Purpose Musculoskeletal (MSK) pain is a common cause of work absence. The recent SWAP (Study of Work And Pain) randomised controlled trial (RCT) found that a brief vocational advice service for primary care patients with MSK pain led to fewer days’ work absence and provided good return-on-investment. The I-SWAP (Implementation of the Study of Work And Pain) initiative aimed to deliver an implementation test-bed of the SWAP vocational advice intervention with First Contact Practitioners (FCP). This entailed adapting the SWAP vocational advice training to fit the FCP role. This qualitative investigation explored the implementation potential of FCPs delivering vocational advice for patients with MSK pain. Methods Semi-structured interviews and focus groups were conducted with 10 FCPs and 5 GPs. Data were analysed thematically and findings explored using Normalisation Process Theory (NPT). Results I-SWAP achieved a degree of ‘coherence’ (i.e. made sense), with both FCPs and GPs feeling FCPs were well-placed to discuss work issues with these patients. However, for many of the FCPs, addressing or modifying psychosocial and occupational barriers to return-to-work was not considered feasible within FCP consultations, and improving physical function was prioritised. Concerns were also raised that employers would not act on FCPs’ recommendations regarding return-to-work. Conclusion FCPs appear well-placed to discuss work issues with MSK patients, and signpost/refer to other services; however, because they often only see patients once they are less suited to deliver other aspects of vocational advice. Future research is needed to explore how best to provide vocational advice in primary care settings.

目的肌肉骨骼 (MSK) 疼痛是缺勤的常见原因。最近的 SWAP（工作与疼痛研究）随机对照试验 (RCT) 发现，为 MSK 疼痛的初级保健患者提供简短的职业咨询服务可减少缺勤天数并提供良好的投资回报。I-SWAP（工作和疼痛研究的实施）倡议旨在为首次接触从业者 (FCP) 提供 SWAP 职业建议干预的实施测试平台。这需要调整 SWAP 职业咨询培训以适应 FCP 的角色。这项定性调查探讨了 FCP 为 MSK 疼痛患者提供职业建议的实施潜力。方法对 10 名 FCP 和 5 名 GP 进行了半结构化访谈和焦点小组。使用标准化过程理论 (NPT) 对数据进行专题分析并探索发现。结果I-SWAP 达到了一定程度的“连贯性”（即有意义），FCP 和 GP 都认为 FCP 适合与这些患者讨论工作问题。然而，对于许多 FCP 来说，在 FCP 咨询中解决或改变重返工作岗位的心理社会和职业障碍被认为是不可行的，因此优先考虑改善身体机能。也有人担心雇主不会根据 FCP 关于重返工作岗位的建议采取行动。结论FCP 似乎很适合与 MSK 患者讨论工作问题，并指示/推荐其他服务；然而，因为他们通常只在患者不太适合提供其他方面的职业建议时才去看病。未来的研究需要探索如何最好地在初级保健机构中提供职业建议。