Occupational Health &
Student Fitness to Practise
Dr Susan Robson
Director: University Occupational Health Service
The University of Manchester
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How To Get The Best out of
Occupational Health

Need access to a service

Need relevant advice

Appropriate processes

Appropriate functions
2
Occupational Health Services to
Universities UK

Provision varies: At least 50% Universities
Occupational Health Service (most Medical
Schools)

Structure varies:
o In-house specialist led
o Nurse led with Doctor sessions
o Outsourced e.g. NHS providers

Function/ range services varies
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Function (in this context)

Provision of independent medical advice to the
Student and to the Medical School on a Students
medical fitness:
o
To study
o
For clinical practise
4
Manchester Approach

See Students in the following circumstances:o
Medical screening at application;
o
Self referral;
o
Formal referral;
o
Referral from Committees (Health and Conduct,
Fitness to Practise).
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Medical Screening at Application

Medical forms screened:
o
Red/ yellow/ green flagging
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Red Flag

Where relevant mental health/ physical health history for
example:o
Anorexia/ eating disorders;
o
Self harm;
o
Drug and alcohol problem history (details later); or
o
Other significant mental health condition e.g., bipolar etc.
o
History cystic fibrosis
7
Approach

Assess information supplied (including information from
GP)

? Need further information from treating specialist.

? Face-to-face assessment

?Consideration of reasonable adjustments

?Need case meeting/ enhanced disclosure (details later)
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Outcome

Medically fit for course

Medically unfit at present – defer e.g. anorexia

Medically fit with adjustments – may involve regular
reviews/ in consultation with treating specialist etc.

Medically unfit for course.
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Self Referral

Confidential – no reports unless indicated/ agreed

Uncommon

Examples:o
New diagnosis e.g. HIV
o
Request discuss final year disclosure to General
Medical Council etc.
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Referral

Formal referral: Variety of routes e.g. Medical School
SWAP Team/ hospitals support team

Usually results from concern regarding health/ behaviour
etc.

Encourage early referral if indicated.
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Approach

Principal same whether mental health/ physical (mental
health tends to be more complex)

Student is made aware of the reason for the referral and
report will be provided (informed consent)
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On Seeing Student

Full assessment: triggers: relapse signature.

Background information from treating specialist: Diagnosis
prognosis: compliance treatment and advice.

Ensure aware of other support services e.g. Disability
Support Office and the Counselling Service.

Ensure General Practitioner is fully aware/ informed.
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Subsequent Advice

Fitness to study/ for clinical practice.
o
o
Any adjustment necessary/ mitigation.
Need ongoing monitoring (may include drug/ alcohol
testing)
o
Need for interruption e.g. anorexia.
o
Need further treatment from GP/ specialist.
o
Need to refer for independent specialist opinion (details
later)
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Referrals from Health and Conduct/
Fitness to Practise Committee

Rarely is case new to us.

Committee suspect there may be underlying
health problems e.g. erotomania case

Referral as a condition for continuing on course
e.g. regular monitoring/ alcohol/ drug testing.
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NB:

The vast majority of cases where concern will be managed
by early referral and will not come to Fitness to Practise
etc.

The “medical” cases that do proceed to Fitness to Practise
result from concern regarding impact condition/ behaviour
on safety of patients.
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Concern for Patient Safety

Concern for patient safety:o
The severity of the condition/ risk frequent relapse e.g.
mental health, bipolar etc.
o
The lack of insight into the impact of the condition/
behaviour e.g. psychosis, personality disorders.
o
Lack of cooperation with the process/ systems
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Lack of Cooperation

Failure to comply with request regular monitoring.

Failure to comply with prescribed medication e.g. mental
health.

Unwilling to consent to obtain information e.g. treating
specialist.

Unwilling to agree to referral to independent specialist/
subsequent withdrawal of consent release report/ sections
report/ occupational health opinion based on report.
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In all Cases Following Assessment
School advised regarding opinion on medical fitness to
study/ for clinical practise
NB lack cooperation and faculty policies
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Referral for Independent Specialist
Opinion

Considered necessary:o
Conflicting evidence treating specialists etc.
o
Significant and complex concerns e.g. mental health/
personality/ behaviour
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Logistics

Occupational Health recommendation to School/
agreement funding

Occupational Health decides on appropriate specialist –
local if possible.

Explain reason to Student and obtain informed consent:o
To see specialist
o
Provision of report Occupational Health (? School)
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On Receipt of Report by Occupational
Health

Student seen;

Provided with a copy of report;

Advised regarding details of report to be provided to School
(with informed consent).
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Accept

May appear threatening to Student.

Can be very positive outcome for Student and School.

Examples:-
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Drug/ Alcohol Testing & Monitoring
Through Occupational Health

A number of Occupational Health services will not agree to
drug/ alcohol testing/ monitoring

I consider ‘medicine’ Safety critical role.

Such testing can be:
Helpful to Student if it confirms is complying with
treatment and advice

Reassuring to the School when advising Fitness to
Practice
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Any queries?

(? Enhanced Disclosure)
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