Table 2 Barriers and facilitators to a future trial of individual placement and support recruiting in primary care as identified by the key stakeholders: clients, Employment Support Workers and primary care healthcare teams

Doing a trial

Clients: Is it voluntary to take part or compulsory?

All: This is a good thing to test. It is important.

Recruitment to a trial

Clients: Recruitment might be challenging in primary care as our GPs do not know that we are employed/not employed.

HCPs: There is a risk of sending a lot of letters to people with chronic pain who currently are IN WORK.

Clients: I would not be happy if my GP wrote to me about a job intervention

Clients: Lots of opportunities to find unemployed people with chronic pain: Job Centre, from other employment programmes, chronic pain services, Physiotherapists, Rheumatologists, Support groups, Community groups, Libraries

HCPs: We can find people using Read code searches of the primary care database. Although no code for “unemployed”, we can use chronic pain and medications e.g. opioids

HCPs: We know who these patients are personally

ESWs: Recruiting from places other than the Job centres might bring in people who are different and perhaps better motivated

Clients: I would be more likely to consider this if my GP recommended it for me

Acceptability of the intervention

Clients: It needs to be clear that it is a choice to go on the programme that it is not mandatory and that you are not being “forced” into work by anybody

ESWs: Clients need to be motivated to want to work for this intervention to be possible

ESWs: Clients sometimes need more than 12 months support to be ready to apply for competitive employment

Clients: A trial offering this support earlier after you have lost your job would be likely to be much better for people before they have lost confidence etc.

Delivering the intervention

ESWs: We would need to know more about chronic pain and chronic pain services and management to do this

Clients: ESWs would need extra training in chronic pain

Clients: The relationship with the ESW is crucial for this and it works best when you have continuity and build a relationship

Process

Clients: There is a lot of paperwork already involved in IPS assessments

Acceptability of the TAU

All: The booklet provided for “Treatment as Usual” is brilliant.

HCPs: I think it would be very helpful and would be happy to recommend patients if they could have this OR the treatment

Outcomes that are important

HCPs: Motivation to work will be an important factor determining outcome

Clients: Although your main reason for attending is to get a job, you get so much more out of it, e.g. confidence, increased social interaction

ESWs: The clients develop over time; they are not all “ready” for a job at the same stage but you see them benefitting in other ways to begin with. “Readiness for work” could be an important outcome.

HCPs: The benefits will include less pain, more exercise, less depression, better quality of life, not just a job