptorship to help learners gain experience in work and health and its impact
• monitor and evaluate the impact of workforce development activities on health and work outcomes

These actions are essential to building equitable, prevention-focused systems, relevant across all workplace settings, where all AHPs can thrive.

Ensuring the effectiveness of AHPs’ contribution to designing and delivering specialist work and health services

Most AHP leaders will be responsible for or contribute to specialist services designed to support people to remain in or return to work. Examples include:

• occupational health services
• vocational rehabilitation
• individual placement support programmes
• workforce wellbeing programmes

AHPs teams also provide services which support work and health programmes while having a broader remit such as:

• rehabilitation
• musculoskeletal services
• mental health provision
• hospital food programmes

This section is intended to support AHP leaders to optimise the impact of these services by ensuring they are integrated into the broader work and health provision locally.

What AHP leaders need to know

Understanding population need in relation to work and health is a good starting point to designing relevant clinical pathways and AHP work and health services. The Office for Health Improvement and Disparities’ Fingertips platform is a good starting point for information. If you haven’t worked with population data before, there is guidance available on Fingertips. It is important to note that some of this data may be several years old, so should be used as an indication of an issue and direction of travel, rather than a real-time picture. The platform includes a wide variety of public health profiles that provide useful information. 

Another source of information is your local authority joint strategic needs assessment (JSNA). This is a regularly updated document that often uses Fingertips to produce some of the data. Most JSNAs contain neighbourhood profiles, which provide lots of information about a locality.

Identifying where specialist work and health services already exist within your geography is helpful to understand how AHP led services need to interact with them. Provision may be commissioned by local, regional or national agencies and so understanding and connecting with local stakeholders is essential.

National investment in work and health focuses on funding research and local initiatives to reduce health-related economic inactivity, support mental health in the workplace and improve occupational health, aiming to boost the economy and individual wellbeing by helping people enter, remain in or return to the workforce. Recent UK initiatives include:

• WorkWell, a pilot running in 15 locations in England that integrates work and health support. It includes a holistic assessment of work and health needs, provides support and acts as a gateway to other local service provision. It is locally designed and delivered by ICBs, working in partnership with local government and Jobcentre Plus
• Health and work growth accelerators, led by NHS England. These are pilots in areas with the highest economic inactivity linked to health. ICBs are funded to increase focus and will be measured against peoples’ work status. The focus is on supporting people with long-term conditions such as cardiovascular disease, mental illness, diabetes and musculoskeletal conditions
• Connect to Work, part of Pathways to Work, a voluntary, locally led Supported Employment programme. It is opening across all of England and Wales throughout 2025 and early 2026. Connect to Work funding will provide specialist employment support to over 300,000 disabled people, people with health conditions and those with complex barriers to employment over the 5-year duration of the programme

Work and health services involving AHPs

Vocational rehabilitation

Vocational rehabilitation is a multidisciplinary intervention offered to people with physical, psychological and/or social difficulties to support them to return to work or remain in work. It is holistic and is specifically focused on the person, their environment and role. It involves a biopsychosocial approach recognising the interaction between physical, social, psychological and environmental factors on the onset and maintenance of common ill health conditions.

Vocational rehabilitation can include:

• assessment of the person at home or work
• workplace evaluation and job analysis
• goal setting and intervention planning
• mitigating the medical impact of an injury or disability
• support for self-management of health conditions
• health advice relevant to returning to work
• workplace modifications
• injury prevention
• psychological intervention
• career counselling and job placement services
• functional and work capacity evaluations

The vocational rehabilitation report published by the Department for Work and Pensions in 2013 offers evidence-based guidance developed by a vocational rehabilitation task group.

Occupational health

Occupational health is a multidisciplinary specialty that promotes the physical, mental and social wellbeing of workers by preventing work-related illnesses and injuries. It involves managing the impact of work on health and ensuring workers are fit for their roles through:

• assessments
• workplace adjustments
• health surveillance
• support for return-to-work plans

AHPs work in occupational health services alongside doctors, nurses and psychologists.

The range of activities as part of occupational health services can include:

• functional capacity evaluation
• ergonomic advice and display screen equipment assessment
• vocational rehabilitation and planning return to work
• advice on adjustments
• advice on prevention or managing conditions at work
• advice on inclusion
• accessibility and health promotion

The Society of Occupational Medicine is a useful source of relevant materials and holds regular training events.

Individual Placement and Support (IPS) scheme

The Individual Placement and Support scheme (IPS) is an employment support service intended for:

• anyone with a mental health condition who wants to work
• people with physical health issues, addictions or those leaving prison (in some areas)
• young people aged 16 to 25 through child and adolescent mental health services linked IPS services
• veterans and people with disabilities in some specialised programmes

It is an evidence-based programme that aims to help people find and retain employment. This helps the service user to gain an income along with a greater sense of purpose and wellbeing. IPS services combine employment specialists with clinical teams to ensure employment is a core part of treatment and recovery, and includes ongoing, individualised support is delivered for the person and employer to support the person to remain in work.

There are also some excellent examples of local initiatives including at primary care network level, such as primary care occupational therapy pathways supporting people to return to work recognised as an important step to reduce inequalities.

Workplace wellbeing schemes

The World Health Organization has suggested that workplaces are one of the priority settings for health promotion in the 21st century because they influence physical, mental, social and economic wellbeing. This makes workplaces an ideal setting for AHPs to deliver wellbeing interventions and health promotion.

There is a strong business case for workplace wellbeing programmes with the most significant impact being those delivered through directly employed healthcare professionals such as physiotherapists, osteopaths or occupational health experts. Examples include:

• the Welsh Government’s In-Work Support Service, which provides rapid access to tailored occupational therapy, physiotherapy and psychological therapy services, designed to help employed or self-employed people return to work or manage a health condition in work due to a mental health problem or musculoskeletal problem
• the South Eastern Health and Social Care Trust’s condition management programme in Northern Ireland, which recognises the important connections between health, work and wellbeing and provides early support for a time limited period. This multidisciplinary service uses AHP skills to help people with health conditions overcome barriers to work through personalised and holistic intervention

Guidance on healthy workplaces is available from NICE’s healthy workplaces quality standard and the Office for Health Improvement and Disparities’ All Our Health.

Actions AHP leaders can take

AHPs have an important role in influencing the design and implementation of local initiatives. Depending on the route that work support services are commissioned and delivered, there may not be an interaction with health or care leaders. The opportunity to integrate and involve the skills of AHPs needs to be intentional and proactive. It is important to raise awareness of existing skills to support local populations to remain in work.

To ensure the effectiveness of AHPs’ contribution to designing and delivering specialist work and health services, AHPs can:

• identify gaps in current provision and agree an achievable action plan to respond
• ensure that any service design or review includes how work addresses health inequalities, digital innovation and delivering support earlier and closer to where people live and work
• ensure services are inclusive, diverse, compassionate and culturally competent
• audit service provision and undertake ongoing quality improvement
• ensure AHP led services are connected to wider work and health service provision in their area
• identify and promote the application of different AHP skills in work and health, considering where workforce might be allocated to greatest impact
• include work and health in their strategic planning and consider how new or existing services could benefit from improved integration
• identify opportunities that exist within their organisation and community to develop workplace wellbeing services, which could also offer income generation to fund additional workforce and build skills
• identify individuals to act in a champion role for AHPs in work and health to drive forward progress and support peers