It is generally accepted that work, health and wellbeing are connected. How can occupational health professionals help?
What is an OHP?
The aims of an occupational health service are to promote and ensure physical, mental and social wellbeing within the workplace. The Faculty of Occupational Medicine has developed the ‘Safe Effective Quality Occupational Health Service’ (SEQOHS) which is a voluntary accreditation scheme to help raise the overall standards of care delivered by occupational health providers and ensure that their services meet an accepted standard.
The Occupational Health Physician (OHP) is a qualified medical doctor who has a higher postgraduate qualification in occupational medicine recognised by the Faculty of Occupational Medicine. The OHP must demonstrate competencies in this specialty and should ideally visit the workplace to advise on a safe and healthy environment.
The OHP must be able to assess the fitness of workers for specific tasks. In particular this will include understanding the relationship between specific medical issues and safety. Individuals will be monitored following appropriate risk assessments for potential hazards in the workplace. Case management of individuals with specific health or possibly disability concerns may involve recommending suitable alternative workplace modifications and other restrictions. In some cases this may also involve advising employers on whether an individual meets the necessary criteria for an ill-health retirement under the terms of relevant pension fund rules and criteria.
Where problems arise
In my experience of many years of practising occupational medicine the main problem area seems to occur with management referrals.
This is where an employer has a specific or perceived medical issue with an employee and therefore refers the individual for an occupational health assessment. This often reflects concerns about attendance levels attributed to sickness or possibly mental health issues or conflict between employer and employee.
The most common complaints encountered from customer satisfaction surveys are in various forms but commonly as follows:
• OH only regurgitates word for word what the candidate is telling them.
• They always take the side of the employee.
• They always sit on the fence and do not give us clear directions.
• They do not answer the questions we asked.
• They include inappropriate comments and advice.
• They do not support or give direction to his employers.
From the employer’s perspective, these are often very valid criticisms, but why do they occur?
The OHP is specifically trained in trying to assess a situation in an impartial manner to facilitate and enable management to deal with a problem. Although always acting within the professional duties of a registered medical practitioner, the OHP, unlike the GP, is not directly the advocate of the employee and any resultant report is essentially to cover the following points as appropriate to the particular situation.
• Is the individual able to perform their substantive role?
• If not what are the timescales for an anticipated return to work?
• Whether temporary or permanent adjustments assist in facilitating a return to work.
• Whether there is likely to be any residual disability either temporary or permanent.
• The OHP may give an opinion on disability under the Equality Act 2010 that may need to be considered.
• Whether any future medical interventions will be required.
• If the employer has indicated they may be considering termination of employment on medical grounds whether the individual would qualify under particular pension fund rules and criteria.
• Whether there are any other interventions that management can undertake which are feasible within business and other operational considerations to assist in any form of rehabilitation.
• If there is a medical reason which may have contributed to poor attendance or performance.
To answer these questions effectively and give a comprehensive and valuable report to management then the OHP needs a clear and comprehensive referral.
Top Ten Countdown
To get the best out of your OHP here’s ten points to consider in a management referral. Follow all ten to better obtain a useful OHP report.
- Consent. It is often overlooked that this must be obtained before any referral. There is no value to a medical referral if the individual is not prepared to cooperate and is reluctant to be forthcoming.
- Informed Consent. Consent will be invalid if the individual does not fully understand the reasons for the referral and the consequences and other possible sequelae.
- Pre-referral discussion. This is essential to cover the first two points and also may be valuable to both parties in understanding the issues in the workplace and how they may be overcome prior to the OHP input.
- Accurate completion of the referral documentation. Most OH providers use fairly standard management referral documentation that is sometimes overlooked by management or all the options inappropriately requested.
- Reasons for concern. This is probably the most important piece of information on the referral documentation. What has precipitated the need for medical input allows the OHP to focus on the appropriate areas. The referral documentation above may not have all the appropriate options and therefore additions may be required to assist the OHP in the open field usually available on the referral form.
- Specific questions. This allows the OHP to focus on the areas that the employer specifically wishes dealt with and also is very useful as it focuses the employer on what they might expect from the referral.
- Background information. This is commonly omitted from the referral documentation and can be essential in any discussion with the employee as the OHP may then have the one version of events which might contradict that perceived by the referring manager.
- Options. As already stated the pre-referral discussion with the employee may give the manager some thoughts on what may be appropriately available within the workplace for the OHP to consider and advise accordingly. It should be remembered that the employee themselves can often be the best judge of their own capabilities and what they feel they can manage in any situation.
- Information. Any relevant medical information such as GP “fit notes” or other medical reports should be included in the referral.
- Post referral discussion. This can be a very useful management tool in moving matters forward and making sure that all parties are in agreement and understand the points made in the OHP report. This whole management referral process is only of any value if there are some actions facilitated as a consequence.
These points are general and can overlap in some areas but I think they can be summed up in one key word: communication.
Written by Dr Steven Malleson Chief Medical Officer Express Medicals