How primary care can help stroke survivors with returning to work: focus groups with stakeholders from a UK community

Background Evidence about how primary care can best enable stroke survivors going back to work is limited. Aims Exploring the role of primary care in supporting TIA/stroke survivors returning to work with stakeholders from a local UK community. Design Four focus groups with 18 participants, including TIA/stroke survivors, carers, employer representative, GPs, Occupational Therapists and clinical commissioners. Methods Qualitative study using framework analysis. Results There was a mismatch between patient and carer needs and what is provided by primary care. This included lack of GP awareness of invisible impairments, uncertainty how primary care could help in time15 limited consultations and complexity of return-to-work issues. Primary care physicians were not aware of relevant services they could refer patients to, such as OT support. In addition, there was an overall lack of coordination between different stakeholders in the returning to work process. Linking with other services was considered important but challenging due to ongoing changes in service structure and the commissioning model. Suggestions for improvement include a central contact in primary care for signposting to available services, a rehabilitation assessment integrated with the electronic record, and a patient-held share-care plan at discharge from stroke wards. Conclusion Improving the role for primary care in helping stroke survivors returning to work is challenging. However, primary care could play a central role in initiating / coordinating vocational rehabilitation - through focus group discussions with stakeholders from a local community, patients, carers and clinical commissioners were able to put forward concrete proposals to address the barriers identified.