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Developing a Return to Work Plan

Effective Return to Work Plans:

  • Based on a Return to Work policy - in an environment where supporting early return to work is part of normal workplace practice

  • Involve temporary modifications to duties and job tasks - for any work-relevant problem irrespective of where it began

  • Include workers who are able to work only part-time - then build up to full-time as they recover


Closely related sections: Developing an Action Plan, Developing a Stay at Work Plan, Graduated Approaches to Work and Activity


Return to Work


The purpose of a Return to Work plan is to support and enable an ill or injured worker to recover safely whilst getting back to their usual.

In general, people with common health problems get better faster and have fewer long-term difficulties if they are able to recover while they are working in a safe and supportive workplace - sometimes with temporary modifications.


Return to Work - often abbreviated as RTW - is necessary whenever a person has a period away from work. The process may vary from simple to more complex. Either way, it is vital that there is a return to work process.


There is an overlap with the stay at work approach when a worker is increasing back to full hours and usual duties from reduced hours or modified work. The most effective way of doing this is usually with a graduated return to work although this is not always necessary for common health problems.


Usually it is better for people with common health problems to stay at work than have to return to work. Sometimes, though, a short period off work is unavoidable, it is then important to start back at work as soon as possible, at least part-time. That, though, isn’t the end-point - it's very important to have a plan for getting back to full-time.


The Return to Work approach is entirely consistent with the emphasis on identifying obstacles early and tackling them effectively. Return to Work requires the engagement of all key players - worker, line manager, clinicians, and others to ensure there is a coordinated approach to identifying and resolving obstacles to staying at work.


Someone has to take responsibility to identify any obstacles and to broker solutions so that recovery at work can commence as soon as is safe and practicable. If there are any concerns about risks associated with the job, a re-assessment may be required.


The Plan should be simple and doable. As well as identifying the obstacles it will include detail on what the workplace can do to overcome them. That information may be very helpful for helping clinicians to encourage activity and participation in work. Clinicians, like GPs and physiotherapists are experts in diagnosis and treatment, but you’re the workplace expert. Your help is needed for them to understand your workplace. Clinicians who do not get input from line managers may needlessly restrict a worker from staying at, or returning to, work.


People in and around the workplace often lack the confidence to deal with work and health issues. The information and guidance in the toolbox promotes appropriate confidence. You don’t always need medical input to develop a Stay at Work plan. The worker may not be seeing a healthcare practitioner and there may not be a fit note. In these circumstances, it’s really a matter of common sense. But if you’re concerned, you can always ask the clinician. Obviously, if there is a fit note the Return to Work plan needs to take account of the doctor’s advice.


It is possible to prevent needless disability by helping people to return to work. One of the main benefits of an early return to work approach is that it prevents that 'disconnected' feeling workers encounter when they are off work.


Practical Tip: Much of today's work disability due to common health problems can be foreshortened or averted entirely. This is because work absence is hardly ever medically required for more than a few days after illness and injury. To make a positive difference, emphasise these:

  • Being active during convalescence speeds recovery, while extensive work avoidance and "rest" tend to delay it.

  • Prolonged absence or permanent withdrawal from work is bad for people's well-being -- mental, physical, social and economic.

  • Prolonged withdrawal from work is usually being driven by psychosocial factors instead of medical ones.


Successful Return to Work Outcomes
  • Sustainable resumption of productive activity.

  • Identification of obstacles and effectively tackling them.


FACT: People can be helped to stay at, and return to, work


The pivotal thing is to provide a supportive workplace. There are seven key principles to follow.


Develop a Return to Work Policy


Create an environment where staying at work and returning to work are part of normal workplace practice:

  • Accept and manage work injuries or illness originating at work in the same way as those originating elsewhere.

  • Put in place steps that need to be taken when someone reports an injury or illness, and assign specific responsibilities to people involved.

  • Develop a return to work plan whenever a worker has any time off work for a few days, or reduces to part-time.

  • Provide temporary suitable duties whenever possible.

  • Support and monitor the worker's progress while they return to work while recovering.

  • Use effective communication to ensure everyone knows what is being done, why, and for how long.


Practical Tip: It is good to involve workers in the development of a return to work policy. Use a positive approach to explaining it and managing expectations by establishing a Better at Work initiative.


What to Include in a Return to Work Policy

  • The benefits of the Return to Work policy and both the short and long-term goals

  • How Return to Work will be managed

  • Who is responsible for what and when

  • How the policy is communicated

  • A process for reviewing and improving the Return to Work policy, including obtaining feedback from workers


Line Managers and Senior Management need to be aware of the benefits of the return to work approach. It helps to establish a clear picture of what the person can and cannot do, and whether there are any obstacles to recovery.


Workers need to be aware of the benefits of the return to work approach. It makes it possible to have a period of reduced work hours, alternative duties, putting in place physical aids, exploring suitable travel options, or helping the employer make temporary modifications to the workplace. These all help you as a worker by keeping you in the workplace and engaged with your usual life.


Questions that may arise for Line Managers


My worker wasn’t injured or became ill at work, so do I have any influence over their return to work? Yes! The impact that you, and the organisation, have on a non-work illness or injury is usually identical to that for one that started at work. This is because you still have a worker who is struggling to perform their usual duties and job tasks: they have a work-relevant problem. The line manager plays a key role on making it possible for the person to stay at work or return to work wherever the problem began. In general, you're still entitled to ask for information from your worker that enables you to to help evaluate their work ability. Always ask if you're unsure.


Does it cost more to return an employee to work than it does to get a replacement? Probably not. Helping someone to return to work doesn’t need to be expensive. It may be as simple as rearranging job tasks or equipment. In contrast, there can be a high cost if you replace a worker, due to advertising, recruitment time, loss of productivity while you’re recruiting, retraining, possible increases in waste and effects on staff morale.



Better At Work Checklist for Line Managers

  • Is there a Return to Work Policy?

  • Did you make contact with your worker at an appropriate time ** to offer a Return to Work option?

    • If it was not appropriate did you move to developing a Stay at Work plan?

  • Did your worker give you a fit note?

  • Have you explained the Return to Work process to your worker?

  • Have you identified suitable temporary modifications?

  • Have you discussed and agreed these with your worker?

  • Have you identified obstacles to the worker staying at work?

  • Have these been adequately addressed?

  • Is there a timeframe for the Return to Work plan?

    • When will it be reviewed and/or modified if necessary?


Download a copy of the Better At Work Checklist for Line Managers

Checklist for Line Managers


Download a template Stay at Work Plan or Return to Work Plan

Template for Line Managers


** Timing for making contact is an important issue. However, there is no simple formula for deciding when to do this.


The fundamental principle is that the line manager should not allow communication with the worker to be interrupted. It is a common myth that contact with an absent worker is intrusive. Failure to make early contact with people who are off work leaves them isolated and unvalued, thus fostering uncertainty, distress or depression. Lack of contact means these is no chance to make a return to work plan, and no chance to discuss transitional working arrangements. Perhaps the single most important reason to take extra care in deciding when to make contact is when the worker had performance problems or other difficulties with the workplace before onset of a common health problem. It is important to avoid a situation where the worker feels that a Return to Work approach is being offered as something they are obliged to accept rather than something that is done in their best interests.


Making the return to work plan is quite different from the so-called return to work interview! The plan is made before return to actual work, but can be done in the workplace. The sick listed worker comes into work as soon as possible to discuss when and how to get back in a timely, safe and comfortable fashion. You don’t need to wait for a fit note to start planning. Actually, your plans may help the doctor use the fit note to best effect, so the worker should let the doctor know what is possible at work.


Practical Tip: Continued contact with the workplace is crucial to the return to work process. At initial contact with the worker the focus should be in making it positive and un-pressured, and about building good-will and trust.


Line Managers Should Avoid

  • Allowing communication between line manager and worker to be interrupted

  • Delaying the plan until actual return to work

  • Trivialising the injury or illness

  • Allowing modified duties to be beyond the capabilities of the worker

  • Hindering communication with other key players (e.g. GP, rehabilitation professionals, professional case managers, etc.)


Use of Third Parties for Return to Work Coordination


Any return to work plan and programme is based on the principle that the employer can enable a coordinated return to work. If this is not true, then return to work approaches will be undermined and suboptimal.


Some organisations may wish to 'out-source' the Return to Work process – use a case manager to coordinate developing and implementing a plan. This may be a third party case management provider, or it can be an internal process using case management approach, accessed by line managers.


The role of any return to work coordinator, or professional case manager, is to return the worker to appropriate employment in a timely, safe and cost efficient manner.


Practical Tip: Case management is a goal-oriented approach to keeping employees at work and facilitating an early return to work. There is good scientific evidence that case management methods are cost-effective through reducing time off work and lost productivity, and reducing healthcare costs.


Line Managers Have a Key Role


There is very good evidence demonstrating that employers play a key role in the return to work process.

Interventions with a workplace-based component lead to improved return to work outcomes.


Practical Tip: The size of the effect will vary across different circumstances, but you should expect to achieve two-fold improvements in return to work rates.


Four Key Tasks for Line Managers

  1. Keep in contact with the injured workers and assist with an early RTW.

  2. Agree on a RTW plan and RTW goals with the injured worker.

  3. Offer workplace accommodation.

  4. Communicate with healthcare professionals when necessary.


Practical Tip: the readiness of line managers to act as key players in the return to work process seems to depend on:

  • Awareness of the importance of their role.

  • Having the know-how and ability to be able to assist

  • Motivation or incentive to participate


Work Trials as Part of the Return to Work Process


Reasons to consider using a work trial include:

  • Rebuilding work skills, self-confidence and establishing work routines following a longer absence.

  • Building resilience, or 'work hardening'. This involves offering a worker a programme aimed at progressively improving physical or psychological work tolerances.

  • Learning alternative work skills. When a worker returns after an absence, sometimes things have changed. For example, the company may have been re-organised or re-structured, and it is necessary to adapt to different duties and job tasks.


I’m a line manager in a small company. We can’t afford formal occ. health cover, but we can still help our colleagues cope with health at work. The senior management took some advice and introduced a simple protocol for supporting colleagues with work-relevant health complaints. The goal is to help them stay at work or get back quickly if they have to take time off. It’s my job to put it all into action. Basically, I coordinate the process – I act as a case manager, a buddy if you like. I get informed as soon as a colleague is struggling or off work. We talk it through and look for the obstacles. We work out what my colleague can do, with a little help. If necessary, I liaise with the doctor or therapist (we use a simple confidentiality waiver) to help me figure out how best to help my colleague with work tasks whilst they are getting treatment. I devise the Plan and timeline with my colleague and we sort out any temporary work modifications as a team. I use information leaflets to help explain things and bust the myths. I keep an eye on them just in case there are any setbacks. It’s all common sense really - it works well!

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