[Show abstract][Hide abstract] ABSTRACT: Background
Sickness certification causes problems for general practitioners (GPs). Difficulty with the assessment of capacity to work, conflict with patients and other non-medical factors have been shown to influence GPs' decision-making. Inadequate leadership and management of certification issues add to GPs' difficulties.AimsTo explore problems associated with sickness certification, as part of a larger mixed method research project exploring GPs' experiences and perceptions of sickness certification in Ireland.MethodsA qualitative study in an urban region of Ireland. A focus group of four male and four female GPs explored problems encountered by GPs in certifying sickness absence. Thematic data analysis was used.ResultsThree major themes emerged: perception of the sickness certification system, organization of health care and cultural factors in sickness absence behaviour. Employment structures in public and private sectors and lack of communication with other health care providers and employers were identified as complicating sickness certification.ConclusionsGPs encounter a complexity of issues in sick certification and are dissatisfied with their role in certifying sickness absence. Our results open the debate for policy change and development in Ireland.
Occupational Medicine 05/2013; 63(5). DOI:10.1093/occmed/kqt056 · 1.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: The complexity of a fitness for work consultation is well documented. General practitioners (GPs) find that such consultations often create conflict and they feel ill-prepared for the task. Objectives: We aimed to examine the consultation process in the fitness for work consultation and to report on the response of GPs to two hypothetical consultations of work related sickness absence, one of a psychological and one of a physical nature. Methods: Three areas of the consultation were examined; social/family circumstances, workplace history and information required assessing the severity of the condition. We used a randomized design using an online questionnaire completed by 62 GPs located in the Republic of Ireland. Analysis was conducted in NVivo 8 qualitative software using thematic and content analysis techniques. Results: GPs may be expected to collect and consider information relating to social, domestic, financial, lifestyle and workplace factors, including workload, job satisfaction, job strain, work ethic, inter staff relationships and employee support mechanisms. The mode of presentation may trigger specific information seeking in the consultation. Conclusion: GPs may evaluate fitness for work in a variety of ways depending on medical and non-medical factors. Further research should further examine the factors that may influence the GPs decision to prescribe sickness leave.
The European journal of general practice 05/2013; 19(4). DOI:10.3109/13814788.2013.786037 · 1.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
General practitioners (GPs) have a central role in providing advice about fitness for work, yet there are concerns about their understanding of the relationship between work and health.AimsTo assess whether GPs in one Cornish practice record the occupation of patients of working age and to quantify how important GPs in Cornwall consider recording of occupation in working-age patients.Methods
An audit of the notes of 300 working-age patients in one practice, a search of the computer records at a different practice and a questionnaire survey of 202 GPs in practices in Cornwall.ResultsOccupation was recorded in 50 (17%) of the 300 patient notes audited. The questionnaire response rate was 31%. Few (8%) respondents reported training in occupational medicine. Most (65%) of GPs recorded their patients' occupation some of the time. A third (32%) of GPs did not consider it important to record patients' occupations.ConclusionsGPs in two Cornish practices recorded the occupation of working-age patients infrequently, but over two-thirds of GPs in Cornwall believe it is important to do so. If these results reflect the practice of UK GPs, the new 'e-fit note' may be of limited value in monitoring and analysing sickness absence.
Occupational Medicine 12/2012; 63(2). DOI:10.1093/occmed/kqs209 · 1.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sickness certification is a common task undertaken by General Practitioners (GPs) in most developed countries. Research suggests that they find this task complex and difficult. Primary health care structures and sickness certification practices differ across Europe and little research explores GPs certifying practices in the Republic of Ireland.
The aim of the study was to explore GPs' views on sickness certification, the strategies used to issue sickness certificates to patients and scope for improvement in the current system.
A qualitative thematic approach used one to one in-depth interviews with 14 individual GPs, across 11 primary health care practices in Ireland. Analysis of the data was conducted using NVivo 8 qualitative software.
GPs can find their role as certifier problematic, and a source of conflict during the consultation process with patients. GPs were concerned with breaching patient confidentiality and in particular disclosing illness to employers. They reported feeling inadequate in dealing with some cases requesting sickness leave, including certification for adverse social circumstances. Sickness certification was often given in response to patient demand. GPs felt a need for better communication between themselves, employers and relevant government departments.
This study highlights the various complexities and challenges that GPs face when dealing with patients requiring sickness certification. Issues in assessment of fitness for work and problems within the social welfare structure were recurrent themes. The study highlights the opportunities to improve the system and how these might be achieved. Further research is now warranted in Ireland.
The European journal of general practice 05/2012; 18(2):92-9. DOI:10.3109/13814788.2012.672967 · 1.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Issues surrounding sickness absence are of interest due to growing awareness of the costs to employers and the UK economy, a greater understanding of the interaction between health and work, and increasing evidence that work is beneficial to physical and mental well-being. The Health & Occupation Reporting network in General Practice (THOR-GP) is a national source of information on work-related sickness absence.
To assess the factors influencing work-related sickness absence in the UK.
General practitioners (GPs) report cases of work-related ill-health via an online web form. Sickness absence information reported with each case was compared by demographic information, diagnosis/symptom and employment factors.
Between 2006 and 2009, THOR-GP received 5683 case reports of work-related ill-health; 53% were musculoskeletal diagnoses and 31% were mental ill-health diagnoses. Over half (56%) of cases reported had associated sickness absence. Diagnosis had a highly significant influence on the occurrence of any associated sickness absence. Eighty-one per cent of mental ill-health cases were reported to result in sickness absence compared to 50% of musculoskeletal cases. Public sector employees incurred sickness absence more frequently than those from the private sector. Industries with the highest mental ill-health incidence rates had sickness absence episodes most frequently. Within employment groups, levels of sickness absence were inversely proportional to the level of self-employment.
These data reported by GPs with vocational training in occupational medicine may help to inform policy decisions targeting work-related exposures and the management of sickness absence, thereby reducing the UK burden of work-related sickness absence.
Occupational Medicine 03/2012; 62(2):105-11. DOI:10.1093/occmed/kqr205 · 1.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: GPs can find their role as issuers of sickness certification problematic, particularly in trying to maintain a balance between certifying absence and preserving the doctor-patient relationship. Little research has been published on consultations in which sickness absence has been certified.
To explore negotiations between GPs and patients in sickness absence certification, including how occupational health training may affect this process.
A qualitative study was undertaken with GPs trained in occupational health who also participate in a UK wide surveillance scheme studying work-related ill-health. Telephone interviews were conducted with 31 GPs who had reported cases with associated sickness absence.
Work-related sickness absence and patients' requests for a 'sick note' vary by diagnosis. Some GPs felt their role as patient advocate was of utmost importance, and issue certificates on a patient's request, whereas others offer more resistance through a greater understanding of issues surrounding work and health acquired through occupational health training. GPs felt that their training helped them to challenge beliefs about absence from work being beneficial to patients experiencing ill-health; they felt better equipped to consider patients' fitness for work, and issued fewer certificates as a result of this.
Complex issues surround GPs' role in the sickness-certification process, particularly when determining the patient's ability to work while maintaining a healthy doctor-patient relationship. This study demonstrates the potential impact of occupational health training for GPs, particularly in light of changes to the medical statement introduced in 2010.
British Journal of General Practice 10/2010; 60(579):721-8. DOI:10.3399/bjgp10X532350 · 2.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The provision of occupational health (OH) services to the UK population is limited and concentrated in certain industries. Occupational physicians (OPs) therefore see a different subset of the population than general practitioners (GPs) and their recognition of work-related ill health may differ.
To examine how reports submitted by OPs and GPs compare and to discuss how biases may affect diagnostic and demographic differences.
The Health & Occupation Reporting network collects information on work-related ill health. OPs and GPs report case details, including demographic information, occupation, industry and suspected agent/task/event. Differences in reporting patterns were assessed.
Musculoskeletal and mental ill-health reports made up over 80% of reports to both schemes although the likelihood ratio (LR) showed OPs were 78% more likely to report a psychological case than GPs. OPs were also more (18%) likely to report a female case. Health & social care was the industry most frequently reported by both groups; however, this was in greatly differing proportions (OPs 38%, GPs 14%). When LRs were adjusted for industry, this reduced the likelihood of an OP reporting cases of mental ill health (to 40%) and found them 10% less likely to report females than GPs.
OP and GP reporting patterns highlight the variation in OH provision and its influence on the data provided. OPs are best placed to report on health and work relationships; however, as some sectors have poor access to OH services, reports from suitably trained GPs will help inform about this 'blind spot'.
Occupational Medicine 04/2010; 60(4):294-300. DOI:10.1093/occmed/kqq022 · 1.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Health and Occupation Reporting (THOR) network for general practitioners (GPs) offers free online continuing professional development (CPD) to contributing GPs. Use of this resource by members is relatively low. Non-uptake is most frequently attributed to lack of time.
The primary aim was to assess the effects of changes made to educational material, available online to GPs participating in THOR-GP, 1 year after a needs assessment which informed the changes. The secondary aim, developed from the findings of the original study, was to compare contributing GPs who undertake work in occupational medicine, with those who do not, in terms of uptake of the educational material and of educational need.
GPs participating in THOR-GP, who responded to a questionnaire to assess their use of THOR-GP's website for CPD, were sent a follow-up questionnaire 1 year after the original survey. Both questionnaires comprised scales derived from the syllabus for the Diploma of the Faculty of Occupational Medicine and questions about attitudes to CPD in occupational medicine.
No change was found in uptake of or rating of components of the website, following modification. Responders worked on average seven sessions per week in general practice and 1.5 sessions in occupational medicine. GPs working in occupational medicine reported greater confidence in some subject areas than GPs not currently working in occupational medicine and were also more likely to engage in CPD activity within the specialty of occupational medicine.
Undertaking work in occupational medicine increases confidence in the subject and stimulates the use of related educational facilities.
Occupational Medicine 04/2009; 59(5):342-6. DOI:10.1093/occmed/kqp013 · 1.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: GPs with training in occupational medicine report cases of work-related ill health and sickness absence to The Health and Occupation Reporting network in General Practice (THOR-GP) using an online webform. This report describes the data reported in 2006 and 2007. GPs mainly reported musculoskeletal disorders and mental ill-health. A much larger proportion of the mental ill-health cases were sickness-absence certified, making up 55.9% of the total days certified. Musculoskeletal disorders are the most frequently reported diagnoses of work-related ill health, but mental ill-health is responsible for most work-related sickness absence.
British Journal of General Practice 10/2008; 58(554):637-40. DOI:10.3399/bjgp08X330753 · 2.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A substantial number of general practitioners (GPs) practice occupational medicine in the UK, working on a sessional basis in addition to their primary care commitments. Many of these GPs hold the Diploma of the Faculty of Occupational Medicine. In addition to the work of these GPs with a special interest, issues relating to work and sickness absence form a significant part of the workload in general practice. Dame Carol Black's report, ‘Working for a healthier tomorrow’, raises concern about the lack of understanding of the relationship between work and a patient's health, and the omission of this evidence from professional training. The report suggests that the work-related advice given to patients by health care professionals can be naturally cautious and may not be in the best interests of the patient for the long term. There is, therefore, an urgent need for research to help health professionals, and in particular, GPs to understand the issues involved in work-related ill-health and in sickness absence certification.
Occupational Medicine 07/2008; 58(4):233-5. DOI:10.1093/occmed/kqn069 · 1.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: WHAT IS ALREADY KNOWN IN THIS AREA• Although an estimated 3200 UK general practitioners (GPs) practise occupational medicine (OM) on a sessional basis there does not appear to have been any published work on this topic. Analogous groups are GPs practising family planning medicine and forensic medicine. These special interest groups have arrangements in place for appraisal.• There does not appear to be any formal structure for their continuing professional development (CPD) or for appraisal or revalidation for GPs practising occupational medicine.WHAT THIS WORK ADDS• Only 15% of this sample of GPs practising occupational medicine had undergone appraisal during the year of study.• GPs practising OM prefer appraisal by other OM-qualified GPs.SUGGESTIONS FOR FUTURE RESEARCH• Work is needed to develop an appraisal package specifically designed for this group of doctors and to recruit suitable appraisers.
Education for Primary Care 06/2008; 19(4):376-381. DOI:10.1080/14739879.2008.11493701 · 1.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: An estimated 3200 UK general practitioners (GPs) practise occupational medicine on a sessional basis.
To assess the educational needs of GPs practising occupational medicine and participating in The Health and Occupational Reporting (THOR) network.
A questionnaire survey of GPs participating in a national reporting scheme, recording occupational ill-health from general practice (THOR-GP). The questionnaire used scales derived from the syllabus for the Diploma of the Faculty of Occupational Medicine to assess the use of the THOR-GP website for continuing professional development (CPD). Questions were also asked concerning the attitudes and experience of these doctors to CPD in occupational medicine.
The response rate was 73% (213/291). Only 22% of responders used the THOR-GP website for CPD. Lack of time was the most frequently cited reason for not using the site. The topics provided on the website which were rated least interesting also appeared as requests for further information in questionnaire returns.
Online learning has the potential to fulfil the needs of GPs practising occupational medicine. The designers of material for online learning should actively manage and modify the material available in response to educational needs. Further research is required into the clinical and business outcomes of online learning for these doctors.
Occupational Medicine 01/2008; 57(8):575-80. DOI:10.1093/occmed/kqm116 · 1.03 Impact Factor