Occupational Medicine Health Screening How they can help your business Dr Mark Feldman.

Occupational MedicineOccupational MedicineHealth ScreeningHealth Screening

How they can help your businessHow they can help your business

Dr Mark FeldmanDr Mark Feldman

Who am I ?Who am I ?

Senior partner general practiceSenior partner general practice

Trainer in general practiceTrainer in general practice

Petersfield ScreeningPetersfield Screening

Health ScreeningHealth Screening

Occupational HealthOccupational Health

Private General PracticePrivate General Practice

Who am I ?Who am I ?

Stress lecturing Stress lecturing

HypnotherapyHypnotherapy

– President of BAMHPresident of BAMH

– PracticePractice

– TeachingTeaching

CustomersCustomers

PharmaceuticalsPharmaceuticals

– Aventis PharmaAventis Pharma

– MartindaleMartindale

– Sanofi Winthrop Sanofi Winthrop

BiotechnologyBiotechnology

– Argenta discoveryArgenta discovery

– SynexisSynexis

CustomersCustomers

ChemistryChemistry

– RhodiaRhodia

– Champion PhotochemistryChampion Photochemistry

Electrical GenerationElectrical Generation

– Thames powerThames power

FinanceFinance

– Mcartney and DowieMcartney and Dowie

CustomersCustomers

EducationEducation

– Peniel academyPeniel academy

AutomotoiveAutomotoive

– AxialAxial

AgricultureAgriculture

– EmbrexEmbrex

ConstructionConstruction

– Noble and TaylorNoble and Taylor

Occupational MedicineOccupational MedicineWhat is it?What is it?

Interface between work and healthInterface between work and health

– Work affecting employees healthWork affecting employees health

– Health affecting employee’s ability to workHealth affecting employee’s ability to work

Occupational MedicineOccupational MedicineWhat do we do?What do we do?

Pre employment questionnairesPre employment questionnaires– To assess suitability for jobTo assess suitability for job

Pre employment examinationPre employment examination– Key workersKey workers– Basis for ongoing screening if requiredBasis for ongoing screening if required

Medical assessmentsMedical assessments– If at risk ie exposure noise, toxins, mechanical If at risk ie exposure noise, toxins, mechanical

stressstress


HASAW 1974HASAW 1974– Implies duty to ensure that recruited staff can Implies duty to ensure that recruited staff can

perform their workperform their work


Review of specific medical problemsReview of specific medical problems– How they affect workHow they affect work– Second opinionSecond opinion

ReferalReferal– NHSNHS– PrivatePrivate

Expediting treatmentExpediting treatment

– Advice to managementAdvice to management CapabilityCapability CapacityCapacity

– PhysicalPhysical– PsychologicalPsychological


Management of sickness absenceManagement of sickness absence

– 40% of employers believe some of their workers 40% of employers believe some of their workers

absence is malingeringabsence is malingering

– 27% of small businesses have a problem27% of small businesses have a problem


Management of sickness absenceManagement of sickness absence 10% of workers take > 7 days per yr10% of workers take > 7 days per yr

9.5% of these take more than 1 episode of 7 days9.5% of these take more than 1 episode of 7 days

Bosses average 3.3 dys per yearBosses average 3.3 dys per year

Workers average 10 days per yearWorkers average 10 days per year

– Most small companies loose on average 31 Most small companies loose on average 31

days due to dubious sickness absencedays due to dubious sickness absence


Management of sickness absenceManagement of sickness absence– Bradford factorBradford factor

100 Warn100 Warn 140 SSP140 SSP

– Clear policiesClear policies

– Early interventionEarly intervention

– Liaison with the NHSLiaison with the NHS

– Making it happenMaking it happen

– Rehabilitation Rehabilitation


Management of sickness absenceManagement of sickness absence

– Different from GPDifferent from GP

Quicker back to workQuicker back to work

– Knowledge of jobKnowledge of job

– Knowledge of company requirementsKnowledge of company requirements

– Knowledge of other work that could be doneKnowledge of other work that could be done

Sickness absenceSickness absence

Fair dismissalFair dismissal

– conductconduct

– capability or qualificationscapability or qualifications

– Redundancy Redundancy

– Statutory restrictionStatutory restriction

– Some other substantial reason justifying dismissal Some other substantial reason justifying dismissal

[ withholding of medical data on PEQ, absenteeism][ withholding of medical data on PEQ, absenteeism]


Fair dismissalFair dismissal– CapabilityCapability– Evidence of ill health – from Occ physicianEvidence of ill health – from Occ physician

Date of return to workDate of return to work

Any residual problemsAny residual problems

Permanent or temporaryPermanent or temporary

Will employee render regular efficient serviceWill employee render regular efficient service


Fair dismissalFair dismissal– Can disagree with GP ifCan disagree with GP if

Patient has been examinedPatient has been examined

Clear reportClear report

Risk to others if stay in employmentRisk to others if stay in employment

Specialist report sought if seen consultantSpecialist report sought if seen consultant


Fair dismissal if inFair dismissal if in– Absenteeism [ frequent short absences ]Absenteeism [ frequent short absences ]

Absence records accurate, assessed, investigatedAbsence records accurate, assessed, investigated

Warnings given sympathetically, problems looked forWarnings given sympathetically, problems looked for

OP opinion takenOP opinion taken

Employee hearing givenEmployee hearing given

Disability Discrimination ActDisability Discrimination Act

May not discriminate on grounds of disabilityMay not discriminate on grounds of disability

– Long term > 12 months physical or mental problem , substantial Long term > 12 months physical or mental problem , substantial

affect on ability to carry out normal day to day activitiesaffect on ability to carry out normal day to day activities

– Make reasonable adjustments to workplaceMake reasonable adjustments to workplace

– BUT can refuse to employ if discrimination is ‘ material to the BUT can refuse to employ if discrimination is ‘ material to the

circumstances of the case and substantial ie typist with circumstances of the case and substantial ie typist with

Rheumatoid.Rheumatoid.


Not allowed to discriminate on recruitmentNot allowed to discriminate on recruitment

Includes Includes

– AIDS, MSAIDS, MS

– insulin dependant diabetesinsulin dependant diabetes

ExcludesExcludes

– Drugs, alcohol, hay fever, voyeurismDrugs, alcohol, hay fever, voyeurism

– Tendency to steal and set firesTendency to steal and set fires


Requires reasonable adjustmentsRequires reasonable adjustments

– Size of firmSize of firm

– Amount of resourceAmount of resource

– PracticalityPracticality

All employers covered [ except forces ]All employers covered [ except forces ]

All employees – inc temporary, part timeAll employees – inc temporary, part time


Importance of good written policiesImportance of good written policies

– Eg when will dismiss for absenceEg when will dismiss for absence

– Can dismiss if take time off work due to Can dismiss if take time off work due to

disability IF would have dismissed anybody who disability IF would have dismissed anybody who

took a similar time off work [ Disability related took a similar time off work [ Disability related

discrimination ] discrimination ]


LegislationLegislation

– RIDDOR [ Reportable diseases] RIDDOR [ Reportable diseases]

– COSHCOSH

– European DirectivesEuropean Directives

– Disability Discrimination ActDisability Discrimination Act

Liaison with / provision of occupational Liaison with / provision of occupational

hygiene functionhygiene function


RIDDORRIDDORhttp://www.riddor.gov.uk/info.htmlhttp://www.riddor.gov.uk/info.html

deathsdeaths

· major injuries· major injuries

· accidents resulting in over 3 day injury · accidents resulting in over 3 day injury

· diseases· diseases

· dangerous occurrences· dangerous occurrences

. gas incidents. gas incidents


COSHHCOSHH


COSHHCOSHH

http://www.coshh-http://www.coshh-

essentials.org.uk/essentials.org.uk/

assets/live/indg136.pdfassets/live/indg136.pdf


COSHHCOSHH

Cases from practiceCases from practice

50 year old phamaceutical inspector with 50 year old phamaceutical inspector with wrist painwrist pain

28 yr old secretary with CFS28 yr old secretary with CFS

38 yr old woman with Bradford factor of 100038 yr old woman with Bradford factor of 1000

Occupational MedicineOccupational MedicineWho do you need?Who do you need?

Competent personCompetent person

– As defined by Employment Medical Advisory As defined by Employment Medical Advisory

Service of HSEService of HSE

– Diploma in Occupational MedicineDiploma in Occupational Medicine

Disease PreventionDisease Prevention Health ScreeningHealth Screening

– Full History and examinationFull History and examination

– Blood pressure Blood pressure

– Exercise stress ECG +cardiac risk assessmentExercise stress ECG +cardiac risk assessment

– Liver function testsLiver function tests

– Renal function testsRenal function tests

– ThyroidThyroid

– DiabetesDiabetes


Visual acuityVisual acuity

Glaucoma check – commonest cause of blindnessGlaucoma check – commonest cause of blindness

Grip strengthGrip strength

HearingHearing

Prostate Specific Antigen for carcinoma prostateProstate Specific Antigen for carcinoma prostate


Lung function testsLung function tests

Cervical SmearCervical Smear

MammographyMammography

Aortic aneurysm > 55 yrsAortic aneurysm > 55 yrs


Faecal Occult blood if family history bowel Faecal Occult blood if family history bowel

cancercancer

Skin cancersSkin cancers

Cases from practiceCases from practice

45 yr old man with mole 3x3 cm on R calf45 yr old man with mole 3x3 cm on R calf

47 yr old man with glucose of 18mM47 yr old man with glucose of 18mM

48 yr old man with alcohol problem48 yr old man with alcohol problem

40 yr old woman with abnormal 40 yr old woman with abnormal

mammogrammammogram

Why Petersfield ScreeningWhy Petersfield Screening

Better reportingBetter reporting All of the testsAll of the tests

– ThyroidThyroid– Exercise stress testingExercise stress testing– Abdominal ultrasoundAbdominal ultrasound– OKPOKP

Follow throughFollow through Ongoing supportOngoing support

The ENDThe END

Dr Mark FeldmanDr Mark Feldman

Petersfield ScreeningPetersfield Screening

Occupational Medicine Health Screening How they can help your business Dr Mark Feldman.

Documents

workoccupational medicinewhat

yearworkers average

employees ability

daysbosses average

workers absence

substantial affect

substantial reason

medical data