Course of treatment

first_imgWithoccupational health on the government agenda and targets to be met in everyworkplace, until recently the primary care sector was seen to be lagging. But apilot scheme to help the profession progress its OH provision has proved asuccess.  By Lesley Abbott and Sue BurkeTheHSE document Working Together: Securing a Quality Workforce for the NHS1,highlights “creating healthy workplaces” and targets April 2000 asthe date by which the following should be achieved year-by-year improvement onsickness absence rates and, where applicable, targeted progress towardsnational minimum benchmark.Havesystems in place to record and monitor workplace accidents and violence againststaff and have published strategies in place to achieve a reduction of suchincidents. Have in place occupational health services and counselling availablefor all staff. This message from the Government is clear and one that has beenacted upon in the vast majority of NHS trusts. It is therefore all the moresurprising that our colleagues in primary care have been left by the waysidewith little or no occupational health provision.ClinicalgovernanceTheintroduction of clinical governance2 will inevitably put pressure on primarycare staff to introduce rigorous systems of clinical and managerial qualitycontrol. Procedures for dealing with poorly performing staff will inevitablyraise questions regarding possible ill-health of the individual. This providesa further compelling reason for primary care to invest in a robust and effectiveoccupational health service.Theabsence of occupational health services in primary care has started to beaddressed in a variety of ways in different parts of the country.Insouth and west Devon, due to the vision and persistence of Dr David Longdon, a localGP, and supported by consultant occupational physician Dr Gerard Woodroof,funding has been released to support a pilot scheme to provide a proactive andcomprehensive occupational health service to GP’s and all practice staff.ProjectstrategyAbbottBurkeAssociates has been employed on a consultancy basis to establish and develop acomprehensive occupational health service tailored to meet the specific needsof primary care staff. Directors Lesley Abbott and Sue BurkeLongdon togetherwith Longdon and Woodroof formed the project group with the aim of developing astrategy and taking the service forward.Theoriginal vision for this extended occupational health service included a coreservice of OH provision, supported by an already well established networkwithin Devon of GP mentorship and support for new principal GPs, plus a LocalMedical Council which demonstrated its commitment to the principles ofoccupational health.Itwould have been relatively easy for the team to develop an occupational healthservice which made assumptions about the needs of primary care staff based onthe individuals’ knowledge of other NHS workers or using data from  previous research3,4. Instead a keenlytargeted approach was adopted to offer a service which did not rely onpre-conceived and conventional systems but sought to be evidence-based andinnovative.Theteam felt it was important to visit practices and talk with doctors and theirstaff in order to build links and discover what the main occupational healthissues were for primary care.AnalysingneedsItwas no great surprise to find that the occupational health and safety needswithin primary care are very different to those in NHS trusts, and indeed aremore akin to small- to medium-sized businesses providing services to anincreasingly demanding clientele. Theoccupational health needs also vary in different areas of the South West fromrural to city settings and single-handed to multiple partner practices.Asin many other work areas, occupational health is not well understood in theprimary care sector and has been greeted by reactions ranging from positivelyhostile, through ambivalent/suspicious, to delighted and relieved that a burdenmay be removed. But as the team continues to publicise the service anddemonstrate its effectiveness, opinion appears to be moving towards the”delighted” end of the spectrum.SpecificconcernsOneof the main concerns of staff, but particularly of GPs, is confidentiality. AGP who is sick, is afraid that they will lose respect, standing and possiblytheir livelihood if patients and colleagues have the slightest glimpse of anyunderlying medical condition. Suchfears about confidentiality become exacerbated as anxiety increases and makesit difficult for the individual to seek help.Thefact that the project coordinators are based some distance from the serviceusers is seen as a means of furthering the confidentiality and impartiality ofthe service. The service also has the support of and direct access to aconsultant psychiatrist and a psychotherapist to whom GPs may be referred intotal confidence.ComprehensiveserviceTheelements of a comprehensive and proactive occupational health service are relativelynew to GPs and other primary care staff. Ruth Chambers, professor of primarycare development proposed a national model in November 1975, in which theseessential elements are defined. We consider that our model combines both theessential elements, plus added-value by:–Development of systems that diminish areas of ambiguity between staff andtherefore reduce stress and save time. For example, the handling and follow upof an incident involving an aggressive and abusive patient.–The perception that staff are cared for. For example, any individual isencouraged to make direct contact with any aspect of the service in totalconfidence whenever they feel the need.–Financial benefits. Staff who are off sick or are in a partnership dispute costthe practice money. This can be reduced by the use of carefully developedsystems saving time and emotional effort. Impartial and independentintervention in incidents that arise when a member of staff is registered as apatient at their own practice and becomes ill.–Support for staff in the management of change. This is particularly pertinentin the current transition to primary care groups and ultimately trusts.–Communication. There is open access to the service by e-mail, answer phone anda dedicated period for direct telephone contact. Service users are encouragedto request a practice visit from the coordinators to address specific personalor practice issues. The visits are mutually beneficial first-hand experienceand information gained from the visit can be used to inform and enhance theoccupational health service as it develops.Practicesgain from direct access to professional knowledge and expertise. An effectiveuse of time, for all concerned, is meeting groups of staff to listen and adviseon their specific needs for example regional practice manager meetings andindividual practice meetings. Themeetings also offer the opportunity for education and training on more specificissues. This is particularly helpful following the introduction of new policiesand procedures or initiatives – for example, pre-employment health assessmentand managing violence and aggression.Theservice publishes a regular newsletter that is aimed at all practice staff,which publicises the service and informs readers of developments and futureplans. Contributions from external agencies are regularly featured to supportcurrent service initiatives and drives – for example, the Suzy Lamplugh Trustsupporting personal safety issues.Everyopportunity is taken to publicise the service to both current and potentialservice users, an important aspect of any pilot scheme, particularly inrelation to sources of future funding and support.  Such an opportunity is presented at the South and West DevonPrimary Care conference in February with presentations, workshops and anexhibition stand.FirmfoundationGoodcommunication is the vital lynchpin in assuring the ultimate success of a sucha complex and diverse service. The team works hard at marketing the occupationalhealth message strategically so that it informs, feeds and motivates bothservice users at ground level and those who have the responsibility ofdeveloping national health policy.Thereis an almost tangible synergy within a practice where staff are healthy,communicating well and confident of the constant support of a reliableoccupational health service. Occupational health and safety systems whichprovide organisational support, reduce the need for GP or practice managerintervention every time something out of the ordinary happens.Thepilot team believes that the Occupational Health Service for Primary Care forDevon and Cornwall has put in place a firm foundation upon which such a servicecan evolve and grow.LesleyAbbott and Sue Burke are directors of AbbottBurke Associates, an occupationalhealth consultancyReferences1HSC (1998). Working Together: Securing a Quality Workforce for the NHS. NHSE.(HSC 1998/162)DoH2HSC (1998) A First Class Service: Consultation document on Quality in the New NHS,(HSC 1998/113)DoH3Chambers R, Miller D, Tweed P and Campbell I (1997)  Exploring the Need for an Occupational Health Service for ThoseWorking in Primary Care. Occ Med,47,8pp485-4904Health Education Authority (1996). NHS Staff Needs Assessment: A PracticalGuide.5Chambers R (1997) Occupational Health Services for GPs – A National Model.Royal College of General Practitioners.Pilotobjectives–Project launch–Establishment and maintenance of communication–Field work–Development of generic occupational health and safety policies and protocols–Practice visits and assessment of OH&S needs – where appropriate–Access and referral to the service for all primary care staff–Monitoring and reporting–Review, future strategy and direction–Getting the service up and runningEssentialelements of an occupational health service for primary care–Easy access–Confidentiality, independence and impartiality–Pre-employment health assessment–Independent medical opinion–Management of potential or actual occupationally acquired infections–Assistance in complying with health & safety legislation–Occupational immunisation programme–Advice and support in the event of workplace accidents and injuries–Rehabilitation following sickness or injury–Training customised to the needs of all staff groups–Counselling–Direct referral to a psychiatrist/ psychoanalyst, as appropriate Previous Article Next Article Comments are closed. 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