Incompetent...
> On 10 May 2014, at 18:53, "Dawn Veal" <[log in to unmask]> wrote:
>
> Hi All,
>
> As per my previous post on this its interesting that I did write a letter to support as the OHP suggests the rationale and suggested a 24hr monitor as suggested below.
>
> I got a snotty letter saying that if this is what we need as it is due to work requirements then we should pay for it privately!
>
> He said that this letter was free futures would not be... huffity huff huff ( he didn't put the huff bit but that's how it felt. How dare I make suggestions on care plans for his patient....)
>
> So where am I now no further forward as the readings off site are around 150-95 as an average and then 200/100 when he sees me but I cannot validate his results....On top of which the GP started him on a low dose of medication that he said he was only doing to pacify me!
>
> The GP's response has affected the employees respect for OH as he thinks I am making a fuss and cannot see as I said to him that ultimately I am just looking out for his wellbeing and that ignore the FLT driving I just want him to have appropriate treatment. That putting on meds just for me was ridiculus as if the 24 hr monitor proved it to be white coat then he didn't need it and he was paying for meds that he didn't need either.
>
> I felt like hitting my head on the wall.
>
> Blasted arrogant GP...this seemed more about him than his patient.
>
> D
>
>
> ________________________________________
> From: [log in to unmask] [[log in to unmask]] On Behalf Of Libby Hassanali [[log in to unmask]]
> Sent: 10 May 2014 09:24
> To: [log in to unmask]
> Subject: Re: [OCC-HEALTH] Hypertension and FLT drivers/ machine operatives
>
> Many thanks for your concise advice... Perfect!
>
> On 10 May 2014, at 01:10, "Carr Barnes" <[log in to unmask]<mailto:[log in to unmask]>> wrote:
>
> Hi
>
> When I used to discuss such cases with a very good OP I had access too he encouraged me to think of it in two separate ways:
>
> 1: The health issue
>
> * elevated BP identified in the workplace that is beyond the parameters of a known legal guidance, in this case DVLA.
>
> This obviously needs referral to the GP for assessment however I think referrals need context so an accompanying letter with the quote from the DVLA, reference to the NICE guidelines and a reference to the employers "zero risk" policy for safety critical roles and what that means for employees i.e your patient will be removed from his duties until his BP meets DVLA guidelines or this has been proven via 24 ABPM that this is "white coat syndrome"; this may have an an impact on terms and conditions of his employment ..or some such (hopefully that is written down somewhere in the organisations policies .... sadly I found it often wasn't). That way the GP and the employee know exactly why the employee is being asked to see the GP and you are not relying on the employee framing the appointment e..g "uh ... the nurse from work sent me .. she doesn't like my pressure reading .. told me to see you for some reason"
>
> To be honest I'm not sure I'd be ringing GP's to make appointments for the employee because they can't be bothered to for whatever reason ....I mean these are adults we are dealing with aren't they? (but that's just me)
>
> 2.The safety critical aspect
>
> * Is the employee at risk of sudden loss of consciousness or impaired consciousness at the wheel where such event would not carry warning signs that would allow the employee time to safely stop work (whatever that involves e.g. removing current load from the lift, parking up safely etc)
> * If yes - then this needs to be told to management in clear unambiguous language. Mr X is at risk of the sudden onset of symptoms e.g. sudden loss of consciousness, impaired consciousness, that would cause him to be immediately to be unable to control the vehicle safely.
> * If no then what risks are there..... Mr X is at risk of developing symptoms over a period of time (minutes? hours? days?) that could lead to a sudden loss of consciousness etc however during the early symptom stage he would be able to safely park the vehicle.
>
> I found many employees and managers unwilling to accept OH advice on this issue due to pay related issues .. if they weren't driving they weren't paid extra weighting ... the employee gives out to manager (with assistance of union), manager feels bullied and pushes back to OH....I found that the more unambiguous you can be in the report about the type of symptoms likely to be experienced the less "wiggle" room that left for "confusion".
>
> BW
>
>
> Carr
>
>
>
>
>
> Regards
>
> Carr
>
>
> On 9 May 2014 21:00, Joan <[log in to unmask]<mailto:[log in to unmask]>> wrote:
> Dear Team,
>
> In a recent very similar case, driving a DVLA group 1 electric truck, similar readings, overweight, no medication insisted he had his own BP monitor at home, his levels were normal there, no symptoms and telling me he is engaging with the GP practice where the nurse was monitoring his BP ongoing, aware he has white coat hypertension.
>
> After a letter to GP, 24 hr monitoring was done and his levels were just above normal to my amazement but the GP has started medication and his levels are significantly lower today.
>
> We did not remove him from driving duties as not indicated per DVLA guidance, this was following OHP advice so long as supported/ reviewed weekly and we ensured his engagement with GP support.
>
> Manual handling is the other significant risk in these cases.
>
> Joan
>
>
> From: Jacqui <[log in to unmask]<mailto:[log in to unmask]>>
> To: [log in to unmask]<mailto:[log in to unmask]>
> Sent: Friday, 9 May 2014, 18:03
>
> Subject: Re: [OCC-HEALTH] Hypertension and FLT drivers/ machine operatives
>
> Hi
> For my penny- I'd send to gp, and taken off truck til note from gp says a "normal reading" on a compliment slip if necessary, (but I'm not always on a site when they come back a day later!) again I share the thought process which says - worse case scenario, kills colleague hse and police says mrs oh person you knew that this bp was dangerous but did not advise cessation of
> Driving. I've had one taken To a&e before 280/155! He wasn't chuffed but they kept him in!!!
> I personally would also say to chap that "it could be incidental finding and I would rather be safe than sorry, " they are generally quite understanding and a phone call to a surgery saying in sending them usually finds them a slot in a full clinic list even if it's with nurse. I also put in gp referral, arm used, position, and cuff size, time frame of readings.
> Jacqui
>
> Sent from my iPhone
>
> On 9 May 2014, at 10:58, Dawn Veal <[log in to unmask]<mailto:[log in to unmask]>> wrote:
>
> Hi All,
>
> Just me again…. This is a bug bear of mine. I have had guys with hypertension who have been very indignant when I explain the results and suspend them form FLT etc until review by GP. Only then to have a GP say they are ok when they saw them yet I report at work and still hypertensive and told to review again and I am told it is White Coat Syndrome!
>
> I then ask them to take a potable BP and test at home and work over a 3 week period 3 times a day and the results remain according to BP UK out of ranges and yet still GP won’t help them so we end up with poor chap pulled back and forth.
>
> As this man also has poor lifestyle I have given advice ( but I know he nods and then ignores)
>
> So moral is I find GP’s not following NICE guidance and pushing them back to me.
>
> Is it just me?
>
> D
>
> From: [log in to unmask]<mailto:[log in to unmask]> [mailto:[log in to unmask]] On Behalf Of [log in to unmask]<mailto:[log in to unmask]>
> Sent: 09 May 2014 09:59
> To: [log in to unmask]<mailto:[log in to unmask]>
> Subject: Re: [OCC-HEALTH] Hypertension and FLT drivers/ machine operatives
>
> Good point, however, important extra points to consider:
>
> * NICE guidelines re referral as per Karen’s earlier email
> * the proteinuria is an extra signpost to something amiss
> * safety critical role – if he has a CVA whilst in control of the FLT and kills a co-worker – it would have been just my misfortune for it to happen on that particular day – think of two of Reason’s models of accident causation – the Swiss Cheese model and the pathogen model.
>
> I wouldn’t want to risk it – suggest no FLT or safety critical roles until he has been referred to his GP with appropriate follow up. If we do not act on the findings of health surveillance it becomes a paper exercise.
>
> Anne
>
>
> On 09/05/2014 09:35, "JANE COOMBS" <[log in to unmask]> wrote:
> Hi Libby
> This has happened to me before and I too was concerned. However, tin hat on, this man may have had issues for years and to suddenly stop him driving and send off site will have serious implications for him and maybe for yourself in terms of reputation. It soon gets round the place and then no one turns up. Especially when, as happened in my case, the GP poo p
> The bp may be white coat syndrome or a result of an earlier situation. Have you tested bp following best practice guidelines using the correct size cuff. Have you used a analogue or digital sphygmomanometer?
> You would be medically suspending this chap and what if the blood pressure doesn't come down for weeks? Is he never allowed back?
>
> Regards
> Jane
> 07710080947
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> On 9 May 2014, at 08:49, "Libby Hassanali" <[log in to unmask]> wrote:
> Morning all,
> Overweight chap, BP 225/125, protein in urine both discovered during routine health surveillance. About to start 8 hour shift; would you advise he is sent off site to get medical input?
> There is no official legislation re hypertension and FLT but HSE suggest being guided by DVLA group 2 guidance which says a consistent resting BP reading of 180/100 and/or side effects of meds that cause drowsiness/ dizziness should not drive.
>
> "Disqualifies from driving if resting BP consistently 180 mm Hg systolic or more and/or 100 mm Hg diastolic or more.
>
> Re/licensing may be permitted when controlled provided that treatment does not cause side effects which may interfere with driving."
>
> HSE states "More stringent activities, such as working in a particularly demanding environment, working at night, moving highly toxic or explosive materials etc, would probably be more appropriate to the Group 2 entitlement."
>
> I advised he was sent off site unless duties could be found in a safer environment; interested to know others angle on this!
>
> Thanks,
>
> Libby
>
>
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