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

Promoting Excellence in Family Medicine Moving from theory to practice Strategies around work and health:  Managing the consultation  Managing the process

Promoting Excellence in Family Medicine A typical scenario

Promoting Excellence in Family Medicine What are your challenges?  What do you find difficult?  What would you like to do better?

Promoting Excellence in Family Medicine Effective consultations  Acknowledge feelings  Manage expectations  Control  Usual patter

Promoting Excellence in Family Medicine A typical scenario You are in a busy Monday morning surgery….

Promoting Excellence in 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?

Promoting Excellence in 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?

Promoting Excellence in Family Medicine Take a step back  Antibiotics and sore throats……

Promoting Excellence in Family Medicine Worklessness 99% of patients return to work quickly but….

Promoting Excellence in 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.

Promoting Excellence in 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 months: 90% chance of never returning to any form of work in the foreseeable future. Waddell and Burton

Promoting Excellence in 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

Promoting Excellence in 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)

Promoting Excellence in 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)

Promoting Excellence in Family Medicine Risks and harm of being out of work  Loss of fitness  Physical and mental deterioration Increased risk of poor health x 2-3  Psychological distress and depression Increased x 2-3  Increased suicide and mortality 20% excess deaths  Social exclusion  Poverty Waddell and Burton, 2006

Promoting Excellence in Family Medicine IB Recipients - Diagnoses

Promoting Excellence in 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

Promoting Excellence in 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

Promoting Excellence in Family Medicine The provisos…  ‘Good job’- nature of the job  Social context - Regional deprivation Overall beneficial effects of work outweigh the risks

Promoting Excellence in Family Medicine Coffee break

Promoting Excellence in Family Medicine A further problem

Promoting Excellence in Family Medicine Introducing Mr. Jones…

Promoting Excellence in Family Medicine Putting theory into practice…  What would you say?  What would you do?

Promoting Excellence in Family Medicine Practical tips and strategies

Promoting Excellence in 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

Promoting Excellence in 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

Promoting Excellence in 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!

Promoting Excellence in 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

Promoting Excellence in Family Medicine Fitness for work: prognosis  Difficult  Evidence base: operations

Promoting Excellence in Family Medicine Fitness for work: prognosis ( see also OUP Handbook of General Practice)

Promoting Excellence in Family Medicine Fitness for work: prognosis  Difficult  Evidence base: operations  If you don’t know, say so  Willingness of patient to rehabilitate; employer to provide options (blind inspector)

Promoting Excellence in 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)

Promoting Excellence in Family Medicine The Balancing Act: Illness vs Disease

Promoting Excellence in Family Medicine Motivation…

Promoting Excellence in Family Medicine Changing behaviour Ambivalence is common, normal Confrontational interviewing - resistance Shift style - resistance diminishes, change talk increases Collaboration, honour autonomy Rollnick and Miller

Promoting Excellence in Family Medicine Motivation Varies in degrees… Not Ready Ready Rollnick and Miller

Promoting Excellence in Family Medicine Method  Importance  Confidence Importance + Confidence = Readiness Rollnick and Miller

Promoting Excellence in 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

Promoting Excellence in Family Medicine Thinking back to Mr Jones Importance = 9 Confidence = 3 What might you do?

Promoting Excellence in Family Medicine Thinking back to Mr Jones Importance = 3 Confidence = 9 What might you do?

Promoting Excellence in Family Medicine Support and resources What's out there?

Promoting Excellence in Family Medicine Sources of support  OH services in the workplace  Disability Employment Advisers  Access to Work Scheme

Promoting Excellence in Family Medicine Resources  Leaflets  Websites  Diploma in Occupational Medicine

Promoting Excellence in 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 thereforeand Sickness absence/certification ‘ protects ’ the worker/patient from work Recognise the risks and harm of long term worklessness

Promoting Excellence in 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

Promoting Excellence in Family Medicine Workshop on Health and Work for General Practitioners