Guidance

Appendix D: service specification

Published 24 April 2024

Applies to England

Purpose of service specification

The purpose of this document is to provide guidance to providers and integrated care boards (ICBs) as to how employment support can be integrated within musculoskeletal (MSK) services.

Background

The 2023 spring budget announced funding to introduce employment advisers (EAs) into MSK pathways.

The testing of employment support within MSK pathways will be introduced through 2 phases of development:

• proof of concept (PoC), going live from 2024, integrating approximately 14 EA teams (typically including a senior employment adviser (SEA) and several EAs within MSK pathways. It will develop our understanding of delivery and support principles for a wider-scale rollout
• wider rollout, beginning in 2025 to 2026 with up to 10 more EA teams joining as fast starters this phase will enable an assessment of the service and its impact on health and economic outcomes for individuals with MSK conditions

The ambition of the EAs in MSK service programme is to:

• help individuals with MSK conditions to enter, return to or remain in work, improving workforce participation
• support better health outcomes
• support reduced health disparities for patients
• gather evidence of impact and build an understanding of the most promising approaches locally

The approach adopted is based on the EAs in NHS talking therapies (TT) programme, which has been successfully running since 2017; and where employment support will be available in every NHS TT service in England by autumn 2024.

EAs are non-clinical and work in a co-ordinated way with health practitioners, providing tailored advice and support to help people maintain, find and re-enter employment. EAs have conversations with clients, who have been referred for employment support, about their interests and goals in relation to work. They assess skills and abilities and help empower people to overcome barriers to entering or maintaining employment and to find suitable learning and work opportunities.

Evidence: health and work benefits of employment support

Placing EAs into NHS TT services has been shown to improve mental health outcomes and support returns to work. See: Employment advisers in improving access to psychological therapies.

Key findings from an evaluation of a trial of EAs in NHS TT included that:

• accessing employment advice has a significant positive impact on mental health
• more than two-thirds (68%) of those who accessed the service reported a positive employment outcome between entry to the service and 12 months later (such as either remaining in work, returning to work after sickness, or finding work)
• out-of-work individuals who accessed employment support were more likely to be in work by the end of their treatment than those who did not

Evidence suggests that, in general, employment has a positive effect on the health of the individual and can therefore, in some cases, generate NHS savings (see: Health matters: health and work). In addition, work that is safe and secure, with good terms and conditions and opportunities for development, is a strong facilitator of improved health and wellbeing and protects against social exclusion. It is therefore anticipated that those who receive employment impacts because of EAs in MSK pathways support are likely to experience increased health outcomes.

In addition, evaluation also shows that the integration of EA within therapeutic teams can free-up therapists to focus on therapy and clinical support, as practical problems relating to employment were dealt with separately by EAs (see: Employment Advisers in Improving Access to Psychological Therapies: process evaluation report).

Research suggests there is a robust evidence base for the value of embedding employment support within healthcare settings, including small scale impact settings. For example, a study (see: Effectiveness of adding motivational interviewing or a stratified vocational advice intervention to usual case management on return to work for people with musculoskeletal disorders) of MSK patients in Norway found that those who received vocational advice took fewer sickness absence days than those who received normal treatment.

A study of work and pain (see: Effectiveness and costs of a vocational advice service  examined the impact of vocational advice, provided by vocational advisers embedded within health practices, for patients who were struggling in work or absent from work due to MSK pain. A key outcome was a significant reduction in work absences over a 4-month period for MSK patients who received vocational advice compared to those who received no advice.

A Canadian programme, which is currently examining the effectiveness of specifically targeted employment interventions designed to help people with inflammatory arthritis, has shown significant success in preventing productivity loss and work cessation over a 2-year period. 

Service model

The PoC phase is intended to design and test a model, which enables MSK services to offer a combined package of healthcare and employment support to those who need it.

The Joint Work and Health Directorate (JWHD) is particularly interested in testing employment support within:

• services for conditions of MSK pain, including chronic primary pain and axial pain
• services provided by physiotherapists and occupational therapists, who are legally able to certify fit notes
• services for people with inflammatory MSK conditions, which often require long term management
• services for people with osteoporosis and fragility fractures

Services will receive investment so that they can recruit EAs to offer employment support, the demand for which is likely to vary across different geographical areas. 

The demand for employment support amongst those receiving treatment for an MSK condition will be tested during the PoC stage. However, using EAs in TT as an approximate benchmark, it is anticipated that approximately 15% to 20% of people receiving treatment for an MSK condition will seek employment support (based on internal management information (MI)).

It is expected that employment advisers will be part of and/or integrated into the organisation in which MSK services are provided. Ideally this will involve EAs being co-located within the geographical area where MSK services are provided.

However, it is recognised that this may not always prove possible due to the diversity of MSK services, operating within primary care, physio services, secondary care, orthopaedic services and tertiary specialist centres, as well as the fact that many services are constrained within limited estates and MSK support is often provided online. It is most important that EAs are integrated into the organisation that is providing the MSK service and that they do not work in isolation.

It will be a decision for the PoC site as to which MSK service employment support it may be best situated within and the type of healthcare professional (HCP), such as nurses, physios, orthopaedic specialists, that the EA should work beside.

The EAs will be expected to work in collaboration with MSK HCPs to ensure that a personalised package of combined MSK treatment and employment support is available to clients who choose to be supported to remain in, return to, or find work.

There may also be opportunities and benefits in MSK services linking up with local EAs in TT services to streamline employment support to clients who may require treatment for mental health as well as an MSK condition. PoC sites are invited to consider the practicalities of establishing this rationalised route of employment support.

JWHD will provide each PoC site with details of their local EAs in TT service. If necessary, relationship managers (RMs), who will provide support and guidance to PoC sites in establishing and integrating employment support, can help facilitate connections with local EAs in TT services. Further information on the role of RMs is provided in annex A.

For clients with significant health issues and complex barriers to employment, EAs will also have a role in signposting. This could include signposting to an employer occupational health service (where available), Access to Work assessments, and engaging with Jobcentre work coaches to assess opportunities for referral to intensive and wraparound services such as universal support, see: 25,000 people to be helped into work as government ramps up roll-out of flagship Universal Support scheme. SEAs and EAs should also seek to establish direct referral routes into their local universal support service (where appropriate).

Clients that do not require MSK treatment and only require employment support should be referred to employment support provision outside MSK services.

Employment advisers should make links with local external employment support providers or relevant community services to ensure an effective means of directing clients to these services.

Recruitment of SEAs and EAs

Sites have the flexibility to decide how to recruit EAs and SEAs and the outlets through which posts will be advertised. These are likely to include channels such as NHS jobs, GOV.UK Find a job, LinkedIn, social media, through Jobcentre Plus (JCP), internal pipelines and local media where appropriate.

PoC sites should use whichever recruitment channels they regard as appropriate to attract a range of candidates. SEAs and EAs are likely to come from a range of professional and/or employment backgrounds and the use of channels beyond formal NHS recruitment routes is likely to widen the recruitment search and yield a broader range of potential candidates. Therefore, it is recommended that sites use NHS channels (such as NHS Jobs) as well as external and specific local recruitment routes to advertise vacancies and thus widen the potential market for candidates.

Sites participating in the PoC could consider recruiting SEAs and EAs in any of the following ways:

• an MSK provider could sub-contract an employment support provider to recruit EAs and build the service
• if an ICB already holds a contract with an organisation to deliver an MSK service, then the MSK provider could directly recruit EAs
• an ICB could recruit EAs directly
• an ICB could invite bids from an employment support provider to recruit EAs and build the service. The ICB will then hold the contract with the employment support provider and provide direction as to which providers of MSK services they will need to work with
• partnering with JCP, for example, by hosting an event at a JCP site or community venue and seeking to recruit directly into EA vacancies

SEAs will be employed in all EA MSK sites. In building employment support provision within an MSK setting the SEA should normally be appointed first using recruitment channels to advertise and fill vacancies. The SEA will then start to build the employment support service and play a leading role in the process for recruiting EAs.

Once the recruitment process has started, the following information will be needed by the central delivery team.

If recruiting EAs and SEAs directly, the central delivery team will need:

• job descriptions, including banding agreed
• SEA job advert issued
• SEA in post
• EA job advert issued
• EAs in post
• date the service goes live (such as when EAs are in post and a service is offered)

If contracting-in an employment support provider, the central delivery team will need:

• agreement of tender specification
• tender specification issued to market
• tender period closed
• contractor selected
• SEA and EAs in post
• date the service goes live (such as when EAs are in post and a service is offered)

Roles of EAs and SEAs

Employment advisers (EAs)

It is expected that employment advisers in MSK will work closely with HCPs working in MSK services by:

• providing clients with information and advice on entering, remaining in, or returning to employment in line with their MSK condition
• empowering people with an MSK condition to set realistic employment goals and to work with the client and HCP to support the client in reaching them

Following referral from an HCP, the EA is responsible for engaging with the client to establish the client’s employment goals and their perceptions of barriers and challenges in meeting those goals. The EA will work with the HCP and the client to produce a personalised action plan to ensure that MSK treatment and employment support are provided to help an individual improve their MSK health and progress their stated employment goals, which may include improving their current employment situation or finding alternative work.

The EA will be expected to build relationships with key agencies in the local labour market - such as JCP, employers, trade unions and employment agencies, to facilitate employment opportunities for their clients. They should also build links with wider health services, such as social prescribing, where available.

The EA should look to represent clients in discussions with current employers only in exceptional circumstances, as other organisations (such as trade unions and employment lawyers, for example) are better placed to do this than EAs.

EAs will also be responsible for collecting a range of client-level data, which will be shared with the JWHD for monitoring purposes. PoC sites are required to report on the delivery of EAs in MSK, using a standard set of metrics specified by the JWHD as part of the MI data capture process. The data will be captured by sites at the individual level, using a template supplied by the JWHD and returned to the JWHD as site-level data.

Expectations of EAs

An EA should:

• be capable of providing employment support to a manageable caseload such as approximately 120 clients per year (if employed full-time)
• support between 8 and 10 new clients per month
• maintain a manageable caseload, for example between 25 to 35 clients at any given time
• have a mixed caseload of clients with differing employment issues, namely those who are in work and working, those who are off sick and those who are out of work
• provide employment support either face to face or remotely through telephone or secure video platforms
• set up an individual client record for each new client at the first EA appointment. Collect data for the record at each appointment, as required. Add data from the HCP referral tool (minimum data set)

The number of sessions that an EA will have with a client will be at the discretion of the EA and their supervisor, the SEA, and will depend on the extent of employment support a client is seeking. On average, it is anticipated that an EA will have up to a total of approximately 8 to 10 sessions with a client, but there are no specific expectations or assumptions about the extent of formal one-to-one client contacts.

In addition, much of the support provided by EAs will not always be in the form of formal one-to-one client sessions but will often revolve around more ad hoc forms of engagement such as responding to queries, phone conversations and exploring employment opportunities on a client’s behalf.

Employment support could continue to be provided after MSK treatment has finished but the help provided by an EA should not be indefinite. The SEA and EA will need to make a judgment as to when to end employment support based on their capacity and resources and whether clients facing multiple or complex barriers to employment could more usefully be referred to specialist services.

An overview, which is not all-inclusive, of the range and type of employment support offered by EAs is outlined below.

In work

EAs should be able to:

• help to prepare for a return to work after a sickness absence
• provide tailored advice and guidance on developing a ‘workability’ or ‘return to work’ plan (for example, for clients who are in work but who have been on sick leave because of an MSK condition and would like to explore the employment options that may be feasible within the limits of their condition)
• support with managing stress and difficulties in the workplace for example, working with clients to create a wellness action plan
• support in gaining reasonable adjustments at work
• signpost advisory and support services - such as community services, trade unions and/or employment lawyers, that can provide a client with in-work representation
• support with improving productivity in work
• where appropriate, liaise with employers and support clients to communicate MSK needs in the workplace
• where appropriate, provide guidance on Access to Work (see: Access to Work: get support if you have a disability or health condition) and other support to help a client remain in employment

Seeking employment

An EA should be able to:

• improve job search skills
• provide careers advice to support career choices and help find work that meets client aspirations
• provide advice on opportunities within the local labour market
• provide advice on education and training to further career
• support with CV writing, completion of application forms, interview technique
• provide advice and guidance on developing a ‘workability’ action plan
• where appropriate, provide guidance on Access to Work support to help a client enter employment
• liaise with JCP work coaches (where appropriate)
• signpost (where appropriate) wider and more intensive job support services such as the Work and Health Programme, Universal Support, and WorkWell

An EA should also:

• use effective communication and listening skills to empower clients in the pursuit of their employment goals and aspirations
• work collaboratively with clients as well as the HCP providing treatment for the MSK condition to develop effective and practical ‘workability’ action plans, such as a plan that details practical steps that can be taken by a client to progress their employment goals and aspirations, and, where necessary, to ensure that outcomes are reported to a client’s GP signpost clients to other sources of support (such as legal advice, social prescribing, NHS services and the benefits system) where appropriate
• comply with all NHS rules and protocols regarding clinical governance, including data confidentiality and information management, safeguarding, processes for the escalation of risks, and GDPR (general data protection regulations) guidance and all localised protocols regarding clinical governance. See: What is GDPR, the EU’s new data protection law?.

An EA must not:

• provide any form of information, advice or guidance relating to the management or treatment of a client’s MSK condition
• disclose any confidential patient data and/or information
• seek to represent clients in discussions with employers (unless necessary)
• provide any form of legal advice, money and/or debt advice or pensions advice

Note: EAs will receive learning and developmental guidance in how to provide money guidance, but must not seek to provide formal money advice.

An example of a job description for an EA is provided in annex B.

Generic support to clients regardless of work status

If necessary and providing this is not duplicating support that a client may be receiving from a social prescriber, EAs will also be expected to provide generic support to people who are experiencing social and economic challenges that are impacting their employment potential. This may include guidance and signposting on issues such as:

• guidance on any entitlements to benefits
• money guidance (not money advice)
• accredited debt services, debt counselling and money advice
• community resources such as food banks
• suitable agencies that can provide specialist expertise and advice on issues regarding housing or accommodation

Guidance on offering the above generic forms of support will be supported by a proposed framework of continuing professional development materials that will be offered to PoC sites.

Senior employment advisers (SEAs)

Once appointed, the SEA should then begin the task of embedding employment support within the MSK pathway by leading on the recruitment of EAs and building the EA team. It is also feasible that SEAs may choose to explore their own networks for recruiting staff after they have been appointed.

It is expected that there will be one SEA for an average of 4 EAs working in an MSK setting. Over time, there may be scope for this ratio to increase to one SEA for 8 EAs as employment support becomes more established within an MSK setting and the team of EAs gain more experience. If an ICB has more than one PoC site, then consideration should be given as to how the SEA might manage multiple EAs in up to 2 sites.

It is expected that SEAs will be a key member of appropriate management teams in MSK settings and participate in all relevant strategic and operational discussions.

They are responsible for:

• leading on the recruitment of EAs
• promoting employment support within MSK settings and working with the appropriate clinical business managers to ensure that EAs are fully embedded in services
• ensuring that EAs work effectively with MSK HCPs and managers so that employment support is embedded in service delivery
• ensuring that EAs are suitably inducted and trained to provide effective employment support
• assessing whether EAs meet the required competencies and standards to provide effective employment support
• managing and supervising a team of EAs
• managing caseloads and allocating referrals from HCPs to EAs
• supporting EAs in their collection of robust client-level MI to enable effective service monitoring
• working with clinical leads to ensure that MSK healthcare practitioners and EAs work effectively to create a combined care pathway and deliver a package of MSK treatment and employment support that is tailored to the specific needs and circumstances of clients
• leading the development of effective relationships with local employers, trade unions, JCP and other key agencies within the local labour market
• potentially providing employment support to a smaller caseload of MSK patients than an EA would have and who may require more specialist support than a less experienced EA may be able to provide. The size of caseload should reflect the number of EAs that are supervised by the SEA

An example of an SEA job description is provided in annex C.

EA and SEA competency frameworks

Competency frameworks for the EA and SEA roles have been developed to inform skills and competencies required to enable the provision of effective employment support. These are provided in annex D.

Deputy senior employment adviser

In sites where there is a high demand for employment support and/or large teams of EAs then it is possible that MSK sites may seek to recruit deputy senior employment advisers (DSEAs). The primary role of a DSEA is to deputise for the SEA where necessary and provide additional leadership and support for EAs.

It is expected that the need for DSEAs will be minimal during the PoC phase of EAs in MSK. If the need for DSEAs grows as the programme expands over time, then a proposed job description and person specification will be provided.

Requests of clinical services

Requests of NHS MSK healthcare practitioners

It is anticipated that the relationship between EA and MSK healthcare practitioners will build over time, and that HCPs will develop an effective understanding of the EA role, what the EA can offer, and how employment can be beneficial for people with MSK conditions.

The intention is that the HCP and EA will build the relationship together and work holistically in assessing ways in which a client can pursue their employment goals within the parameters of their MSK condition. The nature of the EA to HCP relationship is likely to differ from site to site, though key practices will include working collaboratively with a client on a workability action plan, case conferencing and seeking to empower a client in progressing their employment goals.

It is requested that MSK providers receiving investment make changes to clinical practice to ensure that information and awareness of the EA role is promoted within the MSK setting and that a combined personalised package of treatment and employment support is made available to clients.

It is particularly important that the MSK practitioner offers employment support to clients at their first clinical assessment and during treatment. Offers of employment support should not be made in circumstances where overtures of employment support would be inappropriate and/or the patient declines the offer.

See the section ‘When employment support should be offered’ for more information.

It is requested that MSK healthcare practitioners will:

• provide an offer of employment support (through the EA or SEA) to individuals at the MSK assessment stage and, if support is required, to engage with the EA or SEA as appropriate and refer the patient. It is anticipated that the EA would then offer the patient an appointment to discuss their employment support needs. Where appropriate for the clinical service, an offer of employment support could also be made at the appointment booking stage as well as through communications such as leaflets and posters in waiting rooms and text messages for online appointments
• seek a client’s consent, at the referral stage, for passing on to the EA any relevant health information that may relate to their employment circumstances. Any information sharing will need to be within the framework of rules and governance around data confidentiality in the NHS or ICB
• where appropriate, ensure that any personalised package of care is informed by the views of EAs in helping to facilitate the realisation of a client’s employment goals
• keep informed about the progress of employment support and work in collaboration with both the client and EA to ensure that a combined treatment and employment support package is actioned, monitored and updated as the client progresses through the service
• where appropriate, provide advice and guidance on the practicality of any ‘workability action plan’ that has been developed between an EA and a client
• work with the EA in ensuring that all relevant employment and health outcome data is routinely collected during treatment

It is also anticipated that the HCP, rather than the SEA or EA, will keep primary care and/or GPs informed of any impacts that employment support may have upon a client’s MSK condition.

Requests of NHS MSK providers

Data confidentiality and risk

In running an EAs in MSK PoC, applicants will be legally required to ensure they meet established NHS standards for data security and protection, including upholding patient confidentiality, complying with UK GDPR and other applicable data protection legislation.

Sensitive information, including participant data, must be collected, stored, always used appropriately and securely and in line with lawful duties of confidentiality. This will include gaining explicit patient consent to share any data with the EA and following appropriate procedures for information sharing. If necessary, it is strongly recommended that PoC sites consult with appropriate data protection officers, senior information risk owners and/or their Caldicott Guardian when establishing data sharing and governance authority for this project.

Awareness of data confidentiality and risk protocols is included within the learning and development materials that will be offered during the EA induction stage. However, it is anticipated that PoC sites will have well developed protocols relating to information and data security and EAs will need to be inducted into these local conventions and processes.

EAs need to be aware of their responsibilities regarding the management of risk, such as including the reporting of safeguarding concerns and any risks relating to a client’s physical or mental health. It is anticipated that individual PoC sites will have an escalation process and procedures regarding the management of client risks and that EAs will be inducted into these processes. It is especially important that EAs know what they are to do if they are concerned about client risk if working with someone after being discharged from MSK treatment and/or a client who has been referred by an HCP for employment support, but has yet to formally begin their MSK treatment.

SEA or EA access to information on a client’s MSK condition

MSK providers should ensure that EAs have effective access to information that provides at least a summary of the MSK condition, treatments and impact on function. This is beneficial in enabling EAs to gain insight into the life circumstances of clients, the impacts of their MSK condition and to enable the EA to work effectively with HCPs on the development of joint plans to support their employment goals.

JWHD will specify a minimum dataset of client information and request that it is shared with EAs. The means by which information on a client’s MSK condition is collected and provided to an SEA or EA will be a matter for individual services. SEA or EA access to clinical notes may be inappropriate or unethical but using the EAs in TT service as a guide, gaining a basic understanding of a client’s MSK condition and how it impacts upon their employment potential is likely to enhance the service offer.

Client consent for EA access to information on the nature of their MSK condition - as well as client contact details - should be sought at the referral stage. As required by law, SEAs and EAs employed by the NHS will be bound by the same rules and processes regarding data confidentiality and consent as the MSK HCP.

Employment contracting

As is the case for EAs in TT, the employment support provider, whether an NHS provider, third sector organisation, or private company, will be contracted by the NHS to deliver the EAs in MSK service through an ICB.

The approach towards the governance of employment contracting will be a decision for the ICB. It is expected that SEAs and EAs will be incorporated within the same HR arrangements and governance processes as required by the ICB within the overall framework of NHS employment contracting.

Raising awareness of employment support

It is requested that MSK providers lead on raising awareness or provide information about the employment support offer within the MSK setting.

Administrative support

If possible, and where available, SEAs and EAs should receive an equivalent level of administrative and/or secretariat support as that which is provided to HCPs within MSK settings.

Requests of clinical leaders

Clinical leadership is crucial to the success of employment support within MSK settings. Each MSK provider will be asked to identify a senior manager or business lead who will act as a ‘champion’ for employment support within their service.

In addition, if an MSK provider has several area-based teams then champions within each team should be identified.

‘Champions’ should work with the clinical lead and the SEA to ensure that employment support is embedded within MSK services and becomes part of business-as-usual provision.

Requests of clinical supervisors or line managers

The referrals to employment support from individual clinicians should be monitored as part of their supervision and/or line management where appropriate. Note, analysts from the JWHD will provide further guidance on minimum data requirements including the collection and reporting of referrals for employment support.

Managers or supervisors should also ensure that MSK HCPs are working effectively with EAs to monitor any personalised action plan intended to support a client’s employment goals.

Embedding employment support

Services should typically recruit SEAs before EAs. SEAs have responsibility to begin the process of EA recruitment and embedding employment support within the MSK setting.

SEAs should be part of relevant management teams within the MSK provider service, and present regular reports on the outputs and outcomes achieved by those receiving the combined treatment and employment support offer. Any issues that negatively impact the embedding of employment support within MSK services should be discussed within appropriate management teams so that solutions can be found.

The following set-up allocations have been made for EAs and SEAs, including:

• salaries - funding is available to recruit EAs at band 4 (up to top step point) as a set rate or pay point for the salary and for SEAs to be recruited at Band 6 (see: Pay scales for 2023 to 2024) (up to top step point). Services can offer higher rates of pay but the difference would need to be funded at the local level. (Note, these allocations are ‘national’ in scope and do not incorporate high-cost supplements for inner London, outer London, or fringe). In addition, an allocation for yearly salary uplifts will be available, exact uplift allocations are still to be confirmed
• approximately £2,500 per person when they start to cover set up costs (such as IT and phones) after recruitment
• up to 20% uplift on salary to cover overheads (general overhead costs, in addition to yearly continuing professional development requirements)
• up to 30% uplift on salary to cover on costs such as national insurance and pension contributions)
• funding for project management and related activities up to £13,000 per year for each EA team

It is anticipated that the following will be in place to enable EAs to work effectively alongside their MSK colleagues:

• ideally EAs should typically be co-located within the MSK health settings to ensure effective partnership working with MSK healthcare practitioners. However, it is recognised that MSK services are diverse and often provided online. It is important that SEAs or EAs are integrated within the same organisation as the MSK provider irrespective of their geographical location and / or whether services are provided remotely. It will be important to avoid circumstances where SEAs / EAs are working in isolation
• where possible, EAs should have an NHS e-mail address like those of their MSK colleagues
• EAs must be provided with a laptop or equivalent (and if appropriate and / or possible, a mobile phone) to enable them to work effectively from home and from community settings
• a senior manager or managers should be responsible for managing the SEAs within the MSK provider, thereby supporting the SEAs to embed the employment support function within the local MSK service model

Clinical governance

PoC sites will need to provide appropriate clinical governance and oversight for their service and will need to align with NHS best practice on clinical governance. It is expected that PoC sites will have effective governance processes in place regarding issues such as data sharing and information management, safeguarding, processes for the escalation of risks and the management of staff.

It is expected that PoC sites will fully comply with NHS governance standards and Caldicott Principles for the sharing of any MSK health information about a client that may help an EA provide effective employment support to a client.

It is expected that SEAs and EAs will be inducted into the local implementation of NHS standards of governance and accountability soon after their appointment.

Service expansion

Responding to increases in demand for employment support

During the PoC, sites are encouraged to continuously review the status, capacity and resources being used to operate the service. JWHD has planned the PoC on a ratio of one SEA to 4 EAs.

SEAs should inform the EAs in MSK central delivery team of any increases in demand for employment support especially if demand grows to such an extent that each EA is required to support more than the projected upper range of approximately 25 to 35 clients at any given time.

Client waiting times for employment support are likely to vary depending on the type of intervention being sought. Ideally EAs will see clients at the same time as receiving therapy and a waiting time for employment support should not be longer than 4 weeks. Excessive waiting times for an EA should be considered on a case-by-case basis and any cases longer than 4 weeks should be reported to the central delivery team.

As the number of EAs grows, JWHD will assess whether MSK providers can receive increased allocations, within budget limits, to maintain the one to 4 SEA to EA ratio. JWHD can also assess the feasibility of adopting different SEA to EA ratios within budget restrictions.

To maximise the impact of investment, vacancies in sites with persistent low demand for employment support will not be filled. Extra resource will instead be diverted towards sites where there is a higher demand for employment services. Sites are required to inform the EAs in MSK central delivery team when vacancies occur so that a decision as whether to continue to fund the current EA capacity can be made.

Continuing professional development

In addition to providing capacity to deliver employment support, JWHD are aiming to standardise and improve the quality of the employment support available through MSK providers in the future. To enable this, JWHD has proposed a competency framework and induction curriculum for both EAs and SEAs, which could form the basis for continuing professional development, and which shares similarities to a national learning and development programme developed for the EAs in NHS TT programme.

The learning and development products offered to PoC sites are intended to help introduce EAs to the MSK environment they will be working within and inform and support ways in which EAs undertake their roles and responsibilities. They are not intended as modules that will train someone in how to undertake the EA role as the skills or competencies required to provide employment support should be identified through the recruitment process. They are also not intended to replace any mandatory NHS induction programme but could be adapted to complement existing induction programmes that may be offered to new starters within PoC sites.

Continuing professional development: an approach based upon EAs in NHS TT

Many EAs working in an NHS TT context support people with MSK conditions already, and it is proposed that most of the advice and support they offer is applicable for both mental health and MSK conditions.

All components of the learning and development products developed for EA in NHS TT are designed to be delivered by non-HCPs working in combination with practitioners.

In NHS TT, EAs work through a range of learning and development modules as part of their induction. Some parts of the learning and development will complement mandatory forms of learning, such as NHS guidance in safeguarding, managing risks, and data protection issues and so on - that will be provided at NHS site level. EAs in NHS TT gain a working knowledge of TT but do not receive guidance or tuition in providing a therapeutic intervention.

Individual sites may also have their own additional induction processes. Not every site has a probation period but, where they do, the EAs in NHS TT probation period is approximately 6 months. After that probation period, an assessment is made as to whether the EA has gained the required competencies to undertake the role effectively.

A 12-module induction programme has been developed to help ensure that EAs can provide employment support effectively. The modules are there to introduce EAs to the environment they will be working within, and it is intended that they could form the basis for ongoing continuing professional development.

It is anticipated that most MSK pathways will use the 12 modules. However, as is the case with TT, some sites may rely upon their own induction processes to embed employment support within the MSK service.

The modules are undertaken through self-guided learning with case studies and tasks to complete. The modules are regarded as useful tools to teach people how to undertake the EA role and the learning and development is supported by the SEA. It is up to individual services as to when and how the 12-module learning and development modules are completed but it is anticipated that the learning would not usually take longer than approximately 4 weeks to complete.

The existing modules are comprehensive and include learning outcomes, such as:

• case management
• delivering employment interventions
• knowledge of MSK services
• understanding of relevant systems or legislation and/or benefits
• techniques for supporting clients
• facilitating awareness of both the mental and physical conditions often presented by clients

The modules are intended as a framework for continuing professional development that can inform new learning opportunities, the refreshing of existing knowledge, the development of new skills, sharing of best practice and keeping up to date with the latest developments within the MSK profession.

Sites may use this framework to identify opportunities for continuing professional development through resources such as training courses, seminars, workshops, conferences and events, webinars and online eLearning programs. The JWHD will also seek to develop some specific examples of continuing professional development that can be offered to PoC sites.

Adapting learning and development for MSK pathways

The core components of the EA role that are covered within generic induction learning and development are:

• advice on managing difficulties in the workplace
• advice on gaining reasonable adjustments at work
• helping to prepare for a return to work after a sickness absence (return to work planning)
• providing non-therapeutic support and or signposting clients to support for managing stress at work
• signposting to advisory and support services
• reviewing and/supporting CV development, supporting job searches and applications
• improving interview skills
• building confidence and self-esteem
• working knowledge of the impact of MSK conditions on mental health
• support to communicate and disclose a condition to an employer

The following additional components of learning and development to suit MSK pathways are also proposed and incorporated in induction modules, including:

• gaining a working knowledge of the impact of MSK conditions, particularly impacts of pain and fatigue on a client’s employment potential and how to work with MSK practitioners. Note, it is crucial that gaining a working knowledge of the impact of MSK conditions is not used by EAs to provide any kind of clinical advice on how to manage pain and fatigue
• ‘workability’ action planning (such as based on biopsychosocial factors)
• awareness of workplace modifications suitable for MSK patients

Draft learning and development induction programme

A draft overview of proposed modules for induction learning for EAs in MSK pathways is outlined below. Much of the recommended content follows learning and development content within EAs in TT and, where appropriate, contains amendments and adaptations designed to be tailored to MSK settings.

Note, the following is a draft overview of module content and is subject to change. Further details will be provided at the right time.

Draft continuing professional development content 

Module	Title	Content
1	Introduction to EAs in MSK	- overview of the learning and development programme - background to EAs in MSK
2	MSK awareness and the impact MSK conditions can have on a person’s ability to function with a focus on work-related activity	- the EAs in MSK service - work and health awareness - NHS MSK service provision - conditions treated in the MSK service - MSK conditions and barriers to work - awareness of MSK - work and wellbeing - poor health and link to mental health - stigma and myths - self-management support
3	Employment interventions and the link to MSK support	- MSK service model - MSK healthcare providers and their roles - MSK healthcare support and interventions - working with a MSK healthcare practitioner and joint action planning
4	The role of the MSK employment adviser	- the role of an employment adviser working in a MSK service - explaining the EA role to clients - delivering employer-related interventions - action planning; find, remain, return to work
5	Confidentiality, consent and GDPR in the NHS. Data systems and information management	- confidentiality, consent and GDPR - MSK outcome measures - MSK data and MI - information systems
6	Working with clients and client-centred skills	- framework for conducting an interview - setting an agenda - information gathering - planning support - goal setting and action planning - clients with specific needs
7	Risk awareness	- understanding risk - safeguarding and escalation procedures: identifying when your client is at risk to themselves or others
8	Working with employers and other external organisations	- working with employers - a case management approach to job retention - working with external organisations - occupational health - engaging with other services
9	Disability employment legislation and benefits awareness	- employment and disability legislation - health and safety at work - UK state benefits
10	Emotional intelligence	- what is emotional intelligence - emotional intelligence in the workplace - models of emotional intelligence
11	Supervision with your SEA	- types of supervision - supervision of the EA role - the benefits of supervision - preparing for supervision sessions
12	Taking care of your own health and wellbeing	- MSK and mental health wellbeing - self-care - sources of help

Collecting and reporting of data and participation

The expectation is that all sites participating in the PoC and wider roll-out phases of EAs in MSK will collect data and MI as part of its delivery. It is also expected that participating sites will participate in a formal national evaluation of the PoC and wider roll out that will be commissioned during 2024 to 2025. The PoC evaluation will involve a study of processes and the wider roll out evaluation will include surveys (of staff and clients) and an impact assessment. Both phases of the evaluation will include the collection of MI. Timings of and further details about the evaluation have yet to be confirmed but will be shared with sites as soon as possible.

Client-level data will be collected by EAs, with a small data set (EAs in MSK minimum data set) that will need to be collected by HCPs and shared with EAs.

The effectiveness of data collection will be tested as part of the PoC and JWHD will engage separately with sites on any issues and practicalities relating to the collection and reporting of MI.

The effective and consistent collection and reporting of data on service outputs and outcomes is essential to learn what works at a local and national level, inform future models of delivery, understand best practice and demonstrate the impact of the service. Robust data collection will also be fundamental to future decisions on investment.

Individual sites participating in the EAs in MSK PoC will be required to collect monthly MI at the individual client level and report it at aggregate level to the JWHD. (Note, MI requirements may change over time, particularly as the JWHD seeks to gather more comprehensive data on outcomes for example).

MI and data at the site level

Once an EAs in MSK service goes live, a range of MI, including delivery, demographic and outcomes variables, will need to be collated and reported. This will also include a minimum data set that will need to be collected by HCPs.

MI requirements are in development and are likely to include indicators, as follows.

Delivery indicators include:

• volumes of participants
• numbers referred to service
• number started EA support
• take up rate and number of EA contacts
• numbers discharged
• length of time from referral to first EA contact
• length of time on caseload

Participant indicators include:

• employment status at referral (whether in work or out of work)
• sickness status regarding employment (such as in work, in work - but off sick short term, in work but - off sick long term)
• benefit status (on benefit and out of work, on benefit and in work, inactive)
• disability status
• health condition
• employment status at discharge or follow-up

Further guidance and details regarding MI and the process by which data should be collected and reported will be provided in due course. JWHD may also request specific outcome data in the future.

When employment support should be offered

Circumstances where employment support begins prior to the start of treatment

It is expected that employment support and MSK treatment will be provided at the same time to ensure that a combined treatment and employment support packages can be delivered.

Early engagement is often key to resolving in-work issues and receiving employment support can help enhance employability while waiting for treatment. However, it is a decision for the individual MSK providers as to whether they allow clients to access employment support before treatment starts. For example, there are some circumstances when it may be appropriate for a client to start employment support after they have received their MSK assessment and before their treatment has commenced, such as when they have an urgent requirement to resolve issues at work that are impacting negatively on their MSK health.

Provision of employment support when MSK treatment is stopped or paused

It is recommended that a client should still be able to access employment support if their MSK treatment has been paused or discontinued for any reason.

The MSK provider will need to decide whether a client should continue to receive employment support in these circumstances.

Provision of employment support when MSK treatment is completed

There are likely to be circumstances where it will be appropriate for employment support to continue after MSK treatment has been completed within the MSK provider service. This is especially the case for those who started employment support towards the end of their treatment.

It is recommended that, in such circumstances, employment support should be continued until the specific issue the EA and the client are working on is resolved. Normally this would not be longer than one or 2 months but could be longer if there are significant issues that need to be settled.

It is recommended that the continuation of employment support beyond discharge from treatment is reviewed monthly. However, the offer of employment support is not open-ended, if a client requires more intensive support over a prolonged period, it is important that the EA refers them to other initiatives and complementary programmes designed to support people with health conditions, including MSK, to start, stay, and succeed in work. These include Access to Work, additional JCP support, disability employment advisers (DEAs), universal support, and the WorkWell partnership programme.

All EA in MSK sites should make links with these or other appropriate organisations to ensure that clients requiring longer-term support can gain access to alternative employment support offers.

Working with JCP, community services and other employers

SEAs and EAs will need to develop effective linkages and referral pathways with key agencies and community or employment services in the local community.

Working with JCP, Workwell, universal support

It is essential that SEAs or EAs in MSK sites develop close relationships with their local JCP. The DEAs are ideally placed to support joint working between JCP and EA in MSK sites. SEAs should ensure that DEAs and work coaches in local Jobcentres are aware of the existence of the combined MSK treatment and employment support offer.

People receiving treatment in the NHS for an MSK condition, and who are entitled to benefits, should be supported by EAs to engage with JCP to ensure that they are receiving benefits that they are entitled to if they wish to do so.

It is important that work coaches are aware of the process they can use to signpost clients who they think could benefit from combined MSK and employment support, where this is available. However, it is important to ensure that JCP staff are aware that it is not appropriate to refer clients into MSK services. MSK providers should not receive direct referrals from work coaches as it is important that JCP clients do not feel pressurised to take up MSK treatment.

Several EAs in NHS TT sites have developed strong relationships with JCP. Some arranged for both EAs and therapists to visit JCP premises regularly, some undertake assessments at JCP premises, and some have held successful wellbeing workshops with staff and clients that have generated self-referrals to NHS TT. This is an approach that could be developed and implemented in the MSK service.

SEAs or EAs should also seek to establish referral connections with their local WorkWell pilot and/or universal support service (where available).

WorkWell is an early-intervention work and health support and assessment service and a single, joined-up gateway to other support services. Through WorkWell, approximately 59,000 people with health conditions across England will have the opportunity to access holistic support for health-related barriers to employment as well as a single, joined-up gateway into locally available health and employment services.

Universal support, which involves people being placed in employment and then receiving intensive and personalised support to overcome challenges, will expand to support at least 50,000 people per year from 2025 to 2026.

Working with local employers

Some EAs in MSK sites may see more clients who are in work rather than clients who are currently not working. EAs are expected to work with employers to support their clients to fulfil their employment goals.

It is important to remember that EAs provide information, advice and guidance to empower clients to have better conversations with employers. It is not the role of the EA to represent clients at formal meetings with employers. This role should be fulfilled by trade unions or employment lawyers. However, there may be occasions, for example, in generic discussions about reasonable adjustments, or discussing potential flexibilities in working patterns to suit a client’s circumstances and so on - when EAs could support clients at meetings with their employers.

SEAs are expected to establish a good understanding of the local labour market, develop awareness of the large employers within their area, and work with local employer organisations to ensure that employers of all sizes are aware of the MSK offer of combined employment support and treatment.

If feasible, it is recommended that sites participating in the PoC and wider roll out offer workshops for local employers around improving the MSK health and wellbeing of staff and how to effectively support people within their workforce who are experiencing MSK health problems. Such workshops should be delivered by both EAs and MSK healthcare practitioners and could provide opportunities for increased self-referral routes into MSK services.

Note, it is possible that a small number of MSK pathways participating in the PoC, and pilot will be invited by local employers to undertake consultancy work to improve MSK health in the workplace. Such consultancy opportunities can create an additional income stream for MSK providers. However, the core business of EAs is to support MSK patients. Thus, any consultancy opportunities should only be pursued if there is capacity to do so.  

Problem solving and sharing resources

In EAs in MSK, the intention is to use service improvement techniques to enable our sites to enhance the quality of the employment support they provide in line with good practice. Longer-term, all sites are encouraged to share the learning they have gained from delivering employment support within their EAs in MSK site.

To support problem solving and the sharing of resources, the JWHD are scoping out how to support EAs and SEAs to improve the quality of the service they provide for their clients. It is anticipated that the suitability, remit and focus of any approaches will become clearer during the PoC and wider roll out phases of the programme.

In addition, an employment adviser hub, focussed upon issues such as learning and development and best practice and so on, has been established for EAs in TT through the ‘Future NHS Collaboration Platform’ and JWHD will assess the feasibility of enabling EAs in MSK to gain access to this forum.

Annex A: relationship managers

The testing of employment support within MSK pathways is a project run by the JWHD.

The PoC will be supported by a central delivery team, consisting of RMs who will provide advice, support and guidance to sites on how employment support can be best implemented.

The role of the RM will revolve around key aspects such as:

• initial engagement - including setting up the service, providing advice and guidance on recruitment, advising on service specification and agreeing the size of the EA team that will be funded
• ongoing advice and support - including the management of the service, tracking recruitment and finances, establishing a memorandum of understanding for the service, acting as a contact point between PoC sites and JWHD, allocating and approving staff numbers, monitoring the service and reporting to senior forums on service delivery

The responsibilities of the RM will also include liaising with the NHS England regional leads, ICB leads, MSK clinical and service leads and SEAs in each PoC site.

The RM should be the initial contact point for all enquiries about the EA in MSK Initiative. RMs can be contacted through their individual email address or at jwhd.msk@dwp.gov.uk

Annex B: EA job description

Job description

Job title

Employment Adviser within musculoskeletal (MSK) services

Band

4 or 5 (dependent on experience). (Note: based on Agenda for Change pay rates)

Location

To be confirmed

Line manager

SEA

Key relationships

Key relationships include:

• HCPs and clinical MSK staff
• administrators within MSK
• JCP
• External agencies and community groups
• healthcare support services
• local advocacy services
• local employers

Hours of work

To be confirmed

Job purpose

This role is part of an employment advice service, working closely with clinicians who provide MSK healthcare support to people with MSK conditions. The post-holder will support service users with MSK conditions to enter, return to or maintain employment.

The role will include working with external agencies such as JCP, employers, trade unions, employment and training agencies to explore options for developing work opportunities for clients.

Main duties and responsibilities

Main duties include:

• managing a caseload (size of caseload is dependent on whether the employee is working full-time or on a pro-rata basis) of people (approximately 25 to 35 at any one time for an EA on a full-time salary) receiving treatment for MSK health conditions - who have been referred to employment support - and where an MSK condition is a barrier to a client entering, returning to, or maintaining employment

• being led by and focused upon the needs and aspirations of the client, considering their strengths and their MSK related difficulties, to offer effective employment support

• developing, through training, an understanding of pain management and how pain and fatigue impact MSK clients and their workability. To gain an understanding of clinical concepts and the type of physio-therapeutic care provided by a HCP

• developing a workability action plan, which will help empower a client in their journey towards an employment goal and detail specific steps that could be taken to enter work, remain in work or return to work. Action plans will need to take account of a client’s aspirations and abilities as well as the limitations of an MSK condition. A workability action plan will need to be developed in consultation with the client as well as the HCP who is providing the client with MSK-related treatment

• providing tailored advice and support to a client in aspects such as job searches and preparation for interviews

• supporting clients in matching job tasks to their ability as well as identify conceivable work-related modifications - potentially in consultation with an employer (where appropriate) - that can help overcome or minimise MSK-related difficulties that a client may face within the workplace

• conducting employment assessments, incorporating a client’s job goals and any concerns regarding their capacity for work. To examine barriers preventing them from paid employment and whether the individual could develop strategies to address them

• developing in-depth knowledge of the local labour market, including awareness of initiatives and/or specialist interventions that can facilitate employment opportunities for a client with an MSK condition

• providing a client with appropriate tools to help ensure that their needs are met within the workplace. This may include support with self-advocating or the sourcing of an appropriate advocate for the client

• refering and signpost the person to specialist support if they have particularly complex barriers. Where appropriate, this will include signposting a client to agencies who will be able to provide advice on benefits and/or other forms of support to which a client may be entitled

• providing tailored and personalised support after a client has returned to work or secured employment

• developing and maintain the integration of employment support within the wider MSK service

• maintaining comprehensive records on client outcomes as part of an on-site system of MI that evidences trends in service performance and informs an evaluation of employment support provision

• where appropriate, escalating any concerns relating to the health and wellbeing of a client and follow the risk and disclosure policies relevant to the local healthcare setting

• attending regular supervision with the SEA

Person specification

Knowledge and skills

Key knowledge and skills include:

• the capacity to provide effective vocational or employment support (essential)

• the capacity to problem solve and offer creative solutions to barriers and challenges that a client may face in entering, maintaining, or returning to employment (essential)

• the ability to demonstrate an awareness of the impact MSK conditions can have on a person’s life and work opportunities (essential)

• effective written and oral communication skills (essential)

• the ability to assess a client’s strengths and challenges in relation to employment (essential)

• the capacity to tailor and adapt employment support and advice to the life and work circumstances of an individual client (essential)

• excellent interpersonal skills including a capacity to demonstrate empathy and the ability to empower clients in pursuit of their employment goals (essential)

• the ability to collect and report data to support service performance and evaluation (essential)

• the ability to work effectively as part of an integrated work and health team within a clinical setting (essential)

Experience

EAs need experience of:

• providing support and guidance on vocational, employment and job-retention issues - this may include support to work colleagues, service users, and/or members of the public (desirable)
• working as part of a multi–disciplinary team (desirable)
• working with people facing disadvantages or life challenges (such as mental or physical health and/or limited socio-economic opportunities, for example) (desirable)

Qualifications

Educated to at least Qualifications and Credit Framework (QCF) Level 3 or equivalent (A-level, AS-level, International Baccalaureate, Level 3 diploma or award, NVQ and so on) (essential).

Training, and learning and development

The completion of a programme of induction training and continuing professional development will be expected as part of the role. This will include training and development in the core components of employment support as well as additional elements of training - including awareness of the impacts of MSK conditions and how pain and fatigue can limit work options, working with HCPs, and understanding clinical concepts - that are relevant to the clinical settings in which clients are treated.

The post-holder will also be expected to undertake relevant mandatory training for working in a clinical environment such as safeguarding and information governance for example.

The post-holder will also need to demonstrate a commitment to undertake training to fill gaps in knowledge. This is likely to include components such as:

• co-producing ‘workability’ action plans with MSK clients
• aspects of health coaching
• MSK-related workplace modifications
• developments in employment law and the benefits system
• keeping up to date with changes in the local labour market and the availability of resources relating to training and employment

Annex C: SEA job description

Job description

Job title

Senior Employment Adviser (SEA) within musculoskeletal (MSK) services

Band:

5 or 6 (dependent on experience) (Note: based on Agenda for Change pay rates)

Line manager

Senior manager within the musculoskeletal (MSK) service

Key relationships

Key relationships include:

• senior management
• HCPs and clinical MSK staff
• JCP
• external agencies and community groups
• healthcare support services
• local advocacy services
• local employers

Job purpose

This role is part of an employment advice service, working with clinicians as part of an integrated work and health team that support people with MSK conditions.

The post-holder will manage and support a team of EAs that provides employment support to clients with MSK conditions seeking to gain, return to or maintain employment.

Main duties and responsibilities

Key responsibilities include to: 

• lead on the recruitment of EAs and build an employment support team within the MSK service
• manage and supervise a team of EAs who are providing employment support to MSK clients
• ensure that employment support is fully embedded in local MSK service delivery and that clinicians and EAs are working together to create a combined care pathway, whereby clients with MSK conditions can receive employment support that is appropriate to their condition and life circumstances
• oversee the induction of EAs, undertake a training needs analysis and monitor continuing professional development to ensure EAs meet the required competence and standards to provide effective employment support. The induction and training will include core components of employment support as well as non-clinical training in the impacts of MSK conditions and how pain and fatigue can limit a client’s workability
• promote the strategic value of employment support by engaging effectively as part of an integrated work and health management team
• lead and oversee the development of effective working relationships between EAs and key agencies in the local labour market - including employers, JCP, trade unions and providers of vocational training and so on
• ensure the employment advice service is equitable and non-discriminatory in terms of age, gender, ethnicity and disability
• ensure that EAs maintain appropriate client records in line with service operational policy
• establish and oversee a comprehensive approach to the recording of MI to ensure outcome data generates effective evidence of trends in service performance and informs an evaluation (date to be determined) of the employment advice service
• undertake all relevant training and continuing professional development appropriate to the SEA role, including mandatory training for working in a clinical environment such as safeguarding and information governance
• if necessary, provide employment advice and support to a small caseload (potentially 6 to 8 at any one time) of MSK clients who face complex employment issues and may require more specialist help than could be provided by a lesser experienced EA

Person specification

Knowledge and skills include:

• capacity to lead a team and foster good working relationships (essential)
• ability to communicate clearly and persuasively, both verbally and in writing (essential)
• ability to use outcome measures for both clinical and audit purposes (desirable)
• excellent interpersonal skills (essential)
• capacity to ensure a service is delivered equitably and meets the needs of service users (essential)
• capacity to problem-solve and seek creative solutions to the barriers and challenges that may face a client seeking employment support and guidance (essential)

Experience

Key experience includes:

• effective partnership working (essential)
• providing support and guidance on vocational, employment, job-retention issues (desirable)
• working as part of a multi-disciplinary team (desirable)
• managing and supervising others (desirable)
• experience of working within healthcare settings (desirable)

Qualifications

Educated to at least Qualifications and Credit Framework (QCF) Level 4 or equivalent (including Higher National Certificate, NVQ Level 4, Level 4 diploma, award or certificate and so on).

Training

Post-holders should be willing and able to undertake all relevant training and continuing professional development associated with the role as well as in leadership and supervision.

It is important that the SEA completes much of the training that will be undertaken by the EA. This will include training in components of employment support as well as additional elements of training - including impacts of MSK conditions, working with HCPs and the clinical concepts used by HCPs.

Engagement and assessment

Client engagement

Specific competences include:

• an ability to engender trust, develop a rapport and work collaboratively with a client
• awareness that the aim of an employment support intervention is to help clients tackle their problems by harnessing their own resources
• an ability to listen to a client’s concerns in a manner which is non-judgmental, supportive and sensitive
• an ability to use appropriate interviewing techniques to help the client describe the main issues that concern them and ways in which these impact on their life
• an ability to gauge whether the client understands the rationale for the intervention
• an ability to help the client articulate their employment goals

Assessment and triage

Specific competences include:

• knowledge of the relevant assessment processes and tools used within MSK pathways to prioritise treatment for a client
• an ability to undertake preliminary and ongoing assessments of employment needs - in the context of an MSK service - and prioritise a package of support to suit a client’s circumstances
• knowledge of key elements of MSK assessment and triage systems and their application in local protocols
• engagement with HCPs and other professionals
• an ability to work with HCPs to identify and articulate the barriers to work for individuals, for example how MSK can impact on an individual’s ability to take part in work
• an ability to review and adjust a workability action plan in collaboration with a client, HCP and an employer or external party or representative (where appropriate)
• for SEAs, the capacity, in collaboration with senior staff in the work place or employment support services, to develop and maintain effective referral pathways between MSK and employment support services and providers

Disclosing information about MSK problems

Specific competences include:

• knowledge of relevant legislation relating to disability in the workplace and the disclosure of information about health problems
• an ability to help a client make an informed decision regarding what may be disclosed to a potential employer about having a disability

Employment interventions

Establishing a context for the service, and explaining to a client the rationale for the employment intervention

Specific competences include:

• knowledge of the range of employment interventions relevant for people with employment needs and a MSK condition including advice on employment support services, specific interventions to support job seeking, range of workplace interventions and support for employers
• ability to agree goals for the intervention
• an ability to help the client generate and agree their own goals for the intervention
• to identify goals which will be subjectively and objectively observable and potentially measurable
• capacity to adapt interventions in response to client feedback
• an ability to respond to any concerns raised by a client about aspects of employment support
• delivering client led interventions
• an ability to plan a work-based programme to support job retention for those newly in employment or whose employment may be at risk, including supporting a client in discussions with an employer (where appropriate)
• capacity to structure meetings and maintain pace
• an ability to maintain adherence to an agreed agenda and to pace meetings with clients so that all agreed items can be given appropriate attention
• delivering advice and support in the work place
• knowledge of employment support services (such as JCP) and the capacity of local services to adapt to MSK needs
• knowledge of relevant guidance and legislation (such as reasonable adjustments in the workplace and access to benefits)
• an ability to regularly liaise with a client’s employer and/or workplace (where appropriate)

Managing caseloads

Caseload management

Specific competences include:

• an ability to manage and, if necessary, adjust a caseload - such as number of clients, case mix and balance of work - to function optimally
• an ability to identify client risks and escalate concerns to a HCP and/or management through agreed local protocols

MSK knowledge and interventions

Knowledge of MSK services

Specific competences include:

• knowledge of the basic structures of MSK in primary and secondary care

Measuring outcomes

Specific competences include:

• knowledge of the purpose and objectives of outcome measurement and its value in the evaluation of client and service outcomes
• knowledge of MSK datasets and its use in MSK services

Facilitating client-led interventions

Specific competences include:

• an ability to understand and support a client in the use of appropriate self-help and self-monitoring materials

Awareness of the impacts of MSK conditions

Specific competences include:

• knowledge of the presenting issues characteristic of MSK conditions, particularly regarding the impacts of pain and fatigue
• knowledge of the ways in which physical and mental health problems can interact and impact on functioning and employment opportunities
• awareness that MSK conditions can impact on quality of life and exacerbate mental health conditions such as depression and anxiety
• understanding differences and complexities in how clients may respond to poor physical and mental health - including differences in knowledge of their own conditions, attitudes to risk and perceptions of their work-related opportunities and abilities

Annex D: competencies for effective supervision

SEAs

Effective supervision

Specific competences include:

• an ability to undertake supervision in collaboration with an EA
• able to apply principles of adult learning, such as active learning and facilitating supervisee reflections on their professional development
• capacity to help supervisees identify their own strengths and weaknesses and formulate learning objectives to address any gaps
• an ability to respond to a supervisee’s preferred approaches to learning

Effective observation

Specific competences include:

• an ability to use direct observation and make use of contingent feedback to enhance learning in supervision
• capacity to identify and use observation methods such as direct observation of work, and role plays (where appropriate)

Adapting supervision to an organisational and governance context

Specific competences include:

• capacity to tailor supervision to the organisational context within which the supervisee is working - taking account of relevant contractual relationships, local governance arrangements and approaches to risk management

Professionalism

Specific competences include:

• building a constructive relationship with the supervisee
• capacity to conduct supervision in a manner which is congruent with relevant ethical and professional frameworks
• ensuring that supervisees are clear about procedures which will be followed should there be concerns about their practice or performance

Establishing a structure for supervision

Specific competences include:

• capacity to impart clear and concise information about the content and expectations of supervision sessions

• capacity to establish a clear structure regarding:

  • frequency and duration of supervision sessions
  • alternative supervision arrangements in the event of leave and/or unavailability
  • alternative arrangements in the event of emergencies

Case management

Specific competences include:

• capacity to provide a supervisee with a clear rationale for their work, ensuring:

  • effective monitoring of a supervisee’s caseload
  • effectively deciding which cases may need specific action or intervention to enhance outcomes
  • there is no systematic and/or undisclosed bias in selection of cases for discussion (for example, a supervisee only wishing to discuss cases that are progressing well)

Giving and receiving feedback in an appropriate manner

Specific competences include:

• capacity to give feedback which is balanced and focused on specific aspects of the supervisee’s work (rather than making generic or unfocussed observations)
• capacity to understand that feedback is most effective when it is accurate, specific, contingent to specific actions and focussed on actions and behaviours (rather than assumptions based on personal characteristics)
• capacity to be open to any feedback or concerns raised by a supervisee about their supervision

Assessing EA skills and competencies

Specific competences include:

• effectively appraising skills and competencies in a way that is reliable, consistent, and tailored to a supervisee’s level of experience, including:

  • a realistic appraisal of an EA’s knowledge and skill development
  • an effective assessment of an EA’s ability to make links between theory and practice
  • assessing an EA’s:
    • capacity to accurately self-reflect on their progress
    • interpersonal skills
    • ability to work effectively with professional colleagues
    • ability to apply ethical and professional standards in practice

• effectively assessing an EA’s skills and competencies in relation to relevant standards - such as those set by professional accreditation bodies, induction material, relevant course curriculum material, or national occupational standards for employment support