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Jane, I agree with you. I usually start with "as you are aware" if I need to discuss the condition in relation to functional ability and tasks. Elaine Elaine Dobson BSc Hons (OH) Specialist Practitioner RM RGN Occupational Health Manager Automobile Association ________________________________ From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of JANE COOMBS Sent: 16 October 2009 10:27 To: [log in to unmask] Subject: Re: [OCC-HEALTH] Employee consent for reports - GMC guidance I am going to put the cat amongst the pigeons again but really cannot help myself!! So here goes.... Point 1 I know there is guidance from many quarters on confidentiality and the reasons for it but Occ Health it is a slightly different situation than in clinical practice. OH departments serve two masters - both the employee and employer; OH Doctors (as opposed to nurses/advisers), usually get the more difficult situations to deal with - employees can be in conflict with employers, they may be requesting ill health retirement on weak clinical grounds - how can this be dealt with if the employee witholds consent? What about situations where the employee is known to have misled the company by having bogus days off - this is fraud? Many companies now video long term absence cases. Situations that are fraught with complex considerations are dealt with by the OHP. I believe that OH advisers roles are easier to keep to the principles of Access to Medical Reports Act than OH Physicians. In my team we employ the OHP's for the really complex, high profile and 'likely to go to ligitation' cases. This new guidance (and it is only guidance) will certainly affect the service they would be able to provide. Our OHP is on the board of large professional body and has been talking with the GMC about these situations in detail. Currently we are not changing our practice but may be - depends on the outcome of the lobbying. Point 2 Medical details in reports to management/HR are, in my opinion, totally necessary nowadays (sorry Ann). To withhold this information in today's climate of enlightenment and education, I believe, can be seen as obstructive and patronising. There is little point in witholding knowledge that is known by the everyone including the receptionist? What about the diagnosis on the med 3 - how silly do we look if we don't allude to this? Saying that, I would choose what to say, in conjunction with the employee (patient) and with consent, as how best to help their particular situation. We, in Occ Health, should know our organisations and speak their language - so that we can assist both the employee and employer to negotiate a way through a difficult situation. In order for OHA's to break down the barriers within companies and to become part of the fabric, we need to move away from 'medicalising' situations and become more like mediators. Gaining the trust of both employees and employers and moving the situation forward in a win/win way. An (shortened version) example of how this proved beneficial was when a member of my team was dealing with a diabetic who could have hypo's and needed sugar pdq. She wrote (quite correctly) that there was a medical condition which could result in sudden loss of consciousness if the correct treatment was not administered quickly. Management were frightened to death of the consequences - after consent from the employee, the diagnosis and situation was revealed and peace was restored. I know what I am suggesting is quite radical but I believe OH needs to change to meet the challenge of extinction. We cannot afford to marginalise ourselves by taking an unnecessary stance on the subject of confidentiality (lets face, it employees have no idea about our professional code until we go to great lengths to explain it to them) I have seen so many OHA's paint themselves into a corner about this, when a bit of common sense would have sorted it out easily. Now before you all reach for your keyboards - I readily acknowledge that there are situations when confidentiality is utterly crucial, but these are few and far between, I say lets move with the times. I am going now - please be gentle with me.....! Jane Coombs ________________________________ Date: Mon, 12 Oct 2009 22:19:09 +0100 From: [log in to unmask] Subject: Re: [OCC-HEALTH] Employee consent for reports - GMC guidance To: [log in to unmask] The requirements of AMRA apply to a report written by a physician responsible for the care of the employee in conjunction with employment or insurance issues. It does not apply to a report written by a nurse and it could be disputed whether it generally applies to a report written by the OH physician as they are not responsible for the clinical care of the client. Even though AMRA does not apply to reports I have written to Management, I routinely show the report to the client before it is sent. I have nothing to hide and they have the legal right of access to their health records anyway. I question the view that reports written by an OH physician "tend to contain description of clinical detail". Clinical detail included within a response to management is totally inappropriate, no matter who writes that report. Management have no need to know clinical detail. They only need information regarding the implications of the client's clinical condition in relation to workplace issues; clinical detail is unnecessary. Anne On 7/10/09 17:31, "N. Rostami" <[log in to unmask]> wrote: Kim, AMRA (1988 )does not apply to nurse's report as their reports should not contain any clinical details and must only deal with the impact of the UMC on the functional capacity of the subject and thus the advice for adjustments. Refer to this document: page 9 , paragraph 3): Holland-Elliot K, Harrison J, East J, Leeser J, Graham-Cumming A, Skidmore A, and Batty L (2007), Guidance for Occupational Physicians on Compliance with the Access to Medical Reports Act, www.facoccmed.ac.uk/library/docs/atmra_may08.pdf <http://www.facoccmed.ac.uk/library/docs/atmra_may08.pdf> <http://www.facoccmed.ac.uk/library/docs/atmra_may08.pdf> Bearing in mind that the OP reports tend to contain some description of the clinical details when for instance justifying a case for IHR, I think that it is good practice to comply with this Act at all times. I am aware that this can cause a lot of logistical issues in terms of the delay in the release of the OH report to the referrer until it is seen by the subject. As per the Act (and when obtaining a GP report)the subject has a choice to peruse the report prior to its release to the employer. The implication for the employer is that they have to arrange to obtain the employee's written consent. We know that all written correspondence with an employee on long term absence are subject to delay and difficulties. However, in complying with this Act the employer has to discuss fully the reason for the referral to OH with the employee before getting their written consent, rather than just refer the employee to OH without their prior knowledge and the understanding of the reasons. Perhaps, this will be a good reason for why the OH work for the functional assessment/ reasonable adjustments (with no reference to clinical details) will have to be carried out by an OHA for efficacy of time! Whereas all complex cases and IHR cases will naturally be allocated to OP as the timescale for the receipt of the report may not necessary affect the absence length. This said, it is good practice for the OHA to ask the subject if they would prefer to see the report before it is sent to the manager. It is possible to even read out the report to the subject over the phone to ensure that there are no inconsistencies, nor errors in the e.g. dates of the future interventions and such... ________________________________ From: [log in to unmask] [mailto:[log in to unmask]] <mailto:[log in to unmask]> On Behalf Of Kim Scaysbrook Sent: 07 October 2009 12:06 To: [log in to unmask] Subject: [OCC-HEALTH] Employee consent for reports - GMC guidance One of our OP's came in today and has been to a seminar on consent. As I understand what he was saying - the GMC have now interpreted OP role as providing care to individuals (even through they don't prescribe etc) and therefore all reports should have employee consent to release before they go to manager/HR etc on a similar basis to that used under AMRA ie they have the right to see the report and withdraw consent for it's release. He is going to discuss this with the other OP's and the Nurse Manager on Friday. Alan - have you heard anything about this? At present, it doesn't seem to have filtered to the NMC for the OH Nurses but I imagine that their will be implications for us as well. Your thought's appreciated Kim ******************************** Please remove this footer before replying. 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