A natural meeting place?On 1 Jul 2003 in Personnel Today Previous Article Next Article In an innovative approach to providing OH services from primary care, a GPpartnership has shown how occupational health care can work within a generalpractice setting, by Helen Clinkard & James Heffer When the NHS was founded, occupational health was not included. Fifty yearson, the question of who provides occupational health and how it is provided isstill being asked. With the restructuring of major manufacturing industries, many OH doctorsand nurses have gone and OH provision is being provided on a contracted-outbasis. Provision by the private sector has ongoing problems linking with otherhealthcare professionals and tends to be driven by health surveillance needs. As far as we know, there is no comparative data comparing differentarrangements of OH provision in terms of outcomes, cost or quality of service.However, we offer an overview of one arrangement that we believe may haveseveral advantages over conventional arrangements for both user and provider. Most employees with occupational health problems, ‘usually first consulttheir general practitioner’.1 It would therefore seem reasonable to develop anOH system that had strong links with, or was based in, primary care. This positioning of the service would also reflect the current drive to makeOH care more accessible to employees, which is at the core of the Government’spolicy for occupational health, Securing Health Together.2 History of the practice and service The Bradford-on-Avon Health Centre practice has been involved inoccupational health work for several decades. This initially took the form of an appointment of a factory doctor to alocal company. About five years ago, it became clear to the practice that companies wouldrequire a higher degree of skill and professionalism from their OH providers,not least because of the increasing legislative load, particularly from EUdirectives being absorbed into UK practice. It was also clear that occupational health remains very much a a nurse-ledprofession and the practice wished to reflect these developments in the serviceit was providing. As a consequence, the decision was made to fundamentally change the patternof working. Two GPs obtained the Diploma in Occupational Medicine and thepractice recruited a part-time occupational health nurse (OHN). The practice initially used the nurse to enhance the service it alreadyoffered to one local company. It soon became clear that this arrangementresulted in a better service for the company. This was borne out by the companysecretary, who said: “Occupational health has become a proactive service,working with management to identify problems, helping the employee and thus thecompany; a win-win situation for us.” The service became more accessible to the workforce, there was atransformation in the standard of record keeping and, from the company’sviewpoint, the management of absence improved, with a 30 per cent reduction intotal absence over two years and a saving in sick-pay costs in excess of£100,000 per annum. The improvement in performance was so marked that it encouraged the practiceto offer the service to other local companies. The organisation has since grownsteadily, recruiting staff to match the expanding client list. The current service The current client list covers a wide spectrum of employees, includingmanufacturing, the service sector and the public sector. It includes somehousehold names as well as small and medium-size enterprises (SMEs). All theorganisations served are close to the practice, being in or around westWiltshire. The organisation offers a service menu to clients. This can range from anin-house OH nursing service, with direct access to physiotherapy andcounselling, to individual items of service more suited to the requirements ofSMEs. Collectively, the clients cover an employee population of about 4,000. Quality standards The organisation is part of the NHS Plus scheme, which encourages NHSoccupational health teams to provide services to the private sector,particularly SMEs. The organisation is also part of an offshoot pilot schemeevaluating the potential contribution of general practice to NHS Plus and to OHin general. We hope to be one of the first organisations to have our standardsof service audited as part of this pilot. Perceived advantages The advantages of delivering OH care in this way stems from possessingdetailed knowledge of the local health economy, its general practitioners,primary care teams, hospitals and consultants. Excellent relationships withlocal healthcare professionals including nurses, physiotherapists andpsychologists can be built. Being part of the local NHS means that long waitingtimes for operations or investigations are known to us and companies can beadvised accordingly. The organisation has extensive knowledge of local, privatehealthcare providers, their costs, services and standards. In promoting the practice’s local knowledge in support of the OH work,ethical matters relating to overlap between employees and practice patientsmust also be taken into account. The team is punctilious in explaining to any employee the distinctivecharacteristics of the OH role, and, in particular, that the OH physician isnot the patient’s advocate in the way that a GP may be perceived. This dealswith the vast majority of potential problems. The backing of a group general practice means that on the rare occasion thatan ethical problem cannot be resolved in this way, the patient can be referredto another GP within the practice. All OH documentation is kept completelyseparate from any other medical records in the surgery premises. Working as an OHN within the setting of general practice is exciting andchallenging. It includes the whole spectrum of OH, from risk assessment andhealth surveillance to sickness absence management in a variety of differentsettings and different cultures. There are currently three OHNs on the team; one has the OH certificate,another is starting her OH diploma in September and the third is workingtowards a BSc (Hons) to become an occupational health nursing specialistpractitioner. The practice is currently recruiting for more staff and is offering OHtraining as part of its employment package. The senior adviser role is changingto become more focused on management and having greater involvement in policymaking, procedures and training; for example, in training employees in healthsurveillance, such as skin surveillance programmes and health promotion. There is the opportunity to work in varied environments. These include therubber industry, which has an ageing workforce, where the employees have workedin the industry for most of their lives. In contrast, there is a companyrunning a call centre that has a very young workforce and a high turnover ofstaff. These are examples of a wide variety of work-related experiences that givean all-round knowledge of the working environment in different cultures, ratherthan being isolated in one OH nursing speciality. One of the advantages of working for a general practice is having thesupport of the whole primary healthcare team. The doctors are very supportive,and work alongside the OHNs, helping the whole team in a proactive manner.Nobody feels isolated. Good practice is shared and team working encouraged. Working in a primary care setting also enables staff to think beyond justthe client’s workplace. For example, when planning a health promotion campaign,the local target areas can be identified through consultation with otherhealthcare professionals within the team. This broadens the OHN’s knowledge. The doctors in the practice have a good working relationship with othergeneral practices in the area and this can be very handy for getting lettersback from the employee’s GP sooner rather then later. It also opens up achannel between the local general practices and local industry. The practice is now planning open lunchtime sessions for healthcareprofessionals at the companies to whom it provides OH services. These willenable local GPs to meet the organisations their patients work for, thus improvingthe understanding of local industry and the risks to which employees areexposed. It will also act as a forum where issues such as rehabilitation andthe use of medical certification for workplace absence can be discussed. Our OH team sees the involvement of local general practices as crucial indeveloping future OH provision nationally and is keen to look at different waysin which practices might be involved. The disadvantages have been few, but mainly related to communication – thefact staff are working out in the community and not based at the surgerypremises. However, the OH team now has regular meetings at the practice. Thishelps encourage communication between practice staff and OHNs. The practice feels privileged to have been at the start of this new andexciting project. Occupational health certainly sits very well within generalpractice and it has enabled the OH team to use all its skills to provide afirst-class service for employees in west Wiltshire. Conclusion We consider that Bradford-on-Avon Health Centre has created a viable modelfor basing occupational health care within a general practice setting. Thiscould form the basis of a long-term strategy for reaching out to industrylocally and to SMEs in particular. It offers exciting employment prospects forOHNs, making them part of the primary care team and offering them a variety ofworkplace settings. The new general practice contract, if approved, may give added impetus tothis arrangement of providing OH care, by permitting financial support topractices offering this service. We hope other OHNs and GPs will be encouragedto explore the possibilities presented by this model. References: 1. Snashall, D (ed), Hazards of Work, The ABC of Work Related Disorders, BMJpublishing, 1997 2. Health and Safety Executive, Securing Health Together, 2000 Helen Clinkard is the senior occupational health adviser to Bradford-on-AvonHealth Centre Occupational HealthServices. James Heffer is the lead GP foroccupational health at the practice.Bradford-On-Avon Health Centre,StationApproach, Bradford-on-Avon, Wiltshire, BA15 1DQ, tel: 01225 866611 Related posts:No related photos. Comments are closed.