United Kingdom

OCCUPATIONAL MEDICINE IN UNITED KINGDOM
There are two main bodies for Occupational Medicine in UK:

1. The Faculty of Occupational Medicine
2. The Society of Occupational Medicine.

The Faculty of Occupational Medicine was set up in 1978 to provide a professional and academic body of doctors empowered to develop and maintain high standards of training, competence and professional integrity in occupational medicine. Its objectives are to:

○   act as an authoritative body for consultation in matters of education and public interest concerning occupational medicine
○   promote for the public benefit the advancement of education and knowledge in the field of occupational medicine
○   develop and maintain for the public benefit the good practice of occupational medicine, providing for the protection of people at work by ensuring the highest professional standards of competence and ethical integrity.

The Faculty is a registered charity. Its policies and general direction are determined by the Board, which is elected by the membership.  It is supported by committees, working groups and including regional forums.  It is also responsible for the publication of Occupational and Environmental Medicine.

The Society is also a registered charity and was founded in 1935 as the Association of Industrial Medical Officers; it changed its name to the Society of Occupational Medicine in 1965. It provides education and support to its members through a national and regional programme of continuing medical education and a quality assured appraisal scheme in support of the requirements for medical revalidation in the UK. It has 1800 members and is open to doctors outside of UK with an interest in occupational medicine as well as nationally.  Membership includes general practitioners as well as occupational physicians. It is supported regionally by a group structure arranged in geographical regions.

It has a board, which is elected by the membership determining policies and strategic direct with both national and regional membership.

The Society is concerned with:

○   the protection of the health of people in the workplace
○   the prevention of occupational injuries and disease
○   related environmental issues

SOM is a forum for its membership and aims to stimulate interest, research and education in Occupational Medicine. It has wide-ranging contacts with government departments and professional bodies and responds with the Society’s view to consultative documents and topics of interest and concern affecting the speciality.

POPULATION  

According to the National Statistical Authority, the Office for National Statistics, the total population of the UK in 2016 was 65.64 million.

The total working population (the “labour force”) aged 15-64 years, in 2013 was 41.67 million. The official unemployed population in 2013 was 1.36 million.

The current (2019) state pension age, the age at which many people retire, is currently 65 years for men and for women is gradually increasing from 60 to 65 years of age.

The employment rate for older people has increased considerably since 1992 and is  now around 7.5% of the total working population as shown in the graph below:

Employment rate for people in the UK aged 65+, March to May 1992 to May to July 2016

MANPOWER OF OCCUPATIONAL PHYSICIANS (OPs)

In 2018, the total number of all licensed physicians was 242,433, with practicing specialists in OM (SOM) or competent in OM (by way of training) 571 (General Medical Council)

There are no official figures but it is believed that the unemployment rate amongst occupational physicians is 0% (Nerys Williams personal communication)

Management of work-related health risks relies on H&S legislation in this country and compliance with it. It is the duty holders statutory responsibility to manage the risks to health caused by/made worse by work. UK has not adopted ILO convention and there is no legal requirement for the provision of occupational health services (OHS) to people who work, unless health surveillance is statutorily required. The law does not stipulate provision of any occupational medicine services to the self- employed working population.

The most recent HSE survey of Occupational Health Provision at Work (1993), suggested that 8% of private sector companies used some form of occupational health support, with manufacturing having the highest usage (14%). However, over two thirds of large employers had access compared to 5% of employers with less than 25 employees. A more recent report of Occupational Health Provision within the NHS (1998) suggested that over 99% of the 425 Trusts in England and Wales had access to occupational health support. Forty per cent were using in-house services, 48% purchasing services from other Trusts and 4% from private sector sources.”

(http://www.hse.gov.uk/research/crr_pdf/2002/crr02445.pdf)

PROFESSIONAL TRAINING AND ASSESSMENT OF SPECIALISTS IN OM

1.SPECIALISATION TRAINING

Specialisation training in OM fully conforms to current existing European Union Legislation EU Directive 2005/36/EU. A physician who has earned a University degree in medicine, after 2 years (3 years for general practice) spent in “basic” specialisation training) may start (“higher”) specialisation training in OM, according to law. This is completed after another four years in training in total, and including following the “Specialist training curriculum for occupational medicine” (FOM, 2017) in a GMC-approved training programme.

The curriculum describes the competencies to be attained by the end of specialists training and the assessment strategy. The requirements include:

• Membership of the Faculty of Occupational Medicine part 1 exam
• Membership of the Faculty of Occupational Medicine part 2 exam
• To complete a dissertation (or equivalent)
• To complete the work-based assessments/supervised learning events required for Annual Review of Competence Progression (ARCP)
• To complete annual reviews (ARCP)
• To receive the Certificate of Completion of Training and be entered by the UK General Medical Council onto the Specialist Register.

Note – The curriculum is currently under review. This review has been mandated by the UK General Medical Council who approve the curriculum and assessments.

ASSESSMENT/EXAMS IN SPECIALISATION TRAINING

Assessment for the acquisition of the title of specialist in occupational medicine is effected, at the training stages specified above by :

1. Assessment of multiple choice questionnaire (at the end of the third year of specialist training, by examiners*)
2. Assessment at Clinical exams (at the end of the years 4-6 of speciality training, by examiners*)
3. Completion by candidates and assessment by a review panel (ARCP panel) of individual electronic platform (or work journal) of work performed, continually every 12 months.

Assessment of an MSc Dissertation or equivalent study on an occupational medicine before the end of their final year of training. Oral examinations (vivas) are not conducted as they are not held to be a valid and consistent form of assessment.

Examiners are selected (and trained) as follows:

Examiner selection is via an examiner application and approvals process

Examiner training is via an examiner training session (which is held regularly), examiner auditing and for the clinical exam – a day “shadowing” examiners undertaking OSPE examinations.

Examiners are licensed doctors with at least 2 years experience who have a professional

obligation to keep up-to-date (through continuing professional development (CPD), as part of revalidation).

Examinations are conducted as follows:

Membership of the Faculty of Occupational Medicine part 1 exam – multiple choice paper (single best answer)

Membership of the Faculty of Occupational Medicine part 2 exam – written papers [multiple choice paper questions- single best answer and a modified-essay question paper  and OSPE exam [“clinical stations” – 4 on the “short circuit” and 2 on the “long circuit” plus 1 photographic/ occupational hygiene “station”]

Feedback is given:

1 with regards to.training: by trainee supervision and feedback, including an annual review of competence progression (ARCP)

2.Examinations: by results letter (and by response if an initial inquiry/ appeal is raised)

2. Examiners: by audit and a written report and/or discussion.
3. DIFFICULTIES AND DEFICIENCIES IN SPECIALISATION TRAINING

TRAINING DEFICIENCIES REGARDING:

There are small numbers of OM speciality trainees and one of the biggest challenges has been to develop intelligence about the numbers of occupational health professionals currently in practice and to predict future requirements (Reference: The Council for Work and Health (2016). Planning the future: Implications for occupational health; delivery and training).

Occupational medicine is a small speciality and is “shrinking in size and ageing” (Reference: General Medical Council (2018). The state of medical education and practice in the UK. www.gmc-uk.org ).

3. SHORT SUMMARY OF UNDERGRADUATE TRAINING OF MEDICAL SUDENTS IN OM

 The Faculty of Occupational Medicine is seeking both:

• to encourage medical undergraduates to consider occupational medicine as a career
• and also to extend awareness of health and work issues to general practice and all medical specialties.

As part of this latter aim, the Faculty is supporting a project to provide a competency framework and easily accessible and flexible teaching resources in occupational health to medical schools (Reference: Resources for Medical Schools and Medical Students www.fom.ac.uk) .

4. SHORT SUMMARY OF TRAINING AND ASSESSMENT REGARDING OTHER POSTGRADUATE AND CONTINUING EDUCATION TRAINING IN OM

The Faculty of Occupational Medicine manages specialty training in occupational medicine with the National School of Occupational Health. This includes:

Setting the Part 1 MFOM and Part 2 MFOM examinations and assessments for Specialty Registrars

Approval at end of training and recommendation for specialist registration

Ensuring specialty training in occupational medicine is kept up-to-date with current and best practice

OM PRACTICE

3. FRAMEWORK OF OH PRACTICE

• Occupational health in the UK involves multidisciplinary teams including occupational health nurses, ergonomists, physiotherapists, occupational therapists, psychologists, safety officers and occupational health technicians working with occupational physicians.
• Do physicians during their specialisation training in specialties other than OM receive any training in OM? Generally no but some specialities such as respiratory medicine and dermatology offer opportunities to develop specific expertise in work related conditions.
• Are there laboratory facilities relevant to occupational medicine practice? Yes.

(d) Are occupational health and occupational health risk and protection subjects incorporated into other stages of vocational and general education? No.

4. MAIN DUTIES/TASKS OF OCCUPATIONAL PHYSICIANS (OPs) ACCORDING TO LAW

 (a) Assessing health effects of work, i.e. diagnosing occupational diseases, and exacerbation of non-occupational diseases by occupational factors, (b) performing (or coordinating, or contributing to, or definitively interpreting the results of) occupational health risk assessments in large enterprises, ii. in  circumstances where work “exposures” are complex or potentially very unhealthy, and iii. when insuring an enterprise (i.e. the employer) against OH risk (c) assessing and ultimately and definitively give an expert opinion on working people medical fitness to work in circumstances where work “exposures” are complex or potentially very unhealthy or requiring special physical or mental health characteristics, and ii. on return to work after “serious” illness or injury, (where work might possibly affect work performance or health), (d) designing, coordinating, assessing and interpreting the results of occupational epidemiologic studies (such as intervention studies, operational studies to reveal occupational health effects, studies to reveal new occupational health hazards), (e) interpret the sickness absence rates values and patterns, at an enterprise, (f) identifying priorities in annual occupational action plan at an enterprise, (g) contributing to major accidents preparedness and to provision of emergency health care in circumstances arising from major or specific health hazards, (h) having advisory responsibilities, participating in health and safety at work committees work, communicating the value of OM to management and workers, (i) performing workers health surveillance/preventive medical examinations, (k) collaborating with other OH professionals, (l) examining employees on entry to the pension fund of the enterprise .]

  DIFFICULTIES AND DEFICIENCIES IN OCCUPATIONAL MEDICINE PRACTICE

 STRUCTURAL, ORGANISATIONAL AND OPERATIONAL DEFICIENCIES

 ISSUES RELATED TO DIAGNOSING AND REPORTING CASES OF OCCUPATIONAL DISEASES AND MEDICAL FITNESS TO WORK

 IS THERE A NATIONAL LIST OF OCCUPATIONAL DISEASES? Yes.

 ARE SPECIALISTS IN OM PARTIPATING AS MEMBERS OF WORK RELATED DISABILITY ASSESSMENT PANELS? Yes but not always

 IS MEDICAL FITNESS TO WORK ULTIMATELY DECIDED IN COURT BY A JUDGE? /No

• DEFICIENCIES IN LEGISLATION AND ITS ENFORCEMENT

None

• COMMUNICATION ISSUES. ADVOCACY FOR OM

Undertaken by Society and Faculty of Occupational Medicine and other bodies such as the Council for Work and Health

• WHO PAYS THE SALARY/REMUNERATION OF OCCUPATIONAL PHYSICIAN (OP)? the employer

 ARE OPs MEMBERS OF STAFF OF AN ENTERPRISE? Variable. Some are and some are not

 HAVE A CONTRACT AS SELF EMPLOYED? Some do

ARE EMPLOYEES OF GROUP OCCUPATIONAL HEALTH COMPANIES? Some are

• PRIORITIES/ MOST CONTENTIOUS ISSUES REGARDING OM AS VIEWED BY OCCUPATIONAL PHYSICIANS? No objective data available

6. NAMES AND CONTACT DETAILS & WEBLINKS OF NATIONAL SOCIETY OF OCCUPATIONAL MEDICINE AND OTHER RELATED INSTITUTIONS

www.som.org.uk  and www.facoccmed.ac.uk

Contact Details

Dr. Nerys  Williams,

updated feb 2021