Student Fitness to Practise Occupational Health & Student Fitness to Practise Dr Susan Robson Director: University Occupational Health Service The University of Manchester

How To Get The Best out of Occupational Health Need access to a service Need relevant advice Appropriate processes Appropriate functions

Occupational Health Services to Universities UK Provision varies: At least 50% Universities Occupational Health Service (most Medical Schools) Structure varies: In-house specialist led Nurse led with Doctor sessions Outsourced e.g. NHS providers Function/ range services varies

Function (in this context) Provision of independent medical advice to the Student and to the Medical School on a Students medical fitness: To study For clinical practise

See Students in the following circumstances:- Manchester Approach See Students in the following circumstances:- Medical screening at application; Self referral; Formal referral; Referral from Committees (Health and Conduct, Fitness to Practise).

Medical Screening at Application Medical forms screened: Red/ yellow/ green flagging

Red Flag Where relevant mental health/ physical health history for example:- Anorexia/ eating disorders; Self harm; Drug and alcohol problem history (details later); or Other significant mental health condition e.g., bipolar etc. History cystic fibrosis

Approach Assess information supplied (including information from GP) ? Need further information from treating specialist. ? Face-to-face assessment ?Consideration of reasonable adjustments ?Need case meeting/ enhanced disclosure (details later)

Outcome Medically fit for course Medically unfit at present – defer e.g. anorexia Medically fit with adjustments – may involve regular reviews/ in consultation with treating specialist etc. Medically unfit for course.

Self Referral New diagnosis e.g. HIV Confidential – no reports unless indicated/ agreed Uncommon Examples:- New diagnosis e.g. HIV Request discuss final year disclosure to General Medical Council etc.

Referral Formal referral: Variety of routes e.g. Medical School SWAP Team/ hospitals support team Usually results from concern regarding health/ behaviour etc. Encourage early referral if indicated.

Approach Principal same whether mental health/ physical (mental health tends to be more complex) Student is made aware of the reason for the referral and report will be provided (informed consent)

On Seeing Student Full assessment: triggers: relapse signature. Background information from treating specialist: Diagnosis prognosis: compliance treatment and advice. Ensure aware of other support services e.g. Disability Support Office and the Counselling Service. Ensure General Practitioner is fully aware/ informed.

Subsequent Advice Fitness to study/ for clinical practice. Any adjustment necessary/ mitigation. Need ongoing monitoring (may include drug/ alcohol testing) Need for interruption e.g. anorexia. Need further treatment from GP/ specialist. Need to refer for independent specialist opinion (details later)

Referrals from Health and Conduct/ Fitness to Practise Committee Rarely is case new to us. Committee suspect there may be underlying health problems e.g. erotomania case Referral as a condition for continuing on course e.g. regular monitoring/ alcohol/ drug testing.

NB: The vast majority of cases where concern will be managed by early referral and will not come to Fitness to Practise etc. The “medical” cases that do proceed to Fitness to Practise result from concern regarding impact condition/ behaviour on safety of patients.

Concern for Patient Safety The severity of the condition/ risk frequent relapse e.g. mental health, bipolar etc. The lack of insight into the impact of the condition/ behaviour e.g. psychosis, personality disorders. Lack of cooperation with the process/ systems

Lack of Cooperation Failure to comply with request regular monitoring. Failure to comply with prescribed medication e.g. mental health. Unwilling to consent to obtain information e.g. treating specialist. Unwilling to agree to referral to independent specialist/ subsequent withdrawal of consent release report/ sections report/ occupational health opinion based on report.

In all Cases Following Assessment School advised regarding opinion on medical fitness to study/ for clinical practise NB lack cooperation and faculty policies

Referral for Independent Specialist Opinion Considered necessary:- Conflicting evidence treating specialists etc. Significant and complex concerns e.g. mental health/ personality/ behaviour

Logistics Occupational Health recommendation to School/ agreement funding Occupational Health decides on appropriate specialist – local if possible. Explain reason to Student and obtain informed consent:- To see specialist Provision of report Occupational Health (? School)

On Receipt of Report by Occupational Health Student seen; Provided with a copy of report; Advised regarding details of report to be provided to School (with informed consent).

Accept May appear threatening to Student. Can be very positive outcome for Student and School. Examples:-

Drug/ Alcohol Testing & Monitoring Through Occupational Health A number of Occupational Health services will not agree to drug/ alcohol testing/ monitoring I consider ‘medicine’ Safety critical role. Such testing can be:- Helpful to Student if it confirms is complying with treatment and advice Reassuring to the School when advising Fitness to Practice

Any queries? (? Enhanced Disclosure)