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Rapid Responses: Rapid Responses published:
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General practitioners, occupational health and vocational rehabilitation
- Andrew O. Frank (12 August 2003)
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General Practitioners and Occupational Health Professionals
- Timothy P Finnegan (13 October 2003)
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Andrew O. Frank, Immediate Past President British Society of Rehabilitation Medicine, C/O Royal College of Physicians, London, NW1 4LE
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Editor: The BSRM is very supportive of the consensus statement published recently (1) and in total agreement with the thrust of your editorial (2) – that occupational physicians and general practitioners should be working together to facilitate their patients remaining in work where possible. The editorial, however, also noted that ‘large sections of the UK population do not have access to an occupational health service’ (2). What form can vocational rehabilitation take for those individuals? Whilst recognising that the government is now taking vocational rehabilitation seriously with the pilot work-focussed rehabilitation schemes (3), there is a widespread belief that rehabilitation infrastructure within the NHS is poorly developed in this area (4). It has recently been suggested that there may be a relationship between the decline in British rehabilitation and the escalation in the cost of disability benefits (5). The British Society of Rehabilitation Medicine (BSRM)and the Royal College of Psychiatrists have both called for designated health professionals or “vocational rehabilitation specialists” to provide the expertise to cross the divide between employment and health (4,6). Currently such posts are scarce but need to be developed further. The BSRM have also argued for a National Institute for Vocational Rehabilitation to embrace employment issues from the roles of good management in industry to the detailed rehabilitation into employment of those with work-related health issues. An alternative proposal has been for a ‘Standing Committee’ of leaders in the field that was promoted by the ABI/TUC conference. It is the interface between the worlds of work and health that are complex, and not well understood in either sector. Clearly occupational health services cross these boundaries and have a pivotal role in minimising unnecessary sickness absence. Both physical and psychiatric rehabilitation services, however, need to develop appropriate vocational rehabilitation services to support the population of working age. Only then will we begin to dent the 2.7 million individuals of working age who currently need state benefits. References 1. Beaumont D. Rehabilitation and retention in the workplace - the interaction between GPs and occupational health professionals. A consensus statement. Occup Med 2002;53:254-5. 2. Beach J, Watt D. General practitioners and occupational health professionals: consensus statement to improve interaction is timely and welcome. BMJ 2003;327:303-4. 3. Department for Work and Pensions. Pathways to Work: helping people into employment - the government's response and action plan. Cm 5830, 2003. 4. British Society of Rehabilitation Medicine. Vocational Rehabilitation: the way forward. Report of a Working Group (Chair Frank AO). London: British Society of Rehabilitation Medicine, 2000. 5. Grahame R. The decline of rehabilitation services and its impact on disability benefits. J R Soc Med 2002;95:114-7. 6. Royal College of Psychiatrists. Employment opportunities for people with psychiatric disability. A report of the Royal College of Psychiatrists (Chair Boardman, J.). London, Royal College of Psychiatrists - in press Competing interests: Dr Frank is a medical advisor for Kynixa Ltd |
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Timothy P Finnegan, Deputy Assistant Chief of Staff Medical Wilton SP2 0AG
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Your Editorial (1) by Beach and Watt, highlighting the importance of general practitioners and occupational health professionals working together to achieve a return to work, raises an important structural issue for health in this country. The Editorial drew attention to a Consensus Statement (2). Both items describe the situation as they find it - that is most general practice sits within the National Health Service (NHS) and most occupational health practice sits outwith it. The developing occupational health service of the NHS is an excellent exception. Even in the past, when the occupational health services of the major publicly funded nationalised industries existed, the links with the NHS were, as noted in the articles, not always as strong as would have been desirable. A modern example of where the linkages between general practice and occupational health practice are strong exists in the Armed Forces. There, both roles are often combined in the same individual, usually a general practioner carrying out significant amounts of occupational medicine, supported by occupational medicine consultants. The theoretical difficulties noted in the Editorial, that this may cause with regard to ethics and loyalties do not, in practice, appear to occur. No doubt this is because the executive parts of the Armed Forces (the Chain of Command) are very aware that what is best for the health of an individual is generally best for the health of the organisation. Everyone is aware of the mentally and physically robust requirements needed by Service personnel. Perhaps it is time to challenge the paradigm, which has developed in this country, of the separation of general practice and occupational health practice. The Armed Forces, with employments on Royal Navy ships, in Army regiments and on Royal Air Force stations, offer another way of tackling the need to integrate healthcare at work and at leisure. Prior to the NHS such integration would have been very nomal in many communities. 1. Beach J, Watt D. General practitioners and occupational health professionals. BMJ 2003: 327: 302-3. 2. Beaumont D. Rehabilitation and retention in the workplace - the interaction between general practitioners and occupational health professionals: a consensus statement. Occup Med 2003: 53: 254-5. Competing interests: None declared |
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