Occupational health capacity:
Will we need huge numbers of doctors and nurses to enter the OH profession in the next few years?
If you look at what the report says, I was giving a framework. Until we pilot some of the fit for work services I won’t know what type of professional we will need for them.
We will need good case management at the centre, and maybe physiotherapists someone to help with debt problems cognitive behavioural therapy family counselling an OH nurse or physician.
We need to wait until we’ve had a government response: is it going to permit us to pilot it? And then we must think very carefully about what we need in those pilots.
I visited Tower Hamlets primary care trust (PCT) and it’s already beginning to put into action some of the ideas in the report. The people in its team are not doctor-heavy, but it does have in place a doctor’s advice if and when needed.
I don’t think we can do this until the professions get themselves together, because the doctors, nurses, physiotherapists and vocational rehabilitationists need to understand what each of them could bring to the services and when they would most be needed.
When you refer to OH in the report, are you thinking about the traditional people – doctors and nurses – or are you thinking about others who work in OH, such as counsellors and technicians?
Do I think of it as the classic OH which was started 30, 40 or 50 years ago? No, because I’ve seen in my trips around the country many companies that are practising what would be called OH, but who have also embraced the promotion of health and wellbeing.
If you look at (pharmaceutical company) GSK, you see a delivery of what might be traditional OH, plus something else. For me, it is about embracing all of those people who contribute, it is much broader than occupational medicine or occupational nursing. It has got to be something that is about the health of the working-age population and what’s needed to address that.
How could the new fit note help employees if the firms they work for are small companies that don’t have any OH service to refer to?
If you get a fit note from your GP you may then get the necessary referral from your employer through the fit for work service, because it may need somebody to negotiate that pathway. Just taking the note along to your employer may not do the trick at all because is it going to know what ‘light duties’ means? The fit note needs to be trialled with the fit for work service – I don’t see them as being disconnected at all.
Do you really think that GPs will change the way they practise, at least in the short term?
When I started this work I thought there would be a lot of resistance, and there has been some, but the British Medical Association issued a positive press statement. We must engage the BMA very closely in every stage of this work and maybe we have to move quite slowly to get to the right fit note.
We will use the Royal College of General Practitioners to extend an educational facility for GPs that will be partly online, and they will be prepared to think about health at work. One part of my report that I could get to work on is to establish a register of GPs interested in work and health, and who don’t have to have a diploma. I’m about to start work to see if we could offer an online continuing professional development (CPD) programme so that we can start to build up support for it around the country.
Leadership of the proposed fit for work teams:
Who do you think will be the best people to lead the implementation of the recommendations in your report?
I think that’s for the professions to decide and I don’t necessarily think it has to be a doctor, nurse or a physiotherapist.
I think that those groups have got to come together to really look at what is needed and perhaps to say who the best person would be in certain circumstances: maybe a nurse in other circumstances, maybe a doctor. In multi-disciplinary teams, say, in cancer care, it may be that the doctor learns to be a follower for a time.
You need the leadership at the top of these professions to come together to agree that they’re going to do this, because it requires quite a big cultural change.
Now, that isn’t going to happen over night and I’m not naïve enough to think that is going to be the easiest thing for people to do.
Could people without a medical background take a leadership role?
It depends which part of it you’re trying to deliver. Certainly if you’ve got a case manager in charge they’re not going to be medically qualified, and I see no reason [why this should be a problem}, as long as they know the level of their competencies and when they’re getting to a level that is outside their area of expertise.
The role of occupational health nurses:
Some OH nurses who have advanced qualifications are concerned about tackling health promotion or wellbeing. How would you answer their concerns?
Over the past 18 months I have lectured to many nurses’ groups and I’ve found that about a third of them already embrace [health promotion] a third don’t want to embrace it and feel that it reduces their skills set, and the rest are people in the middle who would really like to give it a try.
It’s not for me to force anybody into a particular mode of practice but I would like them to take a look at what we need in the workplace today and for them to say: ‘Could I add something, without losing my skills set?’
We’ve had to do that in lots of other branches of medicine. If you take doctors, we’ve had to acquire some management skills and the ability to be proper educators.
It’s looking at what is needed and asking if you are the sort of person who can embrace that, and I fully appreciate that not everyone wants to do so.
I would like OH practitioners to look at the training programmes and at the curricula already in existence and to then ask themselves if they have the things that we need for today.
What I came to believe as I did this work was that mental health is very important, but how much training have our OH practitioners had in recognising or supporting people who suffer from mental health problems?
I suspect not very much, and yet it’s the major reason why people leave the workplace.