JIM SWAN is convinced the NHS could ''save a fortune'' if the project he has worked on for two years were implemented Scotland-wide. The Lothian Occupational Health Project was set up to raise awareness about workplace illness and, where possible, to alert employers to dangers and difficulties.

Swan, a resource worker with the Lothian Trade Union and Community Resource Centre, has worked hand-in-glove with the project, whose initial aim was to provide patients at five Lothian GP surgeries with access to occupational health advice. Now that the pilot is coming to an end, he

is convinced similar projects throughout Scotland could help people suffering from conditions such as back pain, hearing loss, or repetitive strain injury because of their working conditions.

The problem with pro-active health schemes, however, is they must vie with existing reactive systems for funding. Although the value of taking occupational health schemes into the GP's surgery has been proven (a similar pilot in Sheffield has been expanded to take occupational-health schemes into half of all general practices), the Lothian project will have to approach the likes of the National Lottery for cash if it's to continue.The problem, in Swan's view, is that the pilot has not been long or big enough to make a marked difference in health patterns.

Yet he considers its achievements to have been ''invaluable''. John Mooney, who interviewed patients during the pilot and was involved in research and evaluation, agrees it was of value to the patients, and says that with one in four people suffering from a health problem caused or made worse by work, this type of project needs tighter focus and better integration.

However, he felt the project was hampered by the element of chance. Since interviews were random, it was by luck that those patients the researchers spoke to were suffering from work-related problems. And although doctors did refer some patients, Mooney had the impression that because they were so busy, ''they thought about occupational health on the afternoons we were there, and forgot it for the rest of the week''.

While the project did raise the profile of the issue in primary care, the impression Mooney gives is of too little, too short, and too restricted. ''There were some success

stories,'' he says. ''When we contacted employers with the GPs' authority, we usually got a favourable response because employers are not used to getting letters from doctors about occupational health problems.''

He felt reassured that most employers are not uncaring, but simply unaware of situations which can cause workplace illness. Less reassuring is the fact that the workplace's contribution to ill health plays a minimal role in medical training. If the Lothian project could be prolonged and taken elsewhere in Scotland, Mooney believes, it could help put occupational health on the map for doctors, patients, and employers.

If Mooney sounds frustrated that the project did not go as far at it could have done, the Health Education Board for Scotland, which co-funded it in conjunction with the Lothian Trade Union and Community Centre, is positive in its end-of-term evaluation. More than 3700 GP patients from all age groups were interviewed by a team of occupational health advisers during the study, and a quarter were found to be suffering from work-related ill health.

Positive action on the statistics which emerged could surely make the future brighter for workers: 45% of patients reported exposure to lifting as a hazard in their job; 39% said stress was part of their job; while a hazardous environment was reported by 34%. Job design was a hazard for a further 20% of patients. The project encouraged people to work in a safe manner, and 50% questioned were given written information about work hazards. Some patients asked the project staff to take up the issues directly with their employers, while others wanted more information and support on claiming compensation for work-related injuries.

Project co-ordinator Kathy Jenkins says if these figures were replicated for the whole of Scotland, ''a worrying picture emerges of the effect work is having on the nation's health''. Yet three-quarters of those interviewed had no access to occupational health advice.

Sometimes, this lack of advice can be life-threatening. One pregnant woman asked the project for advice via her GP about chemicals she routinely used at work. And although control levels for two of the chemicals turned out to be adequate, it emerged during the interview that she worked with Trichloroethylene, a chemical linked in toxicological studies with birth defects. When the employer was approached, he rearranged her work so she could avoid the contact.

One of the project's aims was to take in practices across a wide geographical spread. They finally worked with practices in Livingston new town, the formerly industrial Armadale, different social areas of Edinburgh, and Pennicuik. Jenkins says: ''Two of the main objectives were to see if the pilot project could improve primary-care services for work-related problems, and to move towards prevention by working backwards into the workplace through the unions.'' Interestingly, a lot of patients didn't want to tell their employers they had a problem, or even to tell the project who their employer was. On the other hand, many patients would have liked the project to take on the burden of explaining the problem to employers without involving them.

If the project is re-funded (and it has charitable status so that it can apply elsewhere for backing) these are some of the areas Jenkins would like to explore further. ''The main thrust is to inform and to make connections,'' she says. She is satisfied GPs involved in the project felt their knowledge of occupational illness had been increased, but it took the project to open up the field for them.

If the Lothian figures are reflected elsewhere in Scotland, they show a worrying lack of knowledge of occupational health problems among primary-care professionals. Nor is there any reason to suppose GPs would have cause to improve on the links they make between their patients' symptoms and workplace illness.

In essence, Jenkins believes, we are back to the old story of patients wanting more time which GPs just can't offer. A project like the Lothian one can give that time to talk through the reasons for a patient's asthma, dermatitis, reproductive problems, repetitive strain injury, or ear, nose and throat illnesses.

There has been interest from other areas to run similar projects, and Jenkins and her management team are keen to continue the Lothian one if more funding can be found. She says: ''We would argue very strongly that such a project is preventative, but we are in competition with frontline health services. This is not a top priority.'' One solution could be a national fund through which health authorities could bid for funding for such projects, but the irony is that while such machinations are being discussed, such projects could cut doctors' workloads.

For the worker, nothing seems easy as matters stand. Jim Swan says: ''No-one wants to be crippled.'' But because many people can't afford to take time off to give a work-related illness or injury time to recover, they incur stress because they are working while they are unfit.

Benefits are available to help people through such times, but they have to to go searching for them, and if an incident leads to a compensation claim, the medical-legal situation is full of pitfalls. A co-ordinated occupational health scheme involving doctors, patients, occupational health workers and unions could avoid turning a patient into a victim. Swan says ruefully: ''It makes you wonder why governments don't take a step back and look at these things.''