Fitness for work advice and certification

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Fitness for work advice and certification

• Dr Philip Sawney
• AOHNP(UK) Symposium
• 13 May 2004

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Fitness for work advice certification

• DWPs role
• Overview of current system
• Reform - Issues and challenges

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DWP and People of working age

• DWP
• Minister for Work
• Jobcentre Plus
• HSC/E
• Strategy - To promote work as the best form of
  welfare whilst protecting the position of those
  in greatest need
• Policy lead on statutory certification
  incapacity benefits vocational rehabilitation
• Working Age
• Sickness absence costs 10 bn /year (CBI
  estimate)
• Expenditure on IB 12 bn /year
• 24 of GP consultations are work related

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Fitness for work - Statutory framework

• Medical evidence regulations - DWP guidance
• Forms Med 3 Med 5
• Social security regulations
• NHS (GMS Contracts) regulations including new
  GP contract
• DDA and H S law

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Fitness for work medical advice underlying
principles

• Integral part of clinical management of patients
  of working age
• Start from premise that return to work is optimal
  health outcome
• Recognise the link between clinical care and the
  patients work
• Appropriate diagnosis and management
• Consider alternatives to unfit for work
• Avoid unnecessary medicalisation of absence
  from work
• Support positive expectations re working lives

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Health benefits of working

• Work
• generates self esteem
• reduces dependency
• enhances social identity
• Work environments
• develop social networks
• acquire, retain and develop skills

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Impact of being out of work evidence

• Patients
• Have reduced confidence and self esteem
• Have increased morbidity and mortality -
  particularly mental health
• Have disability greater than underlying
  impairment
• the effects begin at 6 - 12 weeks

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Med 3 Warning this form may seriously damage
your health
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Fitness for work advice and certification

• Absence from work attributed to a health
  condition, injury or disability
• GP - patient axis
• Issue with quality of advice
• Knowledge of workplace
• Shortfall in professional training
• Lack of employer focus

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GP views

• Poor understanding and training many GPs are
  ambivalent about this work - Hitchcock
  Ritchie 2001
• Some dislike perceived gatekeeper role and
  admit to poor practice - Hussey et al BMJ 2004
• Area of work which creates confrontation with
  patients
• GPs estimate that 30 of patients off sick could
  return to work - Dr Foster April 04

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Employers views

• GPs tend to see work as harmful
• GPs are overprotective of patients and
  distrustful of the motives of others
• Need to end the so-called sicknote culture
• Only 10 of employers think GPs provide
  effective support IRS employment review -
  March 04

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Employee (patient) views

• Non-medical factors strongly influence fitness
  and capacity for work
• Need for timely access to professional advice
  from trusted source
• 63 expect to turn to their GP for advice on
  fitness for work and rehabilitation - ONS
  Omnibus Survey 2004

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The GP as advocate

• Setting long term health beliefs and attitudes
• Need to consider the longer term effects of
  worklessness for the patient
• Distinguish between own occupation which GP
  certifies and work in general
• Advocacy can be used as a barrier to
  communication
• Need to more positive expectations about
  patients working lives

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Raising awareness

• Doctors
• Statutory guidance
• Desk aids
• DVD
• Website / Online learning
• Professional meetings
• Direct case related feedback
• Employers
• HSE guidance on absence management
• New website for employers

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Guidance, advice training for doctors

• Guidance/advice IB204 Desk aids
• IB204
• A Guide for Registered
• Medical Practitioners
• Contains the rules background
• information about sickness
• certification report writing for
• certifying medical practitioners

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Web site
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Online learning
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Reform of fitness for work advice and
certification

• Need to balance
• Patient Access
• Quality of advice
• Cost/affordability
• Context
• New NHS GP contract quality targets
• Pathways to Work strategy find an approach
  which better supports work retention /
  rehabilitation
• Legislation and structure of UK benefits system
  (including Statutory Sick Pay)

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A new model ?

• Based on employer-employee axis
• Employee and management have the primary
  responsibility to initiate a timely return to
  work
• Role of healthcare professional confined to
  providing patient with factual information on
  restrictions or limitations arising from the
  diagnosed condition and other supporting advice
  as appropriate
• Management control of sick leave is through
  workplace culture and timely return to work
  programs

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Reform difficult !

• Would require a different approach by all
  stakeholders
• Major training requirement
• Fostering a greater awareness of rights and
  responsibilities including legal (eg DDA and
  Health Safety Law)

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Take GPs out of the loop ?

• Primary care remains point of clinical
  care/advice to people of working age
• Risk of setting up a dual system supported by
  public funding
• Resource limitations not confined to GPs

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Helping patients return to work after illness or
injury.

• Vision
• General Practitioners, Hospital Specialists,
  Occupational Health specialists and Employers
  working together to facilitate optimal workplace
  rehabilitation for all ill or injured persons.
• The key elements of a return to work plan
• Communication
• Recognition of obstacles to a return to work
• Knowledge of support services
• Active management (rather than a passive wait
  and see approach)
• A positive outlook
• A patient centred approach

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Advice on fitness for work by other healthcare
professionals ?

• Joint research
• DWP lead
• Dept of Health
• Cabinet Office
• Steering group of key stakeholders
• Fieldwork in progress
• Report 2004
• Issues roles training workload

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Sickness Certification - the future ?

• Need for excellence in medical care and
  support/encouragement for rehabilitation
• A more rounded view of advocacy re advice and
  communication with employers and OHPs
• Likely to be a mixed economy of specialist
  advice provision
• Driver for change should be improved health and
  work outcomes for patients

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More information

• www.dwp.gov.uk/medical
• Guides - IB 204, deskaids, Disability Handbook
• updates and hot topics
• on-line training material
• information about medical aspects of UK benefits
• research / literature reviews