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What's it like to work in occupational health

Working in occupational medicine is intellectually stimulating, though not necessarily a huge generator of income, writes Dr James Heffer

Working in occupational medicine is intellectually stimulating, though not necessarily a huge generator of income, writes Dr James Heffer

In the town where I live there is a 60 year old man with severe ankylosing spondylitis.

He is unable to see more than four feet ahead because of his flexion deformity. He lives not far from another man, 20 odd years younger, whom I see walking his dogs most days.

One is in full time employment in the manufacturing industry, the other has been on incapacity benefit for 10 years. It is the younger who is on incapacity benefit.

Occupational health (OH) is involved in trying to understand, assess and change this situation. It is concerned with keeping people well at work.

This means advising about workplace safety and the prevention of occupational injuries and disease, assessing fitness for work, and helping to get those who have suffered injury or sickness back into work.

I ended up doing OH work by accident. When I joined a GP partnership twenty years ago, the retiring partner had been a factory doctor to a local firm and so I took over this role.

After a few years I became frustrated.

The work was interesting but needed time and skills that I did not possess. I enjoyed going to the factory; like many people who are not good with their hands I found seeing things being made intrinsically interesting.

The factory made rubber and the mixing room was known as the 'black hole' where men worked stripped to the waist mixing carbon powder, latex and a variety of chemicals in large mills.

It looked, and probably was, a Victorian process. Clearly there was important and legally-required work to be done but I was bogged down.

We agreed as a partnership that if we were going to undertake this work we would do it properly. We decided to employ a nurse to lead the service and I would get some training to provide the medical support.

This was an innovative model for the time, and it worked well for this company. Since then the service has slowly grown, specializing in high quality occupational health services to twenty different organisations in and around Wiltshire.

The current team is myself, one of my partners, four part time OH nurses and two part time secretaries creating a turnover of £150,000 per year and working from offices near to the GP surgery.

Interest factors

The relationship between work and health is interesting intellectually.

The fact that work can cause ill health has been known for centuries, but it is now known that being at work can improve health, particularly mental health. Work, after personal relationships, is probably the most important influence and motivator on people's lives. So I find that occupational health sits particularly well with work as a general practitioner.

Since 90% of all occupational health conditions present to primary care, it seems to me that a significant part of OH should belong to primary care and general practice in particular. It is part of a holistic understanding of patients and their problems.

It is, I believe, a significant loss to our patients that historically occupational has fallen into the hands of NHS secondary care and private commercial enterprises.

A typical day

Over the last few years there has been increasing interest from GPs in occupational medicine. So what are the challenges that can occur? And is the work practical for a busy GP?

I am a full time GP and I take out two sessions to do OH. I see clients outside the surgery so that it is clear to me and clients that I am operating as an independent opinion and not as a GP advocate.

A typical day takes the form of one or two thirty minute consultations with individual clients. I then dictate letters and plan health surveillance for groups of workers and review results. I try to make one workplace visit each week.

In the last six months I have crawled inside a Hercules aircraft fuel tank (horrible), been under a cement making furnace (huge), visited several care homes (coffee and cake), and seen a circuit board manufacturer (complex) and a forestry yard in operation.

There is a weekly team meeting which I chair and there is the administration that goes with any small business - diaries, work programmes, marketing and audit.

Key points for me are:

• you need to ensure practice partner support – this is essential

• you need to distinguish clearly between the roles of GP and OH doctor

Working in a nurse-led team is the way to get the work done. The nurse is the primary contact with the client and there needs to be a good team ethos.

Alternatively, there are ways to work in OH as a solo practitioner. You can be trained and employed by Atos Health Care, the current holder of the Dept of Work and Pensions contract, to perform benefit assessments.

This is an area under close scrutiny as the Government has targets to reduce the number of IB claimants. You can also work in OH for an NHS trust, where training may be given. An associated field is Assurance Medicine, working in the insurance industry to advise about medical matters.

For example I also work for a Friendly Society which provides income protection.

With regards OH generally, there is likely to be an expanded role for doctors in the future. Dame Carol Black's report, which is due in March, is believed to look towards general practice having a greater say in occupational health matters.

Financial issues

For most GPs, earnings in any field outside of GMS must be set against the cost of a locum or colleagues covering one's work. Each person and practice will arrive at what is or is not reasonable for them. I would caution against expecting a large income increase!

If after all this you are still reading and interested, probably the best thing to do is to shadow someone doing this type of work.

A first step would be joining the Society of Occupational Medicine (www.som.org.uk) and making contacts through their local and regional network. I would happily oblige for the Wiltshire/Avon area. Give it a go.

Requirements

There are a number of requirements for working in OH, as follows

? Qualifications. You should really have the Diploma in Occupational Medicine to work in this field. The diploma can be obtained using distance learning with a residential course.

The exam is a multiple choice paper, portfolio submission and viva.

Another useful qualification is the Diploma in Disability Assessment Medicine, which is clinically interesting and pretty much a requirement for benefit assessment work.

Again it is a one year distance learning course with two part exam. Further information is available from the Faculty of Occupational Medicine.

? Support: the Society of Occupational Medicine is very active and gives helpful advice. It has a journal with excellent review articles. Membership of this organisation is advisable

? Appraisal: this has appeared in OH recently. I was appraised last year by a senior army officer. The appraisal was arranged through the Society of Occupational Medicine. I found it required more preparation than a standard GP appraisal and was more informative. No doubt it will become a requirement for fitness to practice in due course.

Dr James Heffer is a GP in Bradford-on-Avon, Wiltshire

Dr James Heffer: 'I find seeing things being made intrinsically interesting.' Dr James Heffer

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