2. Connecting Health en Labour 1
• Introduction
• Primary Health Centre Wantveld
• Primary and Occupational Healthcare: two separate systems
• Advantages
• Disadvantages
• Liberalisation of occupational health services
• Social developments
• Reasons to join forces
• Experiences as a “company doctor in primary care”
• Implement a “company doctor in primary care”
3. Connecting Health en Labour 2
• Referral from nurse practitioner, important information
• Referral from nurse practitioner, advice and guiding
• Empowering the client
• Referral from physiotherapist
• Referral by the GP, important information
• Referral by the GP, advice / possibility’s
• Personal statement
4. Primary Health Centre Wantveld
• 11.000 patients
• 8 general practitioners (5.4fte)
• 4 nurse practitioners (2.4fte)
• 10 assistants (6.0 fte)
• 7 physiotherapists
• 5 psychologists
• Company doctor
• Psychiatrist
5. Primary Healthcare and
Occupational Healthcare
Two totally separate systems:
• Funding
• Patient records
• Medical education programme
• Judicial frame
6. Advantages of separate systems
• No dilemma for the GP and his trusted relationship with his client
• Specialized doctor in work-related diseases or illness during work
• Knowledge of job opportunities within a company so - in case of
dysfunction through illness- the employee can still use his
possibilities
• The presence of a mediator between employer and employee in
case of illness or other work related problems
• Efficient cooperation between company doctor and employer to
guide the employee and advice the employer
7. Disadvantages of separate systems
• No or less attention for work and work related problems in primary
healthcare, interventions are not based on functioning and behavior
• Double diagnoses, dual interventions
• Different or even contradictory opinions from GP and company
doctor
• Difference of opinion about the patient and his illness: GP: “rest
heals” company doctor: “it’s better to wear out than to rust out”
• GP: wait and see company doctor : as soon as possible
specific intervention
• Funding the company doctor by the employer forms the image the
company doctor is an extension of the company
• Only people who are employed and have consent of the employer
can visit a company doctor
8. Liberalisation of the occupational
health service (2005)
• No longer an obligation to join a Health and Safety Executive
• No longer a right by law of the employee to visit the company doctor
• By 6 weeks absence the obligation to consult the company doctor
Consequences:
• Quick intervention not longer possible
• Prevention becomes an issue (especially within the SME’ s)
• A lot of employees from small enterprises have no excess at all
• Impossibility to act within the professional directives
9. Social developments
• Increasing number of freelancers and small businessman
• Increasing number of volunteer carers
• Increasing number of volunteers in many social institutions
• More pressure to stay at work or return to work even with chronicle
restrictions or limitations
• Increasing age of retirement
• Less possibilities to get help from social organizations due to
savings by government
10. Primary and Occupational Healthcare
Reasons to join forces 1
• More attention to work and functioning by the primary healthcare
• More attention on addressing underlying issues
• Prevention of contradictory opinions to the client
• Prevention of double diagnoses and tests
• Prevention of unnecessary referrals or an delay in necessary
referrals
11. Primary and Occupational Healthcare
Reasons to join forces 2
• To focus referrals on function and behavior as well
• Avoiding that psychological or social problems become medical
complaints
• Possibilities for prevention
• For everybody the possibility asking for advise about problems
concerning work, functioning and participation by an independent
specialist
• Independent, close to home, familiar surrounding, easily accessible
12. Experiences as a
“company doctor in primary care”
• 60% psychological problemsempowerment
• 35% advice: laws & regulations, rights & obligations
• 5% musculoskeletal problems
Other opportunities:
• Heart- and lung problems
• Chronicle diseases like Diabetes Mellitus, Rheumatism
• Work related diseases like contact allergie
• Pregnancy
13. Implement a
“company doctor in primary care”
• Wantveld health centre is unique in the Netherlands, even though in
the last six years two pilots have showed the added value of a
company doctor in primary care. All the other company doctors had
to quit when the pilots were ended, there was not any financial
support afterwards.
• Almost impossible finding finance to investigate:
– The cost-benefit analyses
– The optimal way to implement occupational care
– How to finance the occupational care in the primary setting
– Judicial complications, like working in the patient dossier of the
GP
14. Referral from nurse practitioner 1
important information
• Rather severe burnout with depressive
symptoms
• Wife of a small businessman, rapidly growing
enterprise
• Before part time worker, now > 50 hours/week
• Perfectionist attitude, great sense of
responsibility and loyalty
15. Referral from nurse practitioner 2
advice and guiding / own solutions
• Changed workplace less interruptions
• Task description new assistant, tasks repelled
• Own transport to reduce working hours
• Resume hobby’s, gym once a week
• Spending time together with husband with no
heed for work
16. Empowering the client
Gain back control by getting awareness and
insight in problems, so man can make his own
choice based on his preference, standard and
values, into consideration his own position,
limitations and possibility’s
Purpose of questions and home assignments:
• What are the real / underlying problems
• Which is changeable, where is your influence
• What is needed to change / make a change
• How to implement the change and hold it
17. Referral from physiotherapist
• Recurrent complaints despite successful treatment
• Incorrect posture during working at home
• After 1 consult an advice to client, problems solved
• Additionally advice to the physiotherapist more alert
for causing factors
18. Referral by the GP 1
important information
• Older woman with huge hypertension
• Overstrain complaints: emotional, sleeping problems
• A lot of thoughts about one of her sons
The son:
• For 6 years a CVA with rest limitations
• Become unemployed, divorced
• Mess around the house, the garden and financial 7000
euro debt with his family
• Living in The Hague
19. Referral by the GP 2
advice / possibility’s
• Temporarily registered in Wantveld Health Centre
• Referred for a neuropsychological examination,
specialized in labor and reintegration / participation
• Exploring job opportunities
• Usefulness additional therapy
Expectation:
• Limitations on both neuropsychological and psychosocial field
• Recommendation for training or retraining program to join in
• Job-coach for help job application
20. Personal statement
“Work is a wonderful medicine,
it should like the medicine,
be safe, appropriate and well-dosed”
21. More information/ contact
Jeanette Hemke, company doctor
E-mail: Jeanette.Hemke@achmea.nl
Achmea Vitale
P.O.Box 182
2270 AD Voorburg
The Netherlands
