From 2012 the Society of Occupational Medicine will be extending its membership to associated healthcare practitioners, but what benefits, if any, will this bring to OH nurses? Nic Paton reports.
It may not be as old as the royal colleges but the Society of Occupational Medicine (SOM) can nevertheless claim a venerable history. It was founded in 1935, initially as the Association of Industrial Medical Officers, a name that now, of course, speaks very much of a bygone age, and of both the sorts of workplaces and workplace health priorities that were commonplace at the time.
In 1965 it took on its current name to reflect the changing nature of occupational medicine, and in 1977 it was closely involved in the foundation of the Faculty of Occupational Medicine. From January 2012, it will embark on perhaps its most radical evolution since those dates, moving from simply being, as its website states, "a learned body for registered medical practitioners with an involvement or interest in the practice of occupational medicine" to become a much more broad-based organisation - one that is open to and represents associated healthcare practitioners engaged in improving working-age health, including occupational health nurses.
This launch of a new "affiliate" membership is potentially a revolutionary step for the society, and one that was only agreed by the membership at its annual general meeting back in June after a long period of debate and discussion. At a stroke, it will open up the society to OH nurses, ergonomists, occupational hygienists, physiotherapists, psychologists, research scientists, occupational therapists, toxicologists and epidemiologists who hold a professional qualification.
Affiliates will pay the same subs as full medical members, have access to the same resources and have the same voting rights. On top of this, there will be the option of applying to become a more low-key "associate" member (see box).
As SOM president Dr Henry Goodall told Occupational Health magazine at the time the change was announced: "The society thought long and hard about this issue. Occupational health has changed radically over the past 20 years in both structure and delivery and there is much closer work with many associated professions now. To remain representative and relevant, and to reflect the modern aspects of occupational health delivery, this is the way forward.
"It is about working with other co-professionals; recognising that an ageing working population needs to be able to support people to return to work and looking at the ways in which OH services are delivered."
Much as the change from the Association of Industrial Medical Officers to the Society of Occupational Medicine was a reflection of the changing role and nature of workplace health, so this latest move is a reflection of the increasingly collaborative way in which OH nurses, physicians and other healthcare professionals all now work, agrees the society's immediate past president Dr Olivia Carlton.
"To my mind, the motivation for doing this is very clear. It is about recognising the increasingly multi-disciplinary nature of our work and ensuring, as a result, that the society remains relevant and shows some leadership," she explains.
If we can broaden our membership to bring in more allied health professionals, then we will get a richer mix in terms of what we can deliver and in terms of workplace health."
Dr Olivia Carlton
"The primary work of the society is about education and so it is about making those opportunities more widely available and relevant for all. If we can broaden our membership to bring in more allied health professionals, then we will get a richer mix in terms of what we can deliver and in terms of workplace health.
"Sometimes, of course, there are tensions between different professional groups within healthcare. But there are also many personal and professional friendships. If we can all have something in common, something we all feel positive about - such as higher-quality education - then that will, I feel, go a long way towards supporting more effective workplace health provision and intervention," she adds.
"Everyone has something to bring and everybody within the society has to be equal. If you are a member, you are a member, it is very important to keep that ethos going. The reason we have chosen the title 'affiliate' is that the name of the society is still the Society of Occupational Medicine and this is about bringing in other health professionals. But in terms of how they will be seen and their voting rights, there will be no difference. There will be a period of time before they can stand for office, but there will be something for everyone," Carlton continues.
The society's constitution now states that to stand for election as a society officer or trustee one has to have been a member for five years, meaning that, inevitably, there is going to be a time-lag for affiliates. What will be put in place, however, is an interim arrangement whereby an affiliate member may be co-opted on to the council so that their views can be represented, the society has stressed.
"I see this as an incremental process, one that will probably develop organically and change progressively," says Dr Tony Stevens, past president and consultant in occupational medicine.
"And don't forget, it is not just about nurses or doctors. We will also be providing a home for physiotherapists, occupational therapists, psychologists and others. So you cannot assume that the first non-medical president of the society might be a nurse, he or she might be a psychologist," he adds.
Strength in numbers
For Stevens, who championed this change during his presidency, opening up the society is about leadership, about positioning the society to take on a leadership role and reflect occupational and workplace health in all its shapes and forms.
"Personally, I am long past the idea that I am working in a uni-professional environment and, to my mind, uni-professional bodies are becoming less relevant. For occupational health to be relevant, to be able to contribute, it has got to be outward-looking and it can only really have one voice," he says.
The reaction from occupational health practitioners has, by and large, so far been positive, with many recognising the value in the society opening up its membership and the fact that it dovetails nicely with the sort of agenda set out by national director for health and work Dame Carol Black in her 2008 Working for a healthier tomorrow review of workplace health. Nevertheless, there remains some residual scepticism around why the society has decided to go down this route at this time, and exactly how far this new openness will extend in reality in terms of nurses and others being represented or having a voice within what has been up to now, of course, very much a doctor-led organisation.
Value to nursing
As one OH nurse, who did not want to be named, put it to Occupational Health magazine: "Cynically, you have to wonder why they're doing this? Is it a money issue? Is it that they just want the nurses' money yet still want to be seen as leaders, despite the fact the majority of OH provision is now delivered by nurses?
The key is going to be whether nurses feel they are being listened to and perhaps the level of representation they end up having."
Bupa Health and Wellbeing
"There also needs to be an exit strategy in place so, if it isn't working, there is a mechanism by which the nurses can pull out."
Graham Johnson, nursing clinical lead at Bupa Health and Wellbeing, suggests that what will be important is how the affiliate role develops, how it becomes perceived and, crucially, the value that becomes attached to it.
"The key is going to be whether nurses feel they are being listened to and perhaps the level of representation they end up having," he argues.
"I would hope there would not be resistance but it is possible there may be some people who might feel this is just the doctors telling us what to do, even though I don't think that is at all the case any more. Overall, however, I do think it is a positive move, and it will improve working relationships," he adds.
The society, he also points out, has a lot of e-learning and many in-house programmes that would be "fantastic" for occupational health nurses.
"It is really all about the old adage 'united we stand, divided we fall'. We do need as a profession to stand up and be counted, to be visible, and this is something that may help," Johnson contends.
"Any collaboration like this within occupational health is important because we only have small numbers when you look at the medical health field as a whole. So if we can work together effectively that will be great," agrees Christina Butterworth, vice-president of the Association of Occupational Health Nurse Practitioners (AOHNP) (UK).
She, too, suggests that the verdict on the SOM's move will only become clear as new members begin to be integrated into the society and, in turn, how much muscle they are then allowed to flex.
"It does have to be a proper partnership. Will nurses actually have a proper voice or are we just going to be making up the numbers?" Butterworth argues.
"Having said that, I don't think there is any need in principle to get hung up on the fact that this is something being led by the doctors. The AOHNP, for example, has worked well with the society for many years so I don't see any issue with that.
"The key is that it has to be an equal partnership - will it even, for example, keep the Society of Occupational Medicine name in the longer term?" Butterworth contends.
To this extent there may well be a need for the society to work to reassure its existing membership base that it is not somehow going to be "taken over" by nurses or allied health professionals, just as it will need to work to ensure the new affiliates feel truly at home within the society.
Geny Foster, managing director of OH consultancy Medigold and chair of the Commercial Occupational Health Providers' Association (COHPA), argues there is a lot that will be beneficial for nurses from membership of the society. At the same time, the influx of new thinking and new perspectives that is opening up the membership will probably be positive for the existing membership base, too. Having a greater understanding of each other's remits and "day job" can only be good.
There is a lot the society does that could be useful to nurses. Its appraisal system, for example, could be helpful."
"We're more than happy to support anything that progresses the aims of occupational health. Talking to some of my colleagues, both physicians and nurses, I have not yet heard anything really negative about this move, which bodes well," she says.
"There is a lot the society does that could be useful to nurses. Its appraisal system, for example, could well be helpful," she adds.
"Every time you open an organisation up to new members there will always be people who are not so keen on the change. So it may take some time to settle down. But as long as everyone is bringing something positive to the table I cannot see any issues with it.
"It fits well into Dame Carol Black's model of removing silos and, hopefully, it should do nothing but enhance occupational health. Medigold, for example, used to be 100% physicians but is now a mix of nurses and physicians. Our relationships are good already and very collegiate," Foster adds.
Karen Talbot, managing director of OH provider Diverse Health Solutions, agrees that it is a positive step and has the potential to be a great way to encourage the profession to work together more closely.
"It is also a reflection of the way OH is changing. A lot of OH services now tend to be nurse-led, even if input from physicians is also required. A few years ago it was almost completely physician-led. So I do think it is a good step to be opening up the membership like this to other practitioners. It will also be a good mechanism for networking," she suggests.
"At the end of the day, doctors and nurses do have to work together to keep employees healthy in the workplace, and to keep workplace health on the agenda. So, yes, it is a positive step," she adds.
What it may well mean in the longer term, concedes Carlton, is a re-evaluation of the education programmes that are offered to ensure that they become more representative of the broader membership.
"We are going to have to think about our education programmes and look at how they will best reflect the needs of our members as a result," she argues.
"But the feedback we have been getting so far from the allied health professions is that they already really appreciate the educational opportunities the society provides. So I think our education may remain quite medically based, as that is what members want.
"There will be opportunities for a lot of different people who work in the field to join a body that is committed to high-quality education with a regional structure and a friendly attitude to members.
"There will be opportunities within this for nurses to raise their profile as well as opportunities to raise [the profile of] the work they do," she adds.
So what will being an affiliate member mean?
Affiliate members will receive exactly the same benefits and voting rights as full members. Subscription rates for affiliates will be the same as for medical members, and for 2012 it will be £150.
There will also be an additional "associate" status for those who are eligible for affiliate membership but who may prefer an association with the society rather than full membership. It will entitle them to attend continuing professional development meetings and receive regular updates of the latest news in occupational health via the electronic newsletter. The 2012 fee for this category of membership will be £60.
Affiliates will be able to attend educational events and have access to a fortnightly e-newsletter, as well as to the scientific journal Occupational Medicine.
Beyond this, affiliates will be able to make use of the society's "learning zone" and "members only" section, which offers a wide range of learning modules, reference materials and appraisal tools.
The society currently operates 10 regional groups, which run regular continuing professional development meetings.
It also holds an annual scientific conference as well as regular regional and local networking events.
Occupational health practitioners that are interested in becoming affiliates can register on the Society of Occupational Medicine website.