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Why workplaces are a key ingredient in improving the nation’s mental health

by Dr Richard Heron

Our health is always with us. We track it with phone apps, talk about it with friends and family and make toasts to it on special occasions. And just like people on the whole, our health fluctuates and changes from day to day, week to week and year to year.

Sometimes we are in excellent health, untroubled by the events around us and performing at our best at home and at work. At other times our physical or mental health can take a dip. We may be troubled or stressed by events that are out of our control, or our physical health can be impaired by a strain or sprain.

Small problems can knock our confidence, as we find it more difficult to think or move as easily as before. At the other end of the spectrum, up to one in four of us each year may need additional help to address a more serious mental health problem such as anxiety or depression, or we might develop a more complex physical illness that needs clinical attention.

Most of us wouldn’t think twice about discussing a broken arm or bout of flu with a colleague, but we find it much more difficult to talk about our mental health at work. This is why Mental Health Awareness Week is so important. 

This week provides a helpful reminder to normalise the conversation about mental health and to reduce the stigma associated with mental ill health. For many people the majority of their waking hours are spent at work, making the workplace an important setting to address mental as well as physical health matters. 

When it comes to mental health, starting a simple conversation with a colleague we are worried about demonstrates that we have noticed them and that we care. It could be the first step towards getting them the help they need, to addressing factors in the workplace that could help or hinder recovery and for some it could even be a life-saver.

Whenever we are stricken by illness or face the more difficult moments in our lives, the importance of empathy, by someone who genuinely cares, putting themselves in our shoes and listening to us without judgement cannot be underestimated. 

Could this someone be you, a friend, a co-worker or a manager? Could you help someone make that first call to an Employee Assistance Programme or occupational health professional if you have one at work? Early interventions can help co-workers back to health and help them to stay engaged in productive work – a healthy outcome for employee and employer alike.

For more information we recommend:


Can you provide some occupational health case studies?

The Society of Occupational Medicine has been asked by the Government’s work and health unit for 10 - 20 case studies showing a range of examples (different illnesses/conditions) of workers who need/are referred to their workplace OH support. The examples would helpfully cover the interventions/advice the worker is offered and the advice/assessments the employer is offered. Plus a sense of the final outcome (e.g cases where despite a full OH offer the worker leaves employment).

Please send anonymised examples to


The Faculty of Occupational Medicine & the Society of Occupational Medicine respond to the ‘Building our Industrial Strategy’ Green Paper

The Faculty of Occupational Medicine (FOM) & the Society of Occupational Medicine (SOM) welcome the focus this green paper brings to the future direction of our economy, with its focus on productivity, growth and skills.

We applaud the paper’s focus on ensuring our young people develop the skills required to do the high-paid, high-skilled jobs of the future, but there is not enough focus in the paper on ensuring our current workforce can stay healthy, improve productivity and contribute to the economy.

Employee health and wellbeing contributes to successful business performance and we know that highly effective companies commit to a culture of health.

Read the full response.




Prof. Diana Kloss MBE on Brexit and occupational health and safe

Prof. Diana Kloss recently spoke to the North West Society of Occupational Medicine regional group on the impact of Brexit at the Bentley Motors factory in Crewe.

In her talk Prof. Kloss explained the legal position of the government and its relationship to Parliament and the courts. She reviewed the White Paper on the Great Repeal Bill and tried to predict what new legislation will be needed.  She emphasised that workers' rights both in health and safety and employment law were enshrined in law both before the UK joined the EU, and during UK  membership and that these rights may be reviewed after the UK leaves.

In particular, some provisions of the Working Time Regulations, the Agency Regulations and TUPE are unpopular with business and may be amended.  Special consideration was given to the General Data Protection Regulation which will come into force throughout the EU in May 2018.  It is likely that the UK will need to make substantial amendments to the Data Protection Act.

Members were impressed by the Occupational Health (OH) service provided by Bentley, including access to physiotherapy in the workplace and counselling through an Employee Assistance Programme.  This was a great example of the diversity of working in OH. To join the SOM NW Group go to

Diana Kloss is a barrister and part-time chairman of Employment Tribunals in Manchester. She is also an Honorary Senior Lecturer in Occupational Health Law at the University of Manchester.

Diana will also be speaking at an event on the implications of Brexit on UK workplace/workforce health on 10th May. See


North West

Tri service occupational health symposium – March

Sandhurst Military Academy

Held every two years, this event at Sandhurst Military Academy brings together occupational health and medicine professionals working in the armed forces. A key note address from the Chief of Defence People, Lt Gen Richard Nugee, on the first day outlined the challenge: to ensure the maximum number of military personnel are fully deployable. As part of this objective, military occupational health practice helps protect, promote and restore health ensuring medical fitness to both employ and deploy soldier sailors and airmen (common issues being mental health and musculoskeletal injuries). Thankfully, all military personnel have access to good quality occupational health, whereas in the civilian population this is not the case.

Dr Robin Cordell has worked both in the military and civilian sectors and compared occupational health practice between the two. He highlighted the enduring importance of leadership. Workplace health problems can arise wherever there is poor leadership and team functioning. It was reassuring to hear that a core part of the training at Sandhurst is to support a leadership style that serves and aims to improve team dynamics and interpersonal relationships. He also highlighted that military occupational health has unique challenges, hazards and risks such as with the equipment used. Whereas private sector occupational health services have a commercial imperative, in the armed forces there is a shared outcome of facilitating return to work / being deployable for operations.

The first day also covered current issues in the military workforce: women fighting in ground close combat, transgender issues and women as submariners.  I was impressed as to how military occupation health professionals also provide a significant contribution to the broader OM community –through an impressive investment in training of the next generation of professionals and undertaking research. There were some excellent research presentations - for example, examining if there is there a link between higher body mass index and fitness for deployment - is it that the bigger you are the more likely you were going to be unfit to be deployed? The results confirmed that is the case, and that excess weight and obesity effectively cost the Royal Navy 108 deployable bodies – a whole ship of people! However, it was reassuring to know that if the Royal Navy’s population was the same weight as the UK’s population there would be significantly more men unfit to deploy. Other research suggested that recruiting standards should be maintained and that efforts should be made to reduce obesity as this can also lead to increased risk of injury.

Nick Pahl, SOM CEO


SOM and FOM response to Improving Lives: the Work, Health and Disability Green Paper

Consultation event

On Friday 17th February SOM and FOM submitted our joint response to Improving Lives: The Work, Health and Disability Green Paper.

This followed a series of events with our members and stakeholders, from a round table hosted with Lord Blunkett in the House of Lords to a number of multi-disciplinary meetings - one of which was delivered with the Health and Work Unit as a formal part of their consultation.  We also did an online survey encouraging all our members to input and thank you to those who took the time to do so!  There were a lot of questions so we really appreciate it.

The paper will now move towards a white paper allowing the government to set out their proposals for future legislation.  We very much hope the paper will reflect our suggestions and use this opportunity to really make a difference to the employment prospects of those with a disablity or long term health condition. 



The Faculty of Occupational Medicine and Society of Occupational Medicine welcome the Government green paper on work and disability

The Faculty of Occupational Medicine and Society of Occupational Medicine welcome the Government green paper on work and disability which aims to address barriers to access to the workplace.

The Faculty of Occupational Medicine and Society of Occupational Medicine welcome plans announced by the Government to consult on their Improving lives: work, health and disability green paper. This paper aims to halve the disability employment gap and make changes to work capability assessments. We especially welcome the acknowledgement in the green paper that work is in itself a ‘health outcome’.

We share the Government’s dismay that less than half (48%) of disabled people are in employment – over 7 million people in the UK. We know that good work is good for health and employment should be available to all.

Part of the consultation includes a review of GP fit notes to support workers back into their jobs faster, and for longer. We spoke out earlier this year against calls for the period for self-certification to be extended to 14 days and hope that this review will focus on strengthening GP and health professionals’ understanding of occupational health to support patients to return to work successfully.

Dr Sally Coomber, SOM President said:
“We are keen to work with the DWP and DH over the next few months, as they consult on the green paper, so we can develop better occupational health support right across the health and work journey.

At the heart of this must be an accredited and quality assured multi-disciplinary occupational health workforce. Therefore the recent GMC report showing an 11% reduction is specialist occupational physicians between 2011 and 2015 is worrying and the decline in trainee number must be addressed urgently. ”

Dr Richard Heron, FOM President, said:
“I am delighted to see that our efforts to see work as a health outcome are being recognised in government. We support the ambition to develop a system where healthcare professionals recognise the value of a referral for occupational health advice.

However, while “Fit for Work” is a step in the right direction, there is still a way to go before we can say all employees have timely access to safe, effective and quality assured occupational health support which puts the individual and their health circumstances at the heart of a support-tailored programme. There also needs to be workforce capacity to deliver this tailored support.”

We will be consulting with our members and key stakeholders to respond to the green paper.


I know I’m sick… but I have to keep going

We all need a degree of pressure to get us up in the morning, but for each of us there is a point when the nature and quantity of the demands we face will outstrip our body’s capacity.

Hillary Clinton recently provided a stark reminder of this, collapsing at work with pneumonia. Jonathan Brownlee collapsed with dehydration at the end of his triathlon and we now hear that four of five doctors-in-training reports that their job causes them excessive stress and that three-quarters go through at least one shift a month without drinking enough.

As a patient, I do not wish to be harmed by “heroic” healthcare staff presenting to work with an infection they might pass on to me, or having to work dehydrated.  As a member of the public I do not wish to be the passive recipient of impaired political judgements made by sick or over-fatigued decision-makers. More than ever “Great care” is needed at times of economic pressure to avoid situations where personal performance is so reduced that the costs of being at work outstrip the benefits good work bring for worker and organisation alike.

As occupational physicians, we care about your work and your health; and it is our role to point out the emperor’s new clothes to workers and employers alike when we see them!

This is not always comfortable, but it is what occupational physicians have done for generations - reducing previously tolerated workplace hazards such as asbestos, lead and noise. And the impact of work on health and health on work remains a major challenge, especially as our workforce ages. Ageing brings with it increasing susceptibilities to workplace hazards, as well as chronic conditions to contend with at work.

On the face of it judgements about work and health appear simple. We expect to arrive at work, fit for the tasks that we are expected to complete, not be harmed by them and often feel we (the workers) are best placed to make that determination. However, multiple factors from knowledge gaps, organisational pressures, worker-manager relationships (workplace culture) together with out of work issues make that the determination more complex. Rarely is this a topic we are able to discuss with a work-health professional.  These are situations when occupational physicians add value. We assess the complex, multifactorial determinants of wellness; understand work demands/workplace risks and exposures; translate evidence-based, credible advice about what an employee can do into language they, and their manager, feel comfortable with; and most importantly have our advice trusted by both.

According to the HSE labour force survey there have been almost a quarter of a million cases of work related stress, depression or anxiety each year for the last decade (ref: ) .  The suggestion that most mental health problems at work can be best addressed by “simple” mindfulness and yoga is a myth which only fuels the market for attractive, non-evidence based silver bullets to solve complex problems.  Occupational Health practitioners must assess and persuade management to mitigate the many organisational factors that may pre-dispose to mental health issues, and support employees when the sources of distress are non-occupational. 

Addressing the most complex needs of the few, through to the most prevalent needs of the many, calls for seamless, clinically-lead, multidisciplinary team working nurses, physiotherapists, case managers, psychologists, and more.  Only when such teams are efficiently deployed are the best health and work outcomes delivered.  This could be done efficiently with modest transformational investment and reconfiguration of services provided by the NHS to enable GPs and employers to access the services they need to best serve their patients and employees.

As with almost every other branch of health and care in the UK, occupational medicine is facing a sustainability crisis. Already thin on the ground, over half the UK’s occupational physicians are over 55 and a third over 60. Unless the pipeline is refreshed, and quickly, the costs will start to increase for each of us as individuals and employers in the next decade.  This will be just as our ageing population will need us most. The NHS, increasingly challenged to attract and retain healthcare workers, and HM Treasury, looking to increase the productivity of the UK economy, will face critical challenges.

As a Faculty we can and do lobby hard for more resourcing, more training posts and better routes of access to care. As Occupational Physicians, the time could not be more urgent to demonstrate the value we bring, and the needs we can address for a healthier and more productive public and private sector workforce of any age.

Dr Richard Heron President Faculty of Occupational Medicine


Why occupational medicine is important to my work as a GP - and the opportunities afforded me by the DOccMed

In the early 1990s, as a medical student in a large Scottish teaching hospital, I asked a patient, " What is your occupation?  I was cautioned by the teaching consultant to treat every patient the same way: to ask a patient's occupation was risking a prejudicial approach to the practice of medicine.

How different the Italian father of occupational medicine, Bernardino Ramazzini (1633-1714) who advised:

‘ When you come to a patient’s house, you should ask him what sort of  pains he has, what caused them, how many days he has been ill, whether the bowels are working and what sort of food he eats.  So  says Hippocrates in his work Affections.  I may venture to add one more question: what occupation does he follow?  

  [ De Morbis Artificum Diatriba ‘Diseases of Workers’, 1700 ]

It was after attending the Glasgow diploma in occupational medicine course (DOccMed) ten years later - some fifteen years ago - that I began routinely asking patients my two favourite questions:

What is your job? and Can you describe what you actually do?

I believe having the DOccMed has made me a better GP.  And being a GP (of the self-employed, independent contractor variety - with employees) has given me experience of the commoner clinical and employment scenarios I’m presented with in occupational medicine.  Our attached medical students from Aberdeen University also get a taster of what it's like to have a portfolio career.

The DOccMed has opened up a number of avenues beyond routine NHS work, which makes my professional life as a doctor varied and more interesting.  I've been an Approved Doctor with the Maritime and Coastguard Agency for ten years, doing health surveillance medicals for merchant seafarers.  I also provide independent medical assessments for the motor car repairs industry, and Hand-Arm Vibration Syndrome (HAVS) assessments - mainly for workers in the electric power sector, and also for whisky distillery workers.  I work two half days in occupational medicine per week - as does another GP in my practice.  The fees companies typically pay are reasonable, and enough to keep other GPs in the partnership sweet.  

In the past, I did routine medicals for off-shore oil and gas workers; assessed bus and coach drivers; provided pre-employment and sickness absence medicals for a large call centre; was occupational physician to a large Highland estate; and I have seen employees from various National Care Home providers.  

Despite the detailed knowledge and breadth of skills required for practising Occupational Medicine, the specialism is sometimes dismissed, by Hospitalists and GPs alike, typically as Occy Health . Perhaps somewhere you go for your hep B vaccinations?  Regardless, I have successfully encouraged two Highland GPs into obtaining the diploma, and another two are currently committed to Faculty of Occupational Medicine approved DOccMed courses this year.  I have also advised these GPs to join the Society of Occupational Medicine to support their development through the DOccMed, and beyond.  For those of you on Twitter, I’d recommend following the faculty @FOMNews and the society @SOMNews.  The respective websites are and .

A final anecdote.  In May this year, I witnessed a motivational exchange during the Glasgow Occupational Lead Exposure Surveillance course.  A GP introduced herself as " dipping a toe " into occupational health, to which Professor Ewan Macdonald spontaneously replied:

" Welcome to what is undoubtedly the most interesting branch of medicine! "

So says Professor Macdonald.  I may venture to add one more encouragement to all GPs:

... and Occupational Health is especially rewarding when combined with your role as a General Practitioner. ”


By Dr Iain Kennedy (GP and Occupational Physician, Inverness)



What is Occupational Medicine?

Would I recommend GPs take up an interest in Occupational Medicine (OM)? Absolutely. There are already around 1,500 GPs practising in the specialty, with over 1,000 achieving the Faculty of Occupational Medicine’s Diploma in Occupational Medicine. At least half of the Specialist (Consultant) Occupational Physicians I’ve met started out as a GP. The attraction of the field is easily illustrated: in my 13 years with a part time practice in OM I’ve known many full-time specialists who ‘used to be a GP’, but I’m still to meet a GP who used to be a specialist occupational physician! It is clearly an attractive, and sometimes lucrative, field of work.

My interest to occupational health (OH) was down to a chance introduction in my first practice. We were close to a new warehouse and distribution park in the East Midlands, and the first companies setting up there needed pre-employment medicals, particularly for their LGV drivers. As time went on more and more HR managers came to us to carry out statutory medicals and sickness absence assessments, and within a year or two around 10% of the practice income was from this line of work.

What is Occupational Medicine?

Occupational Medicine covers the relationship between health and work. The focus is to ensure that workplaces and work practices are safe and not detrimental to employees’ health, and that employees are fit for the job they are doing. If there are problems the occupational physician’s role is to advise on workplace adjustments and to give appropriate advice and support.

The traditional model of OH has an important role to rehabilitate people back into work after sickness or injuries. However the improving safety culture in the UK, together with an increasingly aging and ‘stressed’ workforce, means that our role is increasingly to help people with long term conditions or mental health problems to stay at work and manage their symptoms within the context of employment.

What are the attractions?

The pace of work is a welcome relief compared to the 10 minute appointments and rushed visits in primary care. A typical appointment would be for 30-45 minutes and allows time to explore a case in detail. There is certainly the feeling that your opinion is important and holds great value for the person you see and the company they work for. I enjoy the close working relationship with an HR manager that develops and the opportunity to understand a whole new culture in the world of businesses. The importance of work to an individual’s health and wellbeing is well understood, so the ability to really make a difference to keep someone in work can be very rewarding.

What are the challenges?

The switch from an advocacy role to one of impartiality is probably the main challenge for GPs. Also, while there are no statutory requirements, I would agree with most in the field that formal training should be a requirement to ensure good practice towards the guiding principles of OH. The Diploma in Occupational Medicine is awarded by the Faculty of Occupational Medicine, and this provides GPs with the extra competencies to understand the effects of work on health, assessment of fitness for work, health surveillance, rehabilitation, workplace visits, ethics and the law.

Setting up a client base can be difficult. Like me, many GPs find a demand for work from local organisations almost by accident. Word of mouth and local contacts have been the main source of new work for many of us. Some GPs also work with local NHS OH departments, or one of the number of number of national OH ‘agencies’, who are always on the lookout for GPs with the Diploma.

I’d urge any GP to diversify into OM. It has been a rewarding and challenging experience for me, and one which I would recommend to anyone.


Dr Rob Hampton, MB ChB, MRCGP, DRCOG, DOccMed

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