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

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Disability l.jpg


Dr Elizabeth Howard MRCGP

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Define Disability

  • Impairment

  • Disability

    • 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

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Disability and Work

  • Discrimination illegal

  • Best Candidate

  • Reasonable adjustments

  • Grant for adaptive equipment

  • BEST not to lose Job

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Are These Disabilities?

  • Hypertension

  • Coronary artery disease

  • Diabetes

  • Cancer

  • HIV

  • Multiple sclerosis

  • Severe facial disfigurement

  • Chronic fatigue /ME

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Disability and the Surgery

  • You are feeling ill,

  • You feel you need to see a doctor today.

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Wake up

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Get out of bed

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Telephone surgery + negotiate urgent appointment

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Wash & Dressed

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Negotiate stairs, have breakfast

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Walk down path, cross the road,

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

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Check in at reception

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Respond to call system

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

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Got to chemist

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Sign and pay for prescriptionSort out medicines

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Choose and book a hospital appointment

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ADL involved in seeing a doctor

  • Wake up – see, set, hear alarm

  • get out of bed

  • Telephone surgery

  • Negotiate for appt

  • Get washed and dressed

  • Stairs, Breakfast and take medicines

  • Walk down road, cross road

  • Get correct bus -+ pay fare, Get off at correct stop

  • Check in at reception

  • Call system

  • Find, communicate with Dr / get on examination couch.

  • Go to chemist

  • Sign / pay for prescription – you are not automatically exempt

  • Get your hospital appt – choose andbook

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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.

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ALERT Colleagues

  • Use Yellow flags or alerts for communication issues

    • Hard of hearing/ deaf

    • Part sighted / Blind

    • Memory impaired- agreed contact

    • Unable to read/ write ( safety – embarrassed)

  • Priority 1 – wheelchair users for neurological reasons,

    • hoists / lifts at home

    • if abdo ‘pain’ – may just sweat or faint

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Dependence vs. Independence

  • Impairment

  • Other disabilities ( e.g. hearing + sight)

  • Personality – self reliant vs. dependant

  • Depression / anxiety

  • Opinions in community

  • Willingness to be seen with aids

  • Ability to afford better aids

  • No two the same !!!

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Pride and Prejudice

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  • Hearing 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

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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 card

  • Low vision aids

  • Tel: 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

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Yew tree Centre

  • Sensory Disability social services

  • Registered blind/ deaf

  • Mock up kitchen with gadgets, fire alarm, baby alarm,

  • Freedom pass – Speech ? Sight/ Hearing ( if cannot drive – blue badge

  • White stick training

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Physio, OT, Speech therapy

  • Tools for independence

  • Require compliance

  • Why can’t I have a wheelchair, then my son can push me around!

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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

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Blue badge & Motability

  • Blue Badge – EU

  • Allows parking on yellow line/ in disabled space 3 hrs

  • NOT always free parking

  • Congestion zone free

  • Too many around – easy or confused GP’s?

  • Form :appalling – amputees

  • Able to walk 50 yds unaided without stopping for severe pain / breathlessness

  • Motability – swap for highest mobility DLA

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  • 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

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Managing Absence

Dr Elizabeth Howard

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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

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



  • 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

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Med 3

  • Needed for 8th day onward

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

  • CONSULTED that day/ previous day


  • 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


    • 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 !!

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Med 5

  • SEEN 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 ?

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Med 4 – Green

  • Requested by DWP for prolonged time off

    • good practice to keep running total

    • for continuing benefits after statutory sick pay.


  • Other contributing DISABLING diagnoses


    • 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)

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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

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ESA – 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

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    DLA vs. AA

    • Age

    • Assessment at home or in centre


    • Care – Mobility – Duration of need

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

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