This regular column is aimed at occupational health (OH) nurses working in isolation and those new to the profession. This month, an experienced OH adviser answers readers’ questions on confidentiality of medical records and whether or not employers should always follow the return-to-work advice provided in an employee’s fit note. Email your own questions to OH.Editor@rbi.co.uk
I spend quite a lot of my time explaining to the business, and to HR in particular, the importance of the confidentiality of medical records. However, most of the literature on this pertains to hospital environments. Do you have any recommendations on more generic OH literature that I could refer to?
Many OH advisers have this concern. HR can misunderstand the difference between medical confidentiality and data protection. The best source of guidance I have found for OH is from the Safe Effective Quality Occupational Health Service managed by the Royal College of Physicians on behalf of the Faculty of Occupational Medicine (see p.12). It is specific to OH and I have used this guidance myself when discussing the confidentiality of medical records with HR departments.
It is very important to ensure that the OH adviser and any OH administrative support staff have signed confidentiality agreements. It is also necessary to ensure that only the OH adviser has the keys for the OH department and filing cabinets.
Ultimately, OH advisers are responsible for our practice and, if medical data is put at risk, we are the ones who would lose our jobs, and potentially our careers.
Often, OH advisers work in isolation and can feel bullied by a business because it pays their salary. However, you must not back down on this issue.
Ask yourself this: if an employee found out that people could access your files or the OH room, how would they feel? It is no different to leaving the door open to your GP surgery and letting people come in and have a root around.
In my opinion, anyone who enters the OH department should be escorted by an OH professional, ie an OH nurse, doctor or support worker who has signed the confidentiality agreement.
I have had a run of employees who suddenly all seem to be off work with either total knee or total hip replacements. While their jobs vary, so does their desire to return to work. Some are eager to return and others wish to follow their GP’s advice. Those who are more reluctant and resistant to returning seem to think they have the right to 12 weeks off work. Can you advise me on this issue?
In my experience, GPs set up OH advisers for a battle by giving employees the impression that they will require the full amount of time off that is recommended in their fit note.
We all know that we are not suddenly fit for our full role and duties the day after an operation, but the severe time constraints under which GPs work can lead to them issuing fit notes that class everyone as “not fit” for a standard period of time after surgery, without looking closely at individual cases.
Ideally, GPs would read the guidelines set out for writing fit notes, but, sadly, some do not. Or, if they do, they do not have time to follow them. It therefore usually falls to OH to educate managers and employees.
A useful document is the Government’s Getting the most out of the fit note – Guidance for employers and line managers. There is a similar guide for employees. Fit note advice is meant for the employee, not the employer (although it can be useful) and their function is to provide access to statutory sick pay. GPs are not specialists in assessing employees’ fitness for work as they do not have the same knowledge of the workplace as an OH adviser, or the ability to consider if other roles may be available in the organisation.
As the OH adviser, you should advise the employer and employee on what work the employee can do, and then the line manager or HR manager can decide if there is work available that fits the criteria. In which case, employees may be fit to return sooner. The Royal College of Surgeons’ Get well soon leaflet includes useful for advice on RTW after common operations.
I also try to encourage employees and managers to advise OH if they have any planned operations that will require an absence of longer than between one and two weeks.
That way, OH advisers can see and give them the link to the above site and then arrange a catch-up telephone call one to two weeks after the operation.
Seeing an employee before they have their operation also helps to progress rehabilitation and return to work. If the OH adviser calls on the employee without having done this groundwork, they are likely to be defensive and less receptive. I hope this advice helps you.