Dr Suleman final presentation Fitness Certification_BAOHS

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Dr Suleman final presentation Fitness Certification_BAOHS Powered By Docstoc
					 Dr. Asim Suleman
General Practitioner
Health and Work

 Health and Work Consultation

 Evidence around health and work

 Fitness certification
Not a typical consultation!!
 How do you feel?

 What would you like out of the consultation?
‘Working for healthier
 Dame Carol Black (March 2008)
 Key findings;
    £100 billion = economic cost of sickness absence and
    GPs often feel ill-equipped to offer advice
    Current sickness certification focuses on what patients
     cannot do
    Insufficient access to support, patients including those
     with mental health problems
Take a step back
 Antibiotics and sore throats

 Smoking

 Folic Acid in pregnancy

 NICE (National Institute for Health and Clinical
 66% of all sickness absence is due to common health
   Less severe mental health problems
   Musculoskeletal
   Cardiorespiratory disorders
Facts and figures
 1 million = sick each week
 3000 = still not back at work at 6 months
 2500 = will still be claiming IB at 5 years

2.7 million people claim IB every year (1 in 13 of working
Length of absence is a risk
 Window of opportunity is 1 – 6 months

 Worker off for 4 – 12 weeks = 10 – 40% chance of being
 off work at one year

 Worker off at 6 – 12 months = 90% chance of never
 returning to any form of work in the foreseeable future

                         (Waddell & Burton 2006)
Risks and harm
 Loss of fitness
 Physical and Mental deterioration
 Social exclusion
 Poverty
 Psychological Distress and depression (Increased x2)

 “The risk of being out of work in the longer term us
  greater than the risk of other killer diseases such as
  coronary heart disease.” (Waddell & Aylward, 2005)
Effect of health on work
 Stamina
 Mobility: walking, bending, stooping
 Agility: dexterity, posture, co-ordination
 Rational: mental state, mood
 Treatment: side-effects, duration of
 Intellectual: cognitive abilities
 Essential for job: food handlers, driving
 Sensory aspects: safety – self and others
Effect of work on health
 Demands of the job: physical, intellectual

 Environment: shop floor/office, risk factors
  (e.g. dusts, chemicals)

 Temporal: shift working, early start

 Travel: business travel – between sites, overseas

 Organisational: lone-working, customers

 Layout: ergonomic aspects of workstation, work equipment
‘Sick note’ to ‘Fit note’
 Key changes;
    Includes telephone consultations / discharge summaries
    Combines previous Med3 and Med5
    Removal of Med4,Med5, Med6 and RM7
    During first 6 months of illness, can only be issued for
     <3 months.
    ‘Return to work’ note no longer required
    Signed only by a Doctor
    Free
    After 7 calendar days
Liaising with employers
 ‘May be fit for work.....’
    ‘if manual handling tasks / heavy lifting avoided’
    ‘but needs regular breaks as cannot sit for long periods’
    ‘if receives prompt interventional therapy’

   Return to work in the middle of the week?

   Ask employer to pay for treatment / investigations?
Case Study – 1
 Alison (35) off 6 weeks with back pain (no serious
  cause). She works at a call centre.
 GP issues Med3 and she ‘may be fit for work.......’
   Referred for physiotherapy – may need time off
   Needs to avoid standing of sitting still for long periods
   Consider an OH assessment
   Workstation review
   Will be the case for 8 weeks
   I will need to / not need to assess you at the end of this
Case Study - 2
 George (52) – chronic anxiety and works on customer
  complaints desk, occasional shop floor duties
 Would like to return but worried about coping
 ‘may be fit for work’
   Phased return
   Avoid customer facing duties
   Create support network at work?
   3 - 5 weeks
   I will need to / need not assess your fitness for work at
    the end of this period.

 ‘Relationships based on openness, trust and good
 communication will enable you to work in partnership
 with your patients to address individual needs.’
            (GMC: Good Medical Practice, Nov 2006)
Any questions?

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