Specialist Medical Qualifications Order 1995. The route to entry on to the Specialist Register of the General Medical Council (GMC) normally involves four years training in an approved post. Very senior practitioners may apply for Fellowship of the Faculty (FFOM).
At least some medical schools now include occupational health training in the curriculum, but only for a few hours. The Faculty has developed a training course, leading to an examination, for physicians who do not need the full specialist qualification. This judges basic knowledge and competence in occupational medicine, with the award of a Diploma for successful candidates. It remains quite separate from the AFOM/MFOM which continues to be the route for those wishing to specialise in occupational medicine. It is likely that a court, in examining whether an employer had employed a competent doctor to give OH advice, would consider the Diploma to be the minimum qualification. A Diploma in Disability Assessment Medicine (DDAM) was created in 1999. The Faculty also offers a Diploma in Aviation Medicine (DAvMed).
The introduction of revalidation as a requirement for all physicians on the medical register was accompanied by a call from the GMC to each College and Faculty to develop its own principles of Good Medical Practice. In 2001, the Faculty of Occupational Medicine first published Good Occupational Medical Practice, the latest update of which was in 2017. The purpose of this document is to provide a standard against which individual physicians may be judged. It accompanies the Faculty’s Ethics Guidance for Occupational Health Practice (Royal College of Physicians, 2018) and SEQOHS: Occupational Health Service Standards which sets standards of good practice for occupational health services. Good Occupational Medical Practice interprets the GMC’s guidelines in the context of occupational medical practice. However, its recommendations do not over‐ride those set out in GMC documentation, and this should also be consulted. Good Occupational Medical Practice, which is endorsed by the BMA, sets out the duties of an occupational physician as follows:
The duties of an OH physician
visit the workplace and advise on the provision of safe and healthy conditions by informed scientific assessment of the physical and psychological aspects of the working environment
promote compliance with relevant health and safety legislation
help develop policies, practices and cultures that promote and maintain the physical, mental and social wellbeing of all workers
assess the fitness of workers for specific tasks, ensuring a satisfactory fit between person and job, recommending suitable adjustments to enable a person to undertake the work they have been selected to perform safely and effectively, considering any health issues or disabilities they may have
monitor the health of workers who are potentially exposed to hazards at work through health surveillance programmes
analyse data from surveillance programmes using sound epidemiological methods to identify trends in worker health and recommend any remedial measures necessary to improve worker health
advise employees and employers regarding work‐related health issues
assess potential cases of occupational injuries and illness; investigating, managing and reporting individual cases appropriately and establishing if this is a single case or if there is a wider incidence
manage immunisation programmes for workplace biological hazards and for business travellers
work with employers to promote best practice in physical and mental health in the workplace to help prevent sick leave
case manage workers who are on sick leave, working with other health professionals to ensure the earliest return of functional capacity and return to work
recommend suitable alternate work in circumstances where a worker cannot perform their normal job, either temporarily or on a permanent basis because of a health problem
determine whether employees satisfy the medical criteria for ill‐health retirement under the terms of the relevant pension fund rules
ensure people have the necessary health information to undertake their work safely and to improve their own health
It is important to understand that the physician has dual responsibilities to the patient and their employer. The role is therefore different to every other branch of medicine where the physician’s primary responsibility is to the patient.
Criticisms of the medical profession and of the lax control over physicians exercised by the GMC led the professional body to create a scheme for revalidation of professional qualifications and this came into force in November 2009. The practice of doctors is subject to regular appraisal. The GMC guidance was published in A Licence to Practise and Revalidation (2003). The Faculty of Occupational Medicine, in conjunction with the Society of Occupational Medicine, developed a programme to assist occupational physicians to obtain revalidation and relicensing. This requires the physician to collect and submit information about his or her practice over a five‐year cycle, with annual reviews. The responsibility for proving competence rests with the individual. It is competence, not excellence, which is needed. The basic scheme is that doctors must collect evidence of their compliance with standards set out in a document published by the Faculty and the Society in 2003: Standards in Occupational Medical Practice: Guidance for Appraisal, since updated. In addition, medical appraisal by another doctor will be required, as well as proof of professional development training and participation in audit. The Society of Occupational Medicine operates a Quality Assured Appraisal Scheme. Appraisal benefits doctors by helping them to show that they are giving good medical care, enabling them to identify and correct weaknesses in their practice, protecting them against unfounded criticism, and assisting in the collection of appropriate data to inform the revalidation process. Appraisal in this sense is separate from appraisal by a manager, which is usually from a standpoint of business efficiency. Management might prefer that the OH doctor did not observe all the ethical standards, for example those relating to confidentiality.
The Standards document, which is based on Good Occupational Medical Practice already discussed, refers to knowledge of the law. Occupational physicians should be able to report to managers on occupational health performance and requirements in ways which are accessible, placing it within a business framework and also providing the medico–legal context. Occupational physicians should keep abreast of changes in legislation and Codes of Practice that affect their practice (and, I would suggest, relevant case law). Research published by the Health and Safety Executive in 2004 assessed the competencies of occupational physicians from the customer’s perspective (Competencies of Occupational Physicians). Readers may be surprised to learn that at the top of the list of required competencies as rated by their customers is advising on law and ethics. Training in law was not, however, highly rated by focus group participants.
1.6 The occupational health nurse
The first recorded occupational health nurse was Philippa Flowerday who was appointed in 1878 by Colmans of Norwich. She assisted the doctor at the factory and then visited sick employees and their families in their own homes. Her work reflected the treatment‐based philosophy of the time and also the ‘doctor’s helper’ attitude to nursing staff. There has been no statutory function for nurses comparable to that of the Appointed Doctors, so that OH nursing was centred very much around the role of providing first aid in the workplace. The sympathetic nurse with time to listen and guaranteed confidentiality was also a popular source of advice for such socio–medical problems as members of the worker’s family drinking too much, overtiredness caused by stress, menopausal symptoms and so on. A survey undertaken on behalf of the Royal College of Nursing
