How can self-employment affect health and care, and what would help?
n 2023, there were around 4.2 million self-employed people in the UK, according to the Chartered Institute of Personnel and Development. Around half a million of these were gig workers, doing ad-hoc work such as food delivery that is facilitated through apps and other digital platforms.
Being self-employed or part of the gig economy can be attractive to those with health conditions, disability, or caring responsibilities. The flexibility of self-employment can help people better manage their health and work life.
However, self-employed and gig workers can also need greater support from health services, and research into the gig economy has highlighted concerns about working conditions and pay.
In this article, we look at the health issues among self-employed people, and the barriers that might prevent them from getting care.
What health problems and care barriers do self-employed people face?
The jobs self-employed and gig workers do range from physically demanding to sedentary, and work-related health issues can be just as varied. The experiences this group has shared with us and research by local Healthwatch also show common concerns.
Work hours can create difficulties with accessing services
People may consider flexibility to be one of the benefits of self-employment. But this can mean they work anti-social hours or on projects that reduce flexibility during regular health service opening hours.
Healthwatch Kent found that fishermen in the county struggled with this because they were often away for sustained periods. Healthwatch Sheffield found a similar issue when they worked with cab drivers from South Asian backgrounds. The work hours made it hard to make doctor appointments, so drivers might put off seeking care unless no other option was available.
Meanwhile, Healthwatch North Yorkshire worked with local farmers, and found that the unpredictability and rurality of the work again created barriers to accessing services. Workers faced problems leaving the farm, and some had to travel long distances to care services.
Healthwatch Richmond-upon-Thames also shared a story that shows how self-employment can impact people’s ability to access services at times that suit them.
“[A] Patient with fibromyalgia described their own difficulties in accessing support for their condition. They are a single parent, self-employed and looking after their children, which has made it very difficult to attend any of the support groups/services on offer. Their GP has referred them to a large number of different services… but they‘ve been unable to attend almost all of them due to the timings available.” — Story shared with Healthwatch Richmond-upon-Thames
Self-employed people may be reluctant to take time off
Research commissioned by an insurance company found that 19% of self-employed people were more likely to have to continue working if they are ill or injured (19% compared to 12% of all working people). In their research, Healthwatch Kent heard how fishermen were concerned that they would not earn money if they were not working.
This could also make them hesitant to stop working even if they had health issues, as one story highlighted:
“He wasn’t able to catch enough fish that year, due to his cancer. His fishing licence was revoked and given to someone else as there’s only a limited amount available. When he was fit again he had to wait until a new licence was available. You don’t feel like you have any other option but to just keep going, even if you have a health problem.” — Story shared with Healthwatch Kent
During their work with farmers, Healthwatch North Yorkshire also found that people were hesitant to take time off, with many people saying they prioritise their farms and the health of their animals above their own health and wellbeing.
Lack of job security could impact mental health
Factors such as the stress of insecure work can impact the mental health of self-employed people. Recent economic problems have contributed to job security for those who are self-employed. For people in the gig economy, this can be even more precarious.
Self-employed people also have a different legal status to directly employed people, and may receive or have less protection of income when unwell.
Healthwatch Kent’s work found the challenges of catching enough fish and working in a difficult economic environment meant many fishermen were stopping work. These challenges also contributed to mental health concerns.
People may face specific health concerns or barriers to care relating to their job
Healthwatch Sheffield found taxi drivers had specific health needs due to long shifts and a lack of movement during work. The anti-social nature of the work times could mean fewer chances to socialise, leading to a lack of a support network to stay healthy.
In addition, sitting for long periods could contribute to higher weight. There was a need for information about weight loss that matched the food people ate at home and was in a language they could understand.
Meanwhile, Healthwatch Kent found that the physical demands of fishing meant physical injury was likely. Healthwatch North Yorkshire’s research also highlighted that farming can be very physically demanding and stressful, and that farmers often work in isolation. This means the potential for mental health problems and physical injuries is higher than in many industries.
Another local Healthwatch that worked with farmers, Healthwatch County Durham, showed how support that considered farmers’ specific needs could help. With other local organisations, they organised drop-in clinics so that farmers didn’t have to make appointments. Over a quarter of local farmers invited came for a check-up.
Other tailored solutions could help self-employed people more broadly, as we recommend below.
What would make care access better for self-employed people?
Improve access to GPs and other primary care services: Gig and self-employed workers often find it hard to access GP services and other primary care settings. GP surgeries should:
- Capture patient choices when patients register
- Embed patient choice in all booking approaches
- Offer patients 24-hour access to GP booking platforms
- Improve continuity of care for those who cannot work due to illness.
Start national data collection: The government should gather better health and employment data on self-employed and gig workers to inform interventions. The most efficient way to do this would be to include the option to identify as self-employed or a gig worker on the PRF1 GP registration form.
Public health planning: Commissioners should consider risks for self-employed and gig workers in public health planning, and tailor interventions to these workers’ specific contexts.
For example, self-employed and gig workers are typically excluded from occupational health services. Public health agencies or local councils could provide occupational health access via digital hubs, mobile clinics, or funded assessments.
Introduce statutory sick pay reform: The government should establish a contributory sick pay scheme for self-employed and gig workers to provide them with financial support during periods of illness.
