Thanks Sue
Useful info. for dealing with unsuitable GP responses.  
 
I agree that GP report is often not needed and that this can be assessed during a consultation with the employee considering issues such as whether the employee is progressing or not etc, where they are in any treatment programme and if timescale for recovery is becoming clearer.  However, there may be reasons to seek one especially in cases where long-term absence could result in termination of contract on ill-health grounds.  This would be absolute confirmation that the employer has considered all aspects and has all relevant information available (albeit in hands of OH on behalf of organisation).  This does mean that some reports requested may just be for confirmation of what you already know.  It may also be useful for good communication between OH and GP that may help for working towards rehabilitation of employee back into work and the OH advisor can provide information about rehabilitation policies, possible adjustments eg phased return to work or adjusted duties/hours that might be available to assist the recovery of employee or support employee who may come under DDA.   
 
However, OHNs should not just automatically request a GP report but have a valid reason to do so and therefore be able to justify their action as well as clearly explain to employee what they hope a GP report will be useful for and what they will do with the info.  This means weighing up whether a GP report would 'add value' to a case, promote good communication or be necessary medical evidence for certain cases.      

Kind regards
Sandra

Date: Thu, 24 Jan 2008 08:56:53 +0000
From: [log in to unmask]
Subject: Re: [OCC-HEALTH] Advice required
To: [log in to unmask]

Hi all
Taking the last point in Sandra's response re GP sending a computerised print out of the entire medical records.
This was passed to me by my OHP
 
The GMC/FOM issued some guidance in 2005. 'In accordance with the Data Protection Act and Good Medical Practice, doctors should only disclose information relevant to the request disclosure and not the whole record.
The GMC also states that consideration should be given to reporting doctors who engage in such inappropriate disclosure to the fitness to practice directorate. Further more occupational health physicians ( and I would assume it would apply to nurses as well) should consider their position if they collude in this activity by authorising payment to doctors offering such disclosure.'
I was advised by my OHP  (FFOM) therefore that these type of reports should be returned to the GP without payment and a note to the following affect.
 'We are unable to accept the report provided because we consider it contains information inappropriate to the request and is therefore contrary to both the Data Protection Act and the GP's Good Medical Practice. We would be grateful if you could provide a more concise report that covers the questions asked in out original letter'
 
Having said all that I  rarely ask for GP reports as mostly they just confirm what I already know. The only time I have found them helpful has been when the individual has little understanding of there own medical condition or the surgery or treatments they may be receiving.
As most hospital consultants now send a copy of their letter to the patient as well as the GP I usually ask the patient for a copy of that. Therefore cheaper, quicker and more informative.
Sue

From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of sandra glenn
Sent: 23 January 2008 19:52
To: [log in to unmask]
Subject: Re: [OCC-HEALTH] Advice required

Hi Andrea
 
For the second question, my first thought was about why did you decide to seek a GP report- was it because a manager had made a written referral to you with specific questions?  Or had you previously seen this employee following a written management referral and were reviewing progress?
 
I ask this as it is not clear from your query what was the trigger for your action.  It is important to have robust systems whereby managers are managing sickness absence and seeking OH advice to help them with this.  OH role is not to manage absence per se although we may advise on policies/processes and have an involvement in training managers.  An employment tribunal would expect there to be formal written documentation from managers before OH get involved and this would include consent for referral to OH.  Clear policies and processes are essential.   OH nurses need to also be very clear about informed consent with good guidance availble from Ethics Guidance published by Faculty of Occupational Health Physicians.  For informed consent such as for GP report, the employee needs to be clear exactly what info is being sought, what will be done with that info. and what might be the consequences of this.  
Following a management referral, it is likely to be preferable to meet with a person in order to explain the role of OH, medical confidentiality and gain informed consent from the client.  This might be a consultation in the OH department, home visit or an agreed place of site provided the employee is willing to engage in the process. 
 
Any report that you wish to send to her manager should have been discussed with her and her consent gained for you to send the report to her manager. 
 
I think that the fact a claim is being made against the company should not particularly affect OH intervention and the OH nurse has a role in advising the manager about reasons for absence, progress, timescale for recovery and any interventions or possible work adjustments that may help the person back to work.  Of course this can only take place if the employee is willing and the OH nurse is able to clearly maintain a neutral, objective position.  If the person is happy to give consent and it is fully informed, then I don't think it matters what the solicitor says.  The employee may see the report at the GP surgery before it is sent and then has the chance to change her mind about supplying the report if she wishes. 
 
It may be worth apologising to the employee about the error in the form that was sent to her and any confusion or distrust that has arisen and this may help re-establish rapport with her.  It may be worth reviewing your forms and documentation. 
 
Another issue that concerns me is when GP's send out long printouts of an employees computerised records instead of writing a report about the relevant condition.  I don't think employees would always be happy with this. 
 
Apologies in advance if I have made too many assumptions from your query. 
 
Kind regards
Sandra
 
Date: Wed, 23 Jan 2008 19:04:04 +0000
From: [log in to unmask]
Subject: [OCC-HEALTH] Advice required
To: [log in to unmask]

Dear List,

I wondered whether you would be able to assist me with a couple of queries?

  1. I have been asked by one of the managers whether or not I have any info on Body Odour. Her job is to issue licenses to taxi drivers, and she is struggling at the moment with the fact that many of the men are, to put it politely, a little smelly. I wondered whether anyone had come across any specific resources apart, from just issuing general hygiene advice. I am also trying to keep this at arms length, and point her in the direction of available information so that she can choose whether or not to use this herself. Otherwise it will be deemed to have been at the request of, or advice issued from, Occupational Health; and I’m trying to avoid that, as it does not involve a specific employee.

 

  1. I have an employee who has been on sickness absence leave since June 2007. This employee had a work related accident, for which she has now employed a solicitor to oversee her injury claim.

As she did not appear to be improving, I thought I would get a handle on the situation by writing to her GP for some info re her diagnosis and treatment to date. I duly sent out a consent form for signature and return, with the requisite information regarding rights under the Access to Medical Reports Act. We received her signed form today , and she also rang today to tell me that her solicitor has instructed her not to sign our consent form, because we have no right to request her medical notes. Unfortunately, our forms for some reason state the request as requiring medical report or records, and what I should have done was to delete the records part when I sent the form out to her. Although I make it clear to everyone that I will only request information relevant to the reason they are currently absent from work, and I do not wish to know about their ingrown toe nail, or whatever from year dot!!

She says her solicitor has sent her a form which he wants me to use instead of our department form, as he is unhappy with the wording of the form.

My first thoughts were not printable!!!! However, I won’t write if she retracts her consent and any advice I give to management will be based on the available info I have to date.

Where do I stand with clients who are on sickness absence leave and making a claim? – I assume that as they are still employed by the organisation, I have every right to gather any relevant necessary information with which to make a decision with regard to fitness, and whatever is happening with regard to a claim is not my concern.

Can I tell the solicitor to take a running jump - if the lady is happy that I will only request the info discussed?

Are there other things I’m missing with this scenario?

 Kind regards

 

Andrea 

 
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