Occupational Health Law. Diana Kloss
on the medical aspects of rehabilitation and training for and placement in employment.
EMAS employs both doctors (EMAs) and nurses (Inspectors of Health and Safety (Occupational Health)) as well as support staff. It also provides the secretariat for two of the Health and Safety Executive’s Advisory Committees:
1 the Workplace Health Expert Committee (WHEC). This committee was set up in 2015 under the chairmanship of Professor Sir Anthony Newman Taylor. Its remit is to give an independent expert opinion to the HSE on new, emerging and existing workplace health issues and the quality and relevance of the evidence base on workplace health issues.
2 the Advisory Committee on Dangerous Pathogens (ACDP).
1.5 The occupational health physician
The British Medical Association (BMA) defines an OH physician as
a doctor who in relation to any particular workplace takes full medical responsibility for advising those working therein including contractors working on the site on all matters connected directly or indirectly with the work. These may have a bearing on health as it affects work and the effect of work on health including that of the public at large, either in general or as individuals. (The Occupational Physician)
An OH physician must be a registered medical practitioner and hold a licence to practise. There is as yet no strict legal requirement that the OH physician should hold any other qualification than ordinary registration but employers are advised to ask for a qualification in occupational medicine. General practitioners who provide occupational health services part‐time should have the minimum qualification of the Diploma in Occupational Medicine (DOccMed). Those involved more comprehensively in occupational medical practice should obtain in addition Associate Membership of the Faculty of Occupational Medicine of the Royal College of Physicians (AFOM). Further experience and a dissertation enables a doctor to apply for membership of the Faculty (MFOM). The MFOM is a career specialist qualification and entitles the doctor to call himself a specialist or consultant. Specialist training in occupational medicine is prescribed by the Postgraduate Medical Education and Training Board and conforms to the requirements of the European 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,