Occupational Health - FAQs
Occupational Health (OH) is concerned with the effects of health on work/ training and effect of work/ training on health.
OH provides advice on proactive measures to prevent work related ill health and can offer rehabilitative advice to help you stay at work/ training or return to work/training if you have a health condition.
OH does not replace A&E or your GP. To arrange investigations or treatment for health conditions you need to make use of the usual NHS primary or secondary care services. However, many OH units can facilitate access to psychological help (e.g. counselling), physiotherapy, and prophylactic treatment in case of communicable disease exposure at work (e.g. if you suffer a needle stick injury).
There are different ways to learn about the local OH provider. You may receive information about the OH provider during your local induction. The placement website (both internal and external) may contain information about OH. You can ask your clinical supervisor or a manager at the placement about OH. Finally, the HR department should be able to advise you. If none of the above are successful you can contact the PSU with information about your specialty and placement and we will help you identify the local OH provider.
You can ask your Clinical Supervisor (CS) or Educational Supervisor (ES) or anyone with a management responsibility within the area to refer you to OH. Many OH providers will accept self-referral. If this is acceptable to your local OH provider, then you can self-refer.
Occupational health operates under the same legal and ethical framework of confidentiality and data protection as other areas of healthcare. The information you provide to OH is kept securely and in confidence and no information is shared with a third party (e.g. your clinical / educational supervisor, Trust administration, Training Programme Director (TPD), HEE office etc.) without your consent.
There are exceptions to confidentiality as laid out in law or by regulators (e.g. the GMC), which apply to OH similar any other profession, however these circumstances are very rare.
Only OH staff have access to OH records. If the OH records are held electronically, then IT may have access to records for technical reasons. However, they are bound by confidentiality rules which governs their access to special category data in relation to all patients in the hospital/ GP surgery.
You will also have access to your own data. Other parties can only have access with your consent.
When you inform the employer (e.g. CS or a local manager) the first step is to carry out a pregnancy risk assessment which should inform whether any action needs to be taken to ensure your safety. You do not necessarily need to be assessed by OH because of pregnancy. However, if you have a health issue or any concern, you can discuss this with your CS/ manager and, if required, seek advice from OH.
If you know what adjustment you require, you can discuss this directly with your CS/ ES and local manager. If you are not sure what support you need, you can seek advice from OH. They may recommend a needs assessment which can inform in detail what adjustments you require. Access to Work is an excellent resource that can perform a needs assessment for any health problem (e.g. hearing impairment, dyslexia etc.), recommend adjustments and fund some adjustments.
The local education provider (LEP) (your placement) is primarily responsible for implementing adjustments. However sometimes, depending on the circumstances, a discussion between LEP, the Post Graduate School and HEE may be necessary.
You should first discuss this with your CS/ ES to identify the reason. Sometimes delays occur for various reasons e.g. identifying the funding, identifying the supplier (if a specific equipment is needed), procurement of equipment (there are several steps for the NHS as a public body to make a purchase) and setting it up. All these factors may cause a delay, which can be frustrating, so the sooner your needs are identified (preferably before you start the post) the better.
Another possible reason could be that the adjustment suggested is not deemed reasonable. It is for the LEP and HEE (if it relates to the competencies you need to achieve) to determine whether an adjustment is reasonable. A case management approach, as suggested by the Welcome and Valued advice published by the GMC, should avoid such situations and also help to resolve them should they arise. You can also seek support from the BMA if you are a member.
To be referred to OH, you should give consent. It is important to remember that OH in general is support mechanism for you and can impartially assess your health in relation to your capability and support you by recommending adjustments. Without OH input, your ES may proceed without the benefit of knowing whether you have a health issue that can impact on your training.
Currently there is no agreed process to automatically transfer the OH advice. The current system works through the trainee informing the new OH department of their condition and what adjustments are in place. A local process is then followed. The trainee can also share the old OH advice with the prospective clinical supervisor or other decision makers in the new placement to speed up the process.
Currently NHS England (London) relies on local OH (and employment relation) provision. In other words, the local placement is responsible for providing the OH service, receiving the OH advice and implementing it. Please see above regarding moving between placements.
Certain specialties have adopted a lead employer model whereby regardless of the placement, all employee relations (e.g. HR) and OH are provided by a single organisation throughout the training programme. These include GP (provided by St George’s University Hospital) and Palliative Care (Epsom and St Helier University Hospitals).
There are three routes which depend on the issue and the internal LEP structure. These can be used individually or simultaneously:
1. Internal (LEP) management hierarchy (local manager, service lead/ service manager, clinical director/ general manager, role names may differ between Trusts)
2. Internal (LEP) training hierarchy (local college tutor, Director of Medical Education (DME), Guardians)
3. External including NHSE (TPD, Head of School (HoS), Postgraduate Dean, PSU) and BMA
OH provides impartial advice to the placement based on medical and functional assessment. It is then the responsibility of the placement to consider whether the adjustments are reasonable and whether to implement them.
It depends on your circumstances. Generally, NHSE should be able to clarify your employment situation which then leads to identifying the OH provider. In exceptional circumstances NHSE may arrange for an OH provider to assess you until the local provision is established.
It usually follows the contract of employment i.e. whoever you have a contract with should provide OH.
The GP School in London uses a lead employer Trust model and the OH service is provided by St Georges University Hospital OH regardless of the placement.
This depends on the organisational structure. The in-house OH services are usually accountable to HR although it is an arm-length relationship i.e. OH is accountable to HR for its performance but does not share information on individuals. Outsourced OH services typically have a contract management team (usually consisting of HR, procurement etc.) which oversees the contract, but the rules are the same as in-house i.e. the contract management only access to collective performance data and not special category/ individual information.
You can raise this with leadership of the OH provider informally or formally. You can also discuss with your ES/CS, local HR and NHSE.