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Promoting Excellence in Family Medicine
Workshop: Health and Work for General Practitioners
INSERT TRAINERS NAMES HERE
Promoting Excellence in
Family Medicine
Setting the scene
The consultation around health and work
Evidence around health and work
Promoting Excellence in
Family Medicine
Moving from theory to practice
Strategies around work and health: Managing the consultation
Managing the process
Promoting Excellence in
Family Medicine
A typical scenario
Promoting Excellence in
Family Medicine
What are your challenges?
What do you find difficult?
What would you like to do better?
Promoting Excellence in
Family Medicine
Effective consultations
Acknowledge feelings Manage expectations Control Usual patter
Promoting Excellence in
Family Medicine
A typical scenario
You are in a busy Monday morning surgery….
Promoting Excellence in
Family Medicine
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
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
Take a step back
Antibiotics and sore throats……
Promoting Excellence in
Family Medicine
Worklessness
99% of patients return to work quickly but….
Promoting Excellence in
Family Medicine
Facts and figures
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
Timing of interventions
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
Work and Health – The Evidence Common Health Problems
CHPs form approximately 66% of all sickness absence:
Less severe mental health
disorders Musculoskeletal disorders Cardio respiratory disorders
Promoting Excellence in
Family Medicine
Mental health problems are common
30% of the 280 million consultations undertaken by GPs each year have a mental health component (RCGP, 2006)
Two-fifths of sickness absence in the UK is caused by anxiety and depression,
One million people live on incapacity benefits due to a mental health problem (Oxford Economics, 2007)
Promoting Excellence in
Family Medicine
Unemployment and mental health
There is evidence that being in work is beneficial for your health and can help you recover from both physical and mental health problems (Waddell & Burton, 2006)
Unemployment damages people’s health and wellbeing (Waddell & Burton, 2006).
Suicide rate in general is increased by 6 times in longer-term worklessness (Bartley et al., 2005)
Promoting Excellence in
Family Medicine
Risks and harm of being out of work
Loss of fitness
Physical and mental deteriorationIncreased risk of poor health x 2-3
Psychological distress and depressionIncreased x 2-3
Increased suicide and mortality20% excess deaths
Social exclusion Poverty
Waddell and Burton, 2006
Promoting Excellence in
Family Medicine
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
IB caseload 1997
27%
6%
13%23%
6%
25%
Mental &Behavioural
Diseases of theNervous System
Circulatory &Respiratory
Musculoskeletal
Injury and Poisoning
Other
Promoting Excellence in
Family Medicine
Facts about people being out of work
Has the equivalent impact as smoking 10 packs of cigarettes per day
Ross 1995
The risk of being out of work in the longer term is greater than the risk of other killer diseases such as coronary heart disease
Waddell & Aylward, 2005
Promoting Excellence in
Family Medicine
Is work good for your health and wellbeing?
Overall beneficial effects of work outweigh the risks
Worklessness is associated with poorer physical and mental health and well being
Work can be therapeutic and can reverse the adverse health effects
Waddell and Burton
Promoting Excellence in
Family Medicine
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
Coffee break
Promoting Excellence in
Family Medicine
A further problem
Promoting Excellence in
Family Medicine
Introducing Mr. Jones…
Promoting Excellence in
Family Medicine
Putting theory into practice…
What would you say?
What would you do?
Promoting Excellence in Family Medicine
Practical tips and strategies
Promoting Excellence in
Family Medicine
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
Fitness for work: work on health Demands of the job: physical, intellectual
Environment: shopfloor/office, risk factors (eg dusts, chemicals)
Temporal: shiftworking, early start
Travel: business travel – between sites, overseas
Organisational: lone-working, customers
Layout: ergonomic aspects of workstation, work equipment
Promoting Excellence in
Family Medicine
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
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
Fitness for work: prognosis
Difficult
Evidence base: operations
Promoting Excellence in
Family Medicine
Fitness for work: prognosis
( see also OUP Handbook of General Practice)
Promoting Excellence in
Family Medicine
Fitness for work: prognosis
Difficult
Evidence base: operations
If you don’t know, say so
Willingness of patient to rehabilitate; employer to provide options (blind inspector)
Promoting Excellence in
Family Medicine
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
The Balancing Act: Illness vs Disease
Promoting Excellence in
Family Medicine
Motivation…
Promoting Excellence in
Family Medicine
Changing behaviour
Ambivalence is common, normal
Confrontational interviewing - resistance
Shift style - resistance diminishes, change talk increases
Collaboration, honour autonomy
Rollnick and Miller
Promoting Excellence in
Family Medicine
Motivation
Varies in degrees…
Not Ready Ready
Rollnick and Miller
Promoting Excellence in
Family Medicine
Method
Importance
Confidence
Importance + Confidence = Readiness
Rollnick and Miller
Promoting Excellence in
Family Medicine
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
Thinking back to Mr Jones
Importance = 9
Confidence = 3
What might you do?
Promoting Excellence in
Family Medicine
Thinking back to Mr Jones
Importance = 3
Confidence = 9
What might you do?
Promoting Excellence in
Family Medicine
Support and resources
What's out there?
Promoting Excellence in
Family Medicine
Sources of support
OH services in the workplace
Disability Employment Advisers
Access to Work Scheme
Promoting Excellence in
Family Medicine
Resources
Leaflets
Websites
Diploma in Occupational Medicine
Promoting Excellence in
Family Medicine
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
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
Workshop on Health and Work for General
Practitioners
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