Devil’s advocate: Occupational health service standards

Population growth means the future will bring greater numbers of older and retired people. Not all of these will be occupational health (OH) practitioners but, judging by recent events, a fair few will be.

The new OH service standards were launched in January. These standards should steadily become one of the foundations of OH practice. They will take time to implement, with organisations accrediting from 2011. Beyond that we should see a gradual raising of the bar so that the standard of OH care continually improves.

There was no lack of experience in the audience at the launch of the standards in January. Some had already retired from clinical practice, some were about to, and a fair number qualified in medicine or nursing in the 1960s and1970s. Only one of the doctors in attendance had first started their medical training in the past 30 years. And there was a similar story for the nurses.

However, wintry weather, transport disruption, and an early evening launch in central London meant some people who might have attended the launch event did not. The time and location suited those who had been working in the capital. These factors will have had some impact on the demographics of the launch attendees.

But where are the OH leaders of the future?

The bad news is the training production line is not delivering large numbers of new specialists (at least in medicine). Only 11 candidates sat the Associateship of the Faculty of Occupational Medicine in January, and only about a dozen speciality registrar (StR) posts were advertised in the British Medical Journal (BMJ) last year. The faculty board has recently spent a day devoted to encouraging trainees into the speciality.

The number of job adverts in occupational medicine is also small. In 2009 there were about a dozen consultant-level posts advertised in the BMJ by commercial OH providers. Only one consultant-level post in a private company has been advertised there in the past two years – a highly specialised role in the nuclear industry. The corporate doctor role has been all but consigned to history in the UK private sector.

Last year, the BMJ carried adverts for 16 NHS consultants in occupational medicine (but a third were only part-time). Some of the posts were repeatedly advertised, including those in Portsmouth, Southampton, Norwich, Northampton, York and Barking. This failure to fill even a small number of new opportunities is why occupational medicine is still on the shortage occupation list.

The good news is that events like the launch of the standards remind us that many of the existing OH nursing and medical leaders will be vacating their posts in the next few years. If we can recruit able new trainees into the speciality, then interesting and challenging opportunities should open up for them.

The standards are about the future. They should have the most impact on OH practitioners at the start of their careers, trainees, and recently registered specialists. They may not have witnessed the launch, but these people are the true custodians of the new standards.

Richard Preece (University of Manchester 1982-1987) is a consultant OH physician.

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