Promoting Excellence in Family Medicine 1 Workshop: Health and Work for General Practitioners

Promoting Excellence in Family Medicine 2 Setting the scene The consultation around health and work Evidence around health and work

Promoting Excellence in Family Medicine 3 Moving from theory to practice Strategies around work and health: Managing the consultation Managing the process

Promoting Excellence in Family Medicine 4 A typical scenario

Promoting Excellence in Family Medicine 5 What are your challenges? What do you find difficult? What would you like to do better?

Promoting Excellence in Family Medicine 6 Effective consultations Acknowledge feelings Manage expectations Control Usual patter

Promoting Excellence in Family Medicine 7 A typical scenario You are in a busy Monday morning surgery….

Promoting Excellence in Family Medicine 8 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 9 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 10 Take a step back Antibiotics and sore throats……

Promoting Excellence in Family Medicine 11 Worklessness A state which includes not being in paid employment and not actively seeking employment. Source: Dame Carol Blacks Report Working for a Healthier Tomorrow (2008)

Promoting Excellence in Family Medicine 12 Worklessness 99% of patients return to work quickly but….

Promoting Excellence in Family Medicine 13 Work and Health – The Evidence Common Health Problems 66% of all sickness absence is due to common health problems: Less severe mental health disorders Musculoskeletal disorders Cardio respiratory disorders These are potentially remediable conditions

Promoting Excellence in Family Medicine 14 IB Recipients - Diagnoses

Promoting Excellence in Family Medicine 15 Facts and figures (data 2008) Based on figures before introduction of ESA 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 16 Length of absence is a risk 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 17 Risks and harm of being out of work Loss of fitness Physical and mental deterioration Increased risk of poor health x 2-3 Social exclusion Poverty Waddell and Burton, 2006

Promoting Excellence in Family Medicine 18 Risk and harm – mental health risks Psychological distress and depression Increased x 2-3 Increased suicide and mortality 20% excess deaths

Promoting Excellence in Family Medicine 19 Families and work Children in workless households: have a higher prevalence of recurrent health conditions and lower well-being suffer higher rates of psychiatric disorders are more likely to experience worklessness themselves during adult life

Promoting Excellence in Family Medicine 20 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 21 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 peoples 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 22 Fact about people being out of work 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 23 Is Work good for your health and wellbeing? Strong evidence exists that unemployment is harmful to health. The unemployed have higher mortality, poorer general health, poorer mental health and higher medical consultation, medication consumption, and hospital admission rates. (Waddell & Burton)

Promoting Excellence in Family Medicine 24 Is work good for your health and wellbeing? Overall beneficial effects of work outweigh the risks Work can be therapeutic and can reverse the adverse health effects Waddell and Burton

Promoting Excellence in Family Medicine 25 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 26 Coffee break

Promoting Excellence in Family Medicine 27 A further problem

Promoting Excellence in Family Medicine 28 Introducing Mr. Jones…

Promoting Excellence in Family Medicine 29 Putting theory into practice… What would you say? What would you do?

Promoting Excellence in Family Medicine 30 Practical tips and strategies

Promoting Excellence in Family Medicine 31 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 32 Fitness for work: work on health Demands of the job: physical, intellectual Environment: shop floor/office, risk factors (e.g. dusts, chemicals) Temporal: shift working, early start Travel: business travel – between sites, overseas Organisational: lone-working, customers Layout: ergonomic aspects of workstation, work equipment

Promoting Excellence in Family Medicine 33 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 34 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 35 Employment and Support Allowance (ESA) Introduced on Oct 27 th 2008 Still provide a Medical certificate (Med3) New Work Capability Assessment What a patient can do not what they cant do

Promoting Excellence in Family Medicine 36 Fitness for work: prognosis Difficult Evidence base: operations If you dont know, say so Willingness of patient to rehabilitate; employer to provide options

Promoting Excellence in Family Medicine 37 Fitness for work: prognosis ( see also OUP Handbook of General Practice) Source:

Promoting Excellence in Family Medicine 38 Other resources…

Promoting Excellence in Family Medicine 39 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 40 The Balancing Act: Illness vs Disease

Promoting Excellence in Family Medicine 41 Motivation…

Promoting Excellence in Family Medicine 42 Changing behaviour Ambivalence is common and normal Confrontational interviewing - resistance Shift style - resistance diminishes, change talk increases Collaboration, honour autonomy Rollnick and Miller

Promoting Excellence in Family Medicine 43 Motivation Varies in degrees… Not Ready Ready Rollnick and Miller

Promoting Excellence in Family Medicine 44 Method Importance Confidence Importance + Confidence = Readiness Rollnick and Miller

Promoting Excellence in Family Medicine 45 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 46 Thinking back to Mr Jones Importance = 9 Confidence = 3 What might you do?

Promoting Excellence in Family Medicine 47 Thinking back to Mr Jones Importance = 3 Confidence = 9 What might you do?

Promoting Excellence in Family Medicine 48 Support and resources What's out there?

Promoting Excellence in Family Medicine 49 Sources of support OH services in the workplace Disability Employment Advisers Access to Work Scheme Fit for work services

Promoting Excellence in Family Medicine 50 Resources Leaflets Diploma in Occupational Medicine E learning for health

Promoting Excellence in Family Medicine 51 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 52 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 53 Workshop on Health and Work for General Practitioners

Promoting Excellence in Family Medicine 54