1. Disability Seminar David Memel, Ember Kelly, Mike Holroyd and GP tutors

5. Learning objectives Understand the meaning and effects of disability for patients, carers, GPs and other members of the primary health care team Be aware of the importance of functional, social and psychological, as well as medical factors in the assessment of patients in primary care Appreciate the range of health, social and voluntary services available to people with disability in the community and how they are organised Develop skills for communication and clinical management of patients with disabilities in the community

6. Programme Lecture Small group work based on –Consulting with a Visually/Hearing Impaired person –Crisis in the Community –Learning Disability and Sexuality –Welfare Benefits

8. Health Condition ( disorder/disease ) World Health Organisation Model of Disability ICF 2001 Environmental Factors Personal Factors Body function&structure (Impairment ) Activities(Limitation)Participation(Restriction)

9. “People are disabled by both social obstacles and their bodies” Year 4 medical student SSC 2012 ‘At sea with disability’

10. Types of disability Physical Psychiatric Learning

11. Communication With Disabled People Hearing Impairment Visual Impairment Speech Impairment Learning Disability

12. Why is the GP important? GP is the the first (and sometimes the only) health professional that patients see GP is the gatekeeper to other services GP often has longstanding contact with the patient and their family GP training emphasises the patient as well as the disease, and is not limited to a single medical speciality

13. The size of the problem In an average general practice of 10,000 patients there are: 600-1100 physically disabled adults (25% severely disabled) –Osteoarthritis 1280-2900 –Rheum Arthritis 100-250 –Ischaemic Heart Dis700 –CVA55 –Multiple Sclerosis8 –Epilepsy50 –Diabetes200 –Asthma (current) 500

14. Consultation rate with GP in last year General popn 3.0 Disabled5.2 Severely disabled10.1

15. Who have disabled people seen in the last year? GP82% Hospital Dr 46% District Nurse16% Health Visitor 7% Physiotherapist10% Occup Therapist3% Social Worker 7%

16. Care in the Community Patient & Carer PRIMARY CARE GPs District nurses Health visitors Community matrons Nursing homes Hospices HOSPITAL Consultants Physios Outreach nurses SOCIAL SERVICES Social workers OTs Home care VOLUNTARY SECTOR Charities Self help groups INTERMEDIATE CARE TEAMS

17. Different Perspectives Is this the reality? Patient’s perspective Doctor’s perspective Available resources

18. Fitness Certification

19. Fitness certification Self certificate for up to a week Med3 from GP (or hospital doctor) thereafter Based on ability of patient to do their own job Dr can sign as not fit, or that may be fit within limitations (with employer’s agreement) Dr does not have to personally examine patient

20. Employment and Support Allowance Replaced Incapacity Benefit for new claimants (2008) –More and earlier support for people with capacity to return to work –Lots of evidence that being off sick is bad for health After 13 weeks –(earlier if self employed or unemployed) Assessed by doctor for Dept Work and Pensions “Work Capability Assessment” – ability to do any work

21. Welfare Benefits for Disabled People Complex area, but important doctors understand basics, as can make big difference to people’s lives Know who to encourage to apply Know local sources of specialist advice –Benefits Advice Service, CAB and Benefit Enquiry Line

22. Attendance Allowance and Disability Living Allowance DLA –Aged less than 65 –Care and supervision and/or reduced mobility, or terminally ill. –Due to be replaced by Personal Independence Assessment from April 2013 –Up to £6838/year AA –Aged 65 or more –No mobility component –Up to £4027/year

23. Attendance Allowance and Disability Living Allowance Not means tested Paid direct to disabled person, to spend on what they want Leads to eligibility to other benefits eg housing benefit

24. Further reading Government website on disability www.direct.gov.uk/DisabledPeople –Sections on finance, employment, DDA, equipment Oxford Handbook of General Practice The Patient’s Journey –Series in the BMJ about living with different chronic illnesses COMP2 Handouts –Section on Sick Notes and Welfare Benefits