Promoting Excellence in Family Medicine Workshop: Health and Work for General Practitioners INSERT TRAINERS NAMES HERE.

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


Family Medicine

Moving from theory to practice

Strategies around work and health: Managing the consultation

Managing the process


Family Medicine

A typical scenario


Family Medicine

What are your challenges?

What do you find difficult?

What would you like to do better?


Family Medicine

Effective consultations

Acknowledge feelings Manage expectations Control Usual patter


Family Medicine

A typical scenario

You are in a busy Monday morning surgery….


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?


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?


Family Medicine

Take a step back

Antibiotics and sore throats……


Family Medicine

Worklessness

99% of patients return to work quickly but….


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.


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


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


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)


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)


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


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


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


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


Family Medicine

The provisos…

‘Good job’- nature of the job

Social context - Regional deprivation

Overall beneficial effects of work outweigh the risks


Family Medicine

Coffee break


Family Medicine

A further problem


Family Medicine

Introducing Mr. Jones…


Family Medicine

Putting theory into practice…

What would you say?

What would you do?


Practical tips and strategies


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


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


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!


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


Family Medicine

Fitness for work: prognosis

Difficult

Evidence base: operations


Family Medicine


( see also OUP Handbook of General Practice)


Family Medicine


Difficult

Evidence base: operations

If you don’t know, say so

Willingness of patient to rehabilitate; employer to provide options (blind inspector)


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)


Family Medicine

The Balancing Act: Illness vs Disease


Family Medicine

Motivation…


Family Medicine

Changing behaviour

Ambivalence is common, normal

Confrontational interviewing - resistance

Shift style - resistance diminishes, change talk increases

Collaboration, honour autonomy

Rollnick and Miller


Family Medicine

Motivation

Varies in degrees…

Not Ready Ready

Rollnick and Miller


Family Medicine

Method

Importance

Confidence

Importance + Confidence = Readiness

Rollnick and Miller


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


Family Medicine

Thinking back to Mr Jones

Importance = 9

Confidence = 3

What might you do?


Family Medicine

Thinking back to Mr Jones

Importance = 3

Confidence = 9

What might you do?


Family Medicine

Support and resources

What's out there?


Family Medicine

Sources of support

OH services in the workplace

Disability Employment Advisers

Access to Work Scheme


Family Medicine

Resources

Leaflets

Websites

Diploma in Occupational Medicine


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


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


Workshop on Health and Work for General

Practitioners

Promoting Excellence in Family Medicine Workshop: Health and Work for General Practitioners INSERT TRAINERS NAMES HERE.

Documents

work slide

family medicine risks

family medicine worklessness

family medicine unemployment

family medicine fitness

family medicine facts

family medicine workshop

burton slide