Medical Education, 1984, 18, 448

REPORT

HOUSE OF LORDS SELECT COMMITTEE ON SCIENCE AND TECHNOLOGY

Occupational Health and Hygiene Services

K. M. PARRY

Scottish Council for Postgraduate Medical Education, Edinburgh

The adequacy of the occupational health and hygi- ene services in industry is the subject of the second report* of the House of Lords Select Committee on Science and Technology for the session 1983-84. The recommendations are not entirely new, but they revitalize and give weight to sound ideas for the improvement of an occupational health service for all employed people. A non-statutory code of good practice is preferred to a mandatory one-a code which would cover the qualifications of personnel as well as the quality and control of the service.

The Committee was impressed by the quality of the formal qualifications available and recommends more training posts simply to match current levels of service, noting that the profession is becoming disproportionally aged; the Government is advised to ‘increase the number of trainee posts for doctors wishing to specialise in occupational medicine’, although it is not entirely clear how this should be done since the Committee believes that the service should remain largely privately funded.

The majority of doctors in occupational medicine are not whole-time specialists however, and the Committee agrees with the Faculty of Occupational Medicine that the AFOM is an ‘unrealistically high level of diploma’ for general practitioners working part-time in occupational health. The Committee supports the suggestion of the Royal College of General Practitioners that some 6-month training posts should be established in occupational medicine within some general practice vocational training schemes, and also recommends that some general

‘House of Lords Select Committee on Science and Technology. Occupational Health and Hygiene Services. Session 1983-84. Second Report. Her Majesty’s Stationery Office, London. 1984. Pp. 60. €4.65.

practitioners should have an opportunity of under- taking 2-month training periods. The Committee favours the development of distance learning to enable doctors to undertake part-time courses, parti- cularly those who do not have easy access to centres of instruction.

The objective is to ensure that all doctors who undertake work in occupational medicine receive some formal specialist training; yet the Committee believes that occupational health should be an integral part of primary care. ‘An individual spends so much of his life at work that occupational medicine should play a more prominent part in the primary service which is available to him; ... both general practice and occupational medicine are concerned, after all, with the same patients’. Quite so, but is it necessary for the general practitioner to don a specialist hat when patients are adversely affected by their conditions of work? Undoubtedly, there is a need for specialists to study the effect of work on health and to promote preventive measures, but surely all aspects of patients’ health, including its relationship to their employment, are a matter of concern to every general practitioner.

This report raises the issue once again of speciali- zation within geaeral practice. General practitioners are general practitioners are general practitioners; their education and training should include an understanding of the relationship between health and work, but that should be an integral part of their development as general practitioners. If any doctors wish to take up occupational medicine on a part-time basis they should be specifically trained for the task, and although an education in general practice may be useful and relevant to occupational medicine it is not a substitute for specialized training.

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