Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act...

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Dr Elizabeth Howard MRCGP

Transcript of Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act...

Page 1: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

Dr Elizabeth Howard MRCGP

Page 2: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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

Page 3: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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

Page 4: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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

Page 5: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

Disability and the Surgery

You are feeling ill,

You feel you need to see a doctor today.

Page 6: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

Wake up

Page 7: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

Get out of bed

Page 8: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

Telephone surgery + negotiate urgent appointment

Page 9: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

Wash & Dressed

Page 10: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

Negotiate stairs, have breakfast

Page 11: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

Walk down path, cross the road,

Page 12: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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

Page 13: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

Check in at reception

Page 14: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

Respond to call system

Page 15: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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

Page 16: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

Got to chemist

Page 17: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

Sign and pay for prescriptionSort out medicines

Page 18: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

Choose and book a hospital appointment

Page 19: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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

Page 20: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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.

Page 21: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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

Page 22: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

Consultation Room

Page 23: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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 !!!

Page 24: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

Pride and Prejudice

Page 25: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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

Page 26: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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

Page 27: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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

Page 28: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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

can push me around!

Page 29: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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

Page 30: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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

Page 31: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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

Page 32: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

Dr Elizabeth Howard

Page 33: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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

Page 34: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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

Page 35: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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 !!

Page 36: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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 ?

Page 37: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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)

Page 38: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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

Page 39: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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

Page 40: Dr Elizabeth Howard MRCGP. Define Disability Impairment Disability Disability Discrimination act defines a disabled person as someone who has a physical.

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