Disability Seminar

David Memel, Ember Kelly, Mike Holroyd and GP tutors

Learning objectives

• Understand the meaning and effects of disability for patients, carers, GPs and other members of the primary health care team

• Be aware of the importance of functional, social and psychological, as well as medical factors in the assessment of patients in primary care

• Appreciate the range of health, social and voluntary services available to people with disability in the community and how they are organised

• Develop skills for communication and clinical management of patients with disabilities in the community

Programme

• Lecture

• Small group work based on– Consulting with a Visually/Hearing Impaired

person– Crisis in the Community– Learning Disability and Sexuality– Welfare Benefits

ICF ComponentsICF Components

Body FunctionsBody Functions&&

StructuresStructures

Activities Activities & &

ParticipationParticipation

Environmental Environmental FactorsFactors

BarriersBarriers

FacilitatorsFacilitators

Functions Functions

Structures Structures

CapacityCapacity

PerformancePerformance

Health Condition (disorder/disease)

World Health OrganisationModel of Disability ICF 2001

Environmental Factors

Personal Factors

Body function&structure

(Impairment)

Activities(Limitation)

Participation(Restriction)

“People are disabled by both social obstacles and their bodies”

• Year 4 medical student SSC 2012 ‘At sea with disability’

Types of disability

• Physical

• Psychiatric

• Learning

Communication With Disabled People

• Hearing Impairment

• Visual Impairment

• Speech Impairment

• Learning Disability

Why is the GP important?• GP is the the first (and sometimes the only)

health professional that patients see

• GP is the gatekeeper to other services

• GP often has longstanding contact with the patient and their family

• GP training emphasises the patient as well as the disease, and is not limited to a single medical speciality

The size of the problemIn an average general practice of 10,000 patients there are:

• 600-1100 physically disabled adults (25% severely disabled)

– Osteoarthritis 1280-2900– Rheum Arthritis 100-250– Ischaemic Heart Dis 700– CVA 55– Multiple Sclerosis 8– Epilepsy 50– Diabetes 200– Asthma (current) 500

Consultation rate with GP inlast year

•       General popn 3.0

•       Disabled 5.2

• Severely disabled 10.1

Who have disabled people seen in the last year?

• GP 82%

• Hospital Dr 46%

• District Nurse 16%

• Health Visitor 7%

• Physiotherapist 10%

• Occup Therapist 3%

• Social Worker 7%

Care in the Community

Patient & Carer

PRIMARY CARE GPs

District nursesHealth visitors

Community matrons

Nursing homesHospices

HOSPITALConsultants

PhysiosOutreach nurses

SOCIAL SERVICESSocial workers

OTsHome care

VOLUNTARY SECTORCharities

Self help groups

INTERMEDIATECARE TEAMS

Different PerspectivesIs this the reality?

Patient’s perspective

Doctor’s perspective

Available resources

Fitness Certification

Fitness certification• Self certificate for up to a week

• Med3 from GP (or hospital doctor) thereafter

• Based on ability of patient to do their own job

• Dr can sign as not fit, or that may be fit within limitations (with employer’s agreement)

• Dr does not have to personally examine patient

Employment and Support Allowance

• Replaced Incapacity Benefit for new claimants (2008)– More and earlier support for people with capacity

to return to work – Lots of evidence that being off sick is bad for

health

• After 13 weeks – (earlier if self employed or unemployed)

• Assessed by doctor for Dept Work and Pensions

• “Work Capability Assessment” – ability to do any work

Welfare Benefits for Disabled People

• Complex area, but important doctors understand basics, as can make big difference to people’s lives

• Know who to encourage to apply

• Know local sources of specialist advice– Benefits Advice Service, CAB and Benefit

Enquiry Line

Attendance Allowance and Disability Living Allowance

• DLA– Aged less than 65– Care and supervision and/or reduced mobility, or

terminally ill. – Due to be replaced by Personal Independence

Assessment from April 2013– Up to £6838/year

• AA– Aged 65 or more– No mobility component– Up to £4027/year

Attendance Allowance and Disability Living Allowance

• Not means tested

• Paid direct to disabled person, to spend on what they want

• Leads to eligibility to other benefits eg housing benefit

Further reading• Government website on disability

www.direct.gov.uk/DisabledPeople– Sections on finance, employment, DDA, equipment

• Oxford Handbook of General Practice

• The Patient’s Journey– Series in the BMJ about living with different chronic

illnesses

• COMP2 Handouts– Section on Sick Notes and Welfare Benefits