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CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical Fitness for work advice and certification Dr Philip Sawney AOHNP(UK) Symposium 13 May 2004.

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Presentation on theme: "CORPORATE MEDICAL GROUP Website: www.dwp.gov.uk/medical Fitness for work advice and certification Dr Philip Sawney AOHNP(UK) Symposium 13 May 2004."— Presentation transcript:

1 CORPORATE MEDICAL GROUP Website: Fitness for work advice and certification Dr Philip Sawney AOHNP(UK) Symposium 13 May 2004

2 CORPORATE MEDICAL GROUP Website: Fitness for work advice & certification DWP’s role Overview of current system Reform - Issues and challenges

3 CORPORATE MEDICAL GROUP Website: DWP and People of working age DWP –Minister for Work –Jobcentre Plus –HSC/E –Strategy - To promote work as the best form of welfare whilst protecting the position of those in greatest need –Policy lead on: ‘statutory certification’; incapacity benefits; vocational rehabilitation Working Age –Sickness absence costs = £10 bn /year (CBI estimate); –Expenditure on IB = £12 bn /year –24% of GP consultations are work related

4 CORPORATE MEDICAL GROUP Website: Fitness for work - Statutory framework Medical evidence regulations - DWP guidance –Forms Med 3; Med 5 Social security regulations NHS (GMS Contracts) regulations – including new GP contract DDA and H & S law

5 CORPORATE MEDICAL GROUP Website: Fitness for work medical advice – underlying principles Integral part of clinical management of patients of working age Start from premise that return to work is optimal health outcome Recognise the link between clinical care and the patient’s work Appropriate diagnosis and management Consider alternatives to ‘unfit for work’ Avoid unnecessary medicalisation of ‘absence’ from work Support positive expectations re: working lives

6 CORPORATE MEDICAL GROUP Website: Health benefits of working Work : generates self esteem reduces dependency enhances social identity Work environments: develop social networks acquire, retain and develop skills

7 CORPORATE MEDICAL GROUP Website: Impact of being out of work: evidence Patients: Have reduced confidence and self esteem Have increased morbidity and mortality - particularly mental health Have disability greater than underlying impairment the effects begin at weeks

8 CORPORATE MEDICAL GROUP Website: Med 3 Warning: this form may seriously damage your health

9 CORPORATE MEDICAL GROUP Website: Fitness for work advice and certification “Absence from work attributed to a health condition, injury or disability” GP - patient axis Issue with quality of advice Knowledge of workplace Shortfall in professional training Lack of employer focus

10 CORPORATE MEDICAL GROUP Website: GP views “Poor understanding and training; many GPs are ambivalent about this work” - Hitchcock & Ritchie 2001 “Some dislike perceived ‘gatekeeper’ role and admit to poor practice” - Hussey et al BMJ 2004 “Area of work which creates confrontation with patients” “GPs estimate that 30% of patients off sick could return to work” - Dr Foster April 04

11 CORPORATE MEDICAL GROUP Website: Employer’s views “GPs tend to see ‘work’ as harmful” “GPs are overprotective of patients and distrustful of the motives of others” “Need to end the so-called sicknote culture” “Only 10% of employers think GPs provide effective support” IRS employment review - March 04

12 CORPORATE MEDICAL GROUP Website: Employee (patient) views Non-medical factors strongly influence ‘fitness’ and capacity for work Need for timely access to professional advice from trusted source “63% expect to turn to their GP for advice on fitness for work and rehabilitation” - ONS Omnibus Survey 2004

13 CORPORATE MEDICAL GROUP Website: The GP as ‘advocate’ Setting long term health beliefs and attitudes Need to consider the longer term effects of worklessness for the patient Distinguish between ‘own occupation’ [which GP certifies] and work in general Advocacy can be used as a barrier to communication Need to more positive expectations about patient’s working lives

14 CORPORATE MEDICAL GROUP Website: Raising awareness Doctors Statutory guidance Desk aids DVD Website / Online learning Professional meetings Direct case related feedback Employers HSE guidance on absence management New website for employers

15 CORPORATE MEDICAL GROUP Website: Guidance, advice & training for doctors Guidance/advice: IB204 & Desk aids IB204 ‘A Guide for Registered Medical Practitioners’ Contains the rules & background information about sickness certification & report writing for certifying medical practitioners

16 CORPORATE MEDICAL GROUP Website: Web site

17 CORPORATE MEDICAL GROUP Website: Online learning

18 CORPORATE MEDICAL GROUP Website: Reform of fitness for work advice and certification Need to balance: –Patient Access –Quality of advice –Cost/affordability Context –New NHS GP contract [‘quality targets’ ] –Pathways to Work strategy – find an approach which better supports work retention / rehabilitation –Legislation and structure of UK ‘benefits’ system (including Statutory Sick Pay)

19 CORPORATE MEDICAL GROUP Website: A new model ? Based on employer-employee axis –Employee and management have the primary responsibility to initiate a timely return to work Role of healthcare professional confined to providing patient with factual information on restrictions or limitations arising from the diagnosed condition and other supporting advice as appropriate Management control of sick leave is through workplace culture and timely return to work programs

20 CORPORATE MEDICAL GROUP Website: Reform difficult ! Would require a different approach by all stakeholders Major training requirement Fostering a greater awareness of rights and responsibilities including legal (eg DDA and Health & Safety Law)

21 CORPORATE MEDICAL GROUP Website: Take GPs out of the loop ? Primary care remains point of clinical care/advice to people of working age Risk of setting up a dual system – supported by public funding Resource limitations not confined to GPs

22 CORPORATE MEDICAL GROUP Website: Helping patients return to work after illness or injury. Vision General Practitioners, Hospital Specialists, Occupational Health specialists and Employers working together to facilitate optimal workplace rehabilitation for all ill or injured persons. The key elements of a return to work plan Communication Recognition of obstacles to a return to work Knowledge of support services Active management (rather than a passive ‘wait and see’ approach) A positive outlook A patient centred approach

23 CORPORATE MEDICAL GROUP Website: Advice on fitness for work by other healthcare professionals ? Joint research: –DWP [lead] –Dept of Health –Cabinet Office Steering group of key stakeholders Fieldwork in progress Report – 2004 Issues = roles; training; workload

24 CORPORATE MEDICAL GROUP Website: Sickness Certification - the future ? Need for excellence in medical care and support/encouragement for rehabilitation A more rounded view of advocacy re: advice and communication with employers and OHPs Likely to be a ‘mixed economy’ of specialist advice provision Driver for change should be improved health and work outcomes for patients

25 CORPORATE MEDICAL GROUP Website: More information Guides - IB 204, deskaids, Disability Handbook updates and hot topics on-line training material information about medical aspects of UK benefits research / literature reviews


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