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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
Promoting Excellence in
Family Medicine 3
Moving from theory to practice
Strategies around work and health:
Managing the consultation
Managing the process
Promoting Excellence in
Family Medicine 4
A typical scenario
Promoting Excellence in
Family Medicine 5
What are your challenges?
What do you find difficult?
What would you like to do better?
Promoting Excellence in
Family Medicine 6
Effective consultations
Acknowledge feelings
Manage expectations
Control
Usual patter
Promoting Excellence in
Family Medicine 7
A typical scenario
You are in a busy Monday morning surgery….
Promoting Excellence in
Family Medicine 8
Managing the scenario
GP
How do you feel? What would you do and why?
Patient
What do you feel? What did you want?
Promoting Excellence in
Family Medicine 9
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?
Promoting Excellence in
Family Medicine 10
Take a step back
Antibiotics and sore throats……
Promoting Excellence in
Family Medicine 11
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)
Promoting Excellence in
Family Medicine 12
Worklessness
99% of patients return to work quickly but….
Promoting Excellence in
Family Medicine 13
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
Promoting Excellence in
Family Medicine 14
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
Promoting Excellence in
Family Medicine 15
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
Promoting Excellence in
Family Medicine 16
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
Promoting Excellence in
Family Medicine 17
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
Promoting Excellence in
Family Medicine 18
Risk and harm – mental health risks
Psychological distress and depressionIncreased x 2-3
Increased suicide and mortality20% excess deaths
Promoting Excellence in
Family Medicine 19
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
Promoting Excellence in
Family Medicine 23
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)
Promoting Excellence in
Family Medicine 24
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
Promoting Excellence in
Family Medicine 25
The provisos…
‘Good job’- nature of the job
Social context - Regional deprivation
Overall beneficial effects of work outweigh the risks
Promoting Excellence in
Family Medicine 26
Coffee break
Promoting Excellence in
Family Medicine 27
A further problem
Promoting Excellence in
Family Medicine 28
Introducing Mr. Jones…
Promoting Excellence in
Family Medicine 29
Putting theory into practice…
What would you say?
What would you do?
Promoting Excellence in Family Medicine 30
Practical tips and strategies
Promoting Excellence in
Family Medicine 31
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
Promoting Excellence in
Family Medicine 32
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
Promoting Excellence in
Family Medicine 33
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!
Promoting Excellence in
Family Medicine 34
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
Promoting Excellence in
Family Medicine 35
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’
Promoting Excellence in
Family Medicine 36
Fitness for work: prognosis
Difficult
Evidence base: operations
If you don’t know, say so
Willingness of patient to rehabilitate; employer to provide options
Promoting Excellence in
Family Medicine 37
Fitness for work: prognosis
( see also OUP Handbook of General Practice)
Source: www.workingfit.com
Promoting Excellence in
Family Medicine 38
Other resources…
Promoting Excellence in
Family Medicine 39
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)
Promoting Excellence in
Family Medicine 40
The Balancing Act: Illness vs Disease
Promoting Excellence in
Family Medicine 41
Motivation…
Promoting Excellence in
Family Medicine 42
Changing behaviour
Ambivalence is common and normal
Confrontational interviewing - resistance
Shift style - resistance diminishes, change talk increases
Collaboration, honour autonomy
Rollnick and Miller
Promoting Excellence in
Family Medicine 43
Motivation
Varies in degrees…
Not Ready Ready
Rollnick and Miller
Promoting Excellence in
Family Medicine 44
Method
Importance
Confidence
Importance + Confidence = Readiness
Rollnick and Miller
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Family Medicine 45
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
Promoting Excellence in
Family Medicine 46
Thinking back to Mr Jones
Importance = 9
Confidence = 3
What might you do?
Promoting Excellence in
Family Medicine 47
Thinking back to Mr Jones
Importance = 3
Confidence = 9
What might you do?
Promoting Excellence in
Family Medicine 48
Support and resources
What's out there?
Promoting Excellence in
Family Medicine 49
Sources of support
OH services in the workplace
Disability Employment Advisers
Access to Work Scheme
Fit for work services
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Family Medicine 50
Resources
Leaflets
www.healthyworkinguk
Diploma in Occupational Medicine
E learning for health
Promoting Excellence in
Family Medicine 51
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
Promoting Excellence in
Family Medicine 52
Key messages
Work is good for your health and well being
Effective negotiation
Early intervention
Rehabilitation as part of the clinical management plan
Promoting Excellence in Family Medicine 53
Workshop on Health and Work for General Practitioners
Promoting Excellence in
Family Medicine 54