Promoting Excellence in Family Medicine 1 Workshop: Health and Work for General Practitioners

Promoting Excellence in Family Medicine 1

Workshop: Health and Work for General Practitioners

Promoting Excellence in

Family Medicine 2

Setting the scene

The consultation around health and work

Evidence around health and work


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Moving from theory to practice

Strategies around work and health:

Managing the consultation

Managing the process


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A typical scenario


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What are your challenges?

What do you find difficult?

What would you like to do better?


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Effective consultations

Acknowledge feelings

Manage expectations

Control

Usual patter


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A typical scenario

You are in a busy Monday morning surgery….


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Managing the scenario

GP

How do you feel? What would you do and why?

Patient

What do you feel? What did you want?


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Two weeks later…

The patient returns and says they are not getting any better in fact things are worse and they are not sleeping……..

What will you do now?


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Take a step back

Antibiotics and sore throats……


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Worklessness

A state which includes not being in paid employment and not actively seeking employment.

Source: Dame Carol Black’s Report “Working for a Healthier Tomorrow” (2008)


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Worklessness

99% of patients return to work quickly but….


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Work and Health – The Evidence Common Health Problems

66% of all sickness absence is due to common health problems:

Less severe mental health disorders Musculoskeletal disorders Cardio respiratory disorders

These are potentially remediable conditions


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IB Recipients - Diagnoses

IB caseload 2006

40%

6%8%

18%

6%

22%

Mental & Behavioural

Diseases of theNervous System

Circulatory &Respiratory

Musculoskeletal

Injury and Poisoning

Other


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Facts and figures (data 2008)

Based on figures before introduction of ESA On average, 1 million people report sick each week

After 6 months, 3,000 of these are still not back at work

Five years on, 2,500 of them will still be claiming Incapacity Benefit

Over 2.7 million people claim Incapacity Benefit every year, which equates to 1 in 13 of the working age population


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Length of absence is a risk

Window of opportunity (1- 6 months)

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

Worker off 6 - 12 months: 90% chance of never returning to any form of work in the foreseeable future

Waddell and Burton


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Risks and harm of being out of work

Loss of fitness

Physical and mental deteriorationIncreased risk of poor health x 2-3

Social exclusion

Poverty

Waddell and Burton, 2006


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Risk and harm – mental health risks

Psychological distress and depressionIncreased x 2-3

Increased suicide and mortality20% excess deaths


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Families and work

Children in workless households:

have a higher prevalence of recurrent health conditions and lower well-being

suffer higher rates of psychiatric disorders

are more likely to experience worklessness themselves during adult life


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Is Work good for your health and wellbeing?

Strong evidence exists that unemployment is harmful to health. The unemployed have higher mortality, poorer general health, poorer mental health and higher medical consultation, medication consumption, and hospital admission rates.

(Waddell & Burton)


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Is work good for your health and wellbeing?

Overall beneficial effects of work outweigh the risks

Work can be therapeutic and can reverse the adverse health effects

Waddell and Burton


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The provisos…

‘Good job’- nature of the job

Social context - Regional deprivation

Overall beneficial effects of work outweigh the risks


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Coffee break


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A further problem


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Introducing Mr. Jones…


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Putting theory into practice…

What would you say?

What would you do?


Practical tips and strategies


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Fitness for work: 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


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Fitness for work: 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


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Generic workplace modifications

Visit: encourage the patient to keep in touch with work

Allow reduced hours: half days

Change pattern of work / shifts: put on days

Change tasks or work content: rehab ladder

Adapt the workplace: alter layout

Reduce the pace of work: freq or longer breaks

Adapt & equipment: large diameter handles

Provide training: new ways of working

Provide for mobility and transport: parking!


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Writing a sick certificate: Liaising with employers

Consider issuing a Med 3: “You need NOT refrain from work” with specific advice to employers about adjustments to duties or hours in the remarks section.

Example of specific advice to employers: " This woman is fit to return to work but is not fit to carry out manual handling tasks for the next two weeks”.

Consider returning the individual to work in the middle of the week rather than a Monday

Paying for treatment / investigations


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Employment and Support Allowance (ESA)

Introduced on Oct 27th 2008

Still provide a Medical certificate (Med3)

New Work Capability Assessment

What a patient ‘can do’ not what they ‘can’t do’


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Fitness for work: prognosis

Difficult

Evidence base: operations

If you don’t know, say so

Willingness of patient to rehabilitate; employer to provide options


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Fitness for work: prognosis

( see also OUP Handbook of General Practice)

Source: www.workingfit.com


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Other resources…


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The DDA

Definition of disabled “person”

“One who has a physical or mental impairment which has a substantial and long-term adverse effect on his ability to carry out normal day‑to‑day activities”

(Tribunal decides, we assess likelihood)


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The Balancing Act: Illness vs Disease


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Motivation…


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Changing behaviour

Ambivalence is common and normal

Confrontational interviewing - resistance

Shift style - resistance diminishes, change talk increases

Collaboration, honour autonomy

Rollnick and Miller


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Motivation

Varies in degrees…

Not Ready Ready

Rollnick and Miller


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Method

Importance

Confidence

Importance + Confidence = Readiness

Rollnick and Miller


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Importance and confidence

“How important is it for you to get back to work?”

“So how confident do you feel about getting back to work?”

Agenda setting- device to hang a constructive consultation on

Rollnick and Miller


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Thinking back to Mr Jones

Importance = 9

Confidence = 3

What might you do?


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Thinking back to Mr Jones

Importance = 3

Confidence = 9

What might you do?


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Support and resources

What's out there?


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Sources of support

OH services in the workplace

Disability Employment Advisers

Access to Work Scheme

Fit for work services


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Resources

Leaflets

www.healthyworkinguk

Diploma in Occupational Medicine

E learning for health


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Shifting attitudes to health & work

Current: Shift to:

Work is a ‘risk’ and (potentially) harmful to physical and mental health.

Work is generally good for physical and mental health

therefore and

Sickness absence/certification ‘protects’ the worker/patient from work

Recognise the risks and harm of long term worklessness


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Key messages

Work is good for your health and well being

Effective negotiation

Early intervention

Rehabilitation as part of the clinical management plan


Workshop on Health and Work for General Practitioners


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Documents

Promoting Excellence in Family Medicine 1 Workshop: Health and Work for General Practitioners