Dr Elizabeth Howard MRCGP

Define Disability ImpairmentDisability

Disability Discrimination act defines a disabled person as someone who has a physical or mental impairment that has a substantial and long –term adverse effect on his or her ability to carry out normal day-to-day activities

Disability and WorkDiscrimination illegal Best Candidate Reasonable adjustments Grant for adaptive equipment BEST not to lose Job

Are These Disabilities?Hypertension Coronary artery disease Diabetes Cancer HIV Multiple sclerosis Severe facial disfigurement Chronic fatigue /ME

Disability and the Surgery

You are feeling ill,

You feel you need to see a doctor today.

Wake up

Get out of bed

Telephone surgery + negotiate urgent appointment

Wash & Dressed

Negotiate stairs, have breakfast

Walk down path, cross the road,

Get on bus, pay fare, get off at correct stop

Check in at reception

Respond to call system

Find Dr , communicate needs, get on couch to be examined

Got to chemist

Sign and pay for prescriptionSort out medicines

Choose and book a hospital appointment

ADL involved in seeing a doctor Wake up – see, set, hear alarm get out of bed Telephone surgeryNegotiate for appt Get washed and dressedStairs, Breakfast and take medicines Walk down road, cross road Get correct bus -+ pay fare, Get off at correct stopCheck in at receptionCall systemFind, communicate with Dr / get on examination couch. Go to chemist Sign / pay for prescription – you are not automatically

exemptGet your hospital appt – choose and book

Disability and the Surgery You are feeling ill, you feel you need to see

the doctor today.

You have a ‘hidden disability’, you are fiercely independent and not ‘housebound’ so do not expect to get a home visit. Your relatives are at work.

ALERT Colleagues Use Yellow flags or alerts for communication

issuesHard of hearing/ deafPart sighted / Blind Memory impaired- agreed contactUnable to read/ write ( safety – embarrassed)

Priority 1 – wheelchair users for neurological reasons, hoists / lifts at home if abdo ‘pain’ – may just sweat or faint

Consultation Room

Dependence vs. Independence ImpairmentOther disabilities ( e.g. hearing + sight)Personality – self reliant vs. dependantDepression / anxiety Opinions in community Willingness to be seen with aids Ability to afford better aids No two the same !!!

Pride and Prejudice

HearingHearing aids – ‘Don’t want to look like a retard’

When did you last see one?Mobiles: Adjust ring tones, Alarms – test first !Modern fire alarms in public buildings More severe Sensory SS -Yew tree lodge /RNID shop (exempt

VAT)Alarms that are loud, vibrate (pillow) / flash

vibrate, FIREALARMS , doorbell baby monitor gadgets

Text phone

Part sighted/ Blind Optician best correction – eventually none Only 1 in 3 registered ( consultant – social services )

part sighted - 3/60-6/60 blind – <3/60 unable to perform work Tax allowance, training stick/ Braille/ audio books, blue

badge, TV licence, travel permit/ taxi cardLow vision aidsTel: Big buttons, speech dialling, verbal orders for

meds. Guide stick – sensory SS , awareness/ help No on bus? Blind spot in ARMD large Guide dog – only young workers/ physical disabled

Yew tree CentreSensory Disability social services Registered blind/ deaf Mock up kitchen with gadgets, fire alarm,

baby alarm, Freedom pass – Speech ? Sight/ Hearing ( if

cannot drive – blue badgeWhite stick training

Physio, OT, Speech therapy Tools for independenceRequire compliance Why can’t I have a wheelchair, then my son

can push me around!

Driving – v important DVLA rules for driving Car vs. Minibus / bus/ HGV

www. DVLA – medical rules Sight < 6/9 corrected < 3/60 one eye ( - may consider after 1 yr) Night blindness Visual defect

Blue badge & Motability Blue Badge – EU Allows parking on yellow line/ in disabled

space 3 hrs NOT always free parking Congestion zone freeToo many around – easy or confused GP’s?Form :appalling – amputeesAble to walk 50 yds unaided without stopping

for severe pain / breathlessness Motability – swap for highest mobility DLA

Prescriptions Medical Exemptions include

Cancer requiring continued medication

ESA/ Tax credits / income support

Not exempt - prepay if more that 14 scripts a year - back repeat sheet on FP10

Dr Elizabeth Howard

Managing Absence Plan return to work from start

Have they talked to their employer? Re-deployment / adjust role

What activities does their job involve Do they like their job?

Best to move job not lose Job 6m off <50% return to work. Over a year few return.

Legally dismiss 1yr Depression – only off in severe / short time, planned

return part of recovery may be difficult to get them to return the longer they are off

Medical certificate – Risk: benefit ---Therapeutic intervention ---

Benefits Risks Forced into sick role

‘msg: work is dangerous ‘Loss of confidence , self

esteem, role in society fear of return esp.

depression Stress

Loss of income Delay in qualification

Tension with boss / colleagues

Protection from physical harm – e.g. post open laparotomy

Space to make initial recovery from SEVERE depression / mental heath

Public health/ infection

control

Med 3 Needed for 8th day onward

( short term absence : self certificate from employer/ private )

CONSULTED that day/ previous day

PROSPECTIVE CLOSED specific date up to 14d ‘OPEN’ certificate 2w, 4w,

should officially be closed with a final date to return but usu only adhered to by some employers

REMARKS Continuous claim Able to work: part time, light

duties, from home ............rehab back into work advice legal obligation to employer. Can remark on adjustments to work without signing off !!

Med 5SEEN by someone

else / you another day .

May give up to 4 weeks forward based on a report less than 4 w old from another doctor.

Gap ?

Med 4 – Green Requested by DWP for prolonged time off

good practice to keep running total for continuing benefits after statutory sick pay.

MAIN DIAGNOSIS , Other contributing DISABLING diagnoses REMARKS:

Treatment and Progress / response, planned rx. On crutches.. 2 sticks/ NEEDS Zimmer frame ..

Ability to travel 90min by public transport to centre. i.e. do they NEED home visit / severely disabled/ taxi funded (Romford)

DS1500, Med 6 & RM7 DS1500

Terminal illness is defined in Social Security legislation as: ‘A progressive disease where death as a consequence of

that disease can reasonably be expected within 6 months'5. claim 'special rules'. Disability Living Allowance

(DLA), Attendance Allowance (AA) or ESA (IB)Med 6

Back of med3 pad : Submitted to DWP with accurate diagnosis at same

time as Med3 or Med 5 if unable to enter proper diagnosis for fear of harm to patient or disclosure to employer will cause harm.

RM7 – not Brooklands ward Confidential submission to request assessment – do not

need to enter a diagnosis

ESAESA – EMPLOYEES support allowance (was IB)

Assess at 3m , no more certificates from GP for same condition

Right to appeal if refused Take hosp letters + medications. Under/ overplay according to finances/ pride / beliefs

ESA 113 – doctors report –severe disability = exempt from medical exam , entered

into support group. Allowed to work but not obliged to

Medical Exam : Qualify for ESA financial support ( was IB)Support group vs. help to prepare for re-entry to work

DLA vs. AA Age Assessment at home or in centre FUNCTIONAL HISTORY Care – Mobility – Duration of need

Cancer requiring chemo/ DXT automatic now to cover costs of illness