Health in Practice Programme

Programme Title

Health in Practice Programme (HiPP)

Programme Leader

Dr Andrée Rochfort

Other Members of Programme Group

Ms Margaret Cunnane – HiPP Administrator

Network Providers (GPs, Psychiatrists, Occupational Physicians and Counsellors)
Management Committee (1 representative from each network above)
Ethics Committee (1 representative from each network above)
Mr Dermot Folan, Assistant CEO and Director of Management in Practice
Programme

Summary of Programme

The Health in Practice Programme is a system of healthcare support for GPs and
GPs family members. The service is both proactive and reactive to members needs
through 1 & 2 below.

1. HiPP - Healthcare Support Networks (HSN). These networks of ‘doctors for

doctors’ and other health professionals provide confidential personal
healthcare and occupational health advice or support to GPs. GP’s families
may also access network services.
2. HiPP - Education and Information Service (EIS) provides information and
advice in response to individual queries and through educational meetings
and the media to general practice on many work-related health issues, e.g.
stress, practice health & safety, safety statements, handling aggression and
violence and its aftermath, sick leave absence, career guidance and
balancing work and life for the increasingly busy doctor.

Background to the Programme

HiPP is the ICGP’s response to the articulated needs of GP members to formally

address the health of GPs, their patterns of healthcare and the barriers (both real and
perceived) to accessing and receiving high quality healthcare.

This programme is the result of seeking a ‘best practice’ model based on

international research and literature, doctor’s health initiatives in other countries,
formal needs assessment of the College membership, and ongoing feedback from
members.

Research shows that in contrast to the relatively formal methods of healthcare used
by the general population, doctors use informal, self-directed and ad hoc pathways of
healthcare for their own health needs, when treating medical colleagues and when
treating their own families.
Unstructured healthcare combined with reluctance of doctors to seek help early and
the reluctance of doctors to intervene when colleagues are in difficulty creates a
pattern of doctors’ health issues being left unaddressed. The cultural norm for
doctors’ healthcare is too often a system of crisis intervention. This holds true for all
types of medical conditions, physical and psychological.

Educational Aims of Programme

GPs are a specific population group requiring specific attention to improve the
identification, management and prevention of personal ill health and work related
illness.

HiPP’s key aim is to educate and support GPs as patients when they become ill,
when they have concerns about their own health or a colleague’s health, and also to
promote and maintain their good health and wellbeing when they are healthy. Being
unwell can result in a doctor feeling both professionally and socially isolated. HiPP
continues to explore health behaviour, health needs and attitudes to health of this
population group.

To keep abreast of global initiatives and research in the growing area of doctors
health.

HiPP provides education and support to doctors who treat doctors and the families of
doctors. The need to support this group is increasingly recognised; HiPP has also
provided advice to GPs and other doctors who are not members of HiPP Networks
on request as regards their care of doctors as patients (including GP’s as patients).
The annual HiPP seminar for Network providers constitutes education as well as
peer support among the network providers.

Research, best practice, and the Medical Council’s ‘Guidance on Ethics and
Behaviour of Medical Practitioners’ 6th Edition, advises that every doctor should have
a GP. HiPP encourages GPs and their families to access the health service formally,
through attending a GP (ideally a HiPP Network GP). In doing so they will utilise the
very same professional service that they deliver to the general population.

Fundamental cultural changes as described above require long term and continuing
education.

Benefits to Members of Programme

As a result of HiPP, GPs have benefited through:

§ Having the option to use a system of GP led confidential healthcare for

themselves and their families.
§ Direct access to clinical advice on management of their own health through
the HiPP Network occupational physicians.
§ Direct access to emotional and psychological support through HiPP Network
counsellors, psychologists and psychotherapists.
§ Exposure to a new level of awareness, or culture, which ‘gives permission’ to
doctors to discuss and assess their own health needs in a formal context as
patients (this needs ongoing attention, see below) while challenging the
culture of self-doctoring.
§ Coordination of information and assistance to actively manage the particular
health risks associated with their job, which has hitherto been overlooked in
undergraduate and postgraduate training.
 § Collegiality, support and advice in managing the health of medical colleagues.

Programme Activities/Tasks

§ Health Education in order to prevent personal and occupational ill health and
health promotion to preserve wellbeing.
§ Provision of information and education through individual queries from GPs /
practices / GP families / publications / college website / workshops and
presentations / the media.
§ Provision of confidential healthcare through the Healthcare Support Networks.
§ Supporting the Networks in delivering the service.

Detailed Programme Description

The target audience includes:

§ GP members and their families (full-time, part-time, locum, sessional, young,

established, GPs in training and retired GP members).
§ Supporting the Healthcare Support Networks of HiPP.

The Education and Information Service (EIS)

Examples of EIS activity include:

Requests for advice from individual GPs and GP family members arose on many
health and work-related health related issues, for example occupational stress
matters, work demands, single-handed GP issues, stigma of illness in doctors, lack
of peer support when ill, sick leave issues, returning to work after sickness absence
retirement issues and requests for career guidance.

Non-network GPs who have GPs as patients or doctors family members as patients
requested advice on clinical management. Such calls are welcome but are dealt with
on a strictly anonymous basis (no name, gender, area to be mentioned)
GP Trainees sought assistance on matters of doctors’ health for project work.

Workshops, presentations and facilitating presentations on e.g. Doctors get sick too!,
Keeping the Doctor Healthy, Workplace Health, The health of doctors, “Physician
heal thyself?” Doctors for Doctors, When the {Health and Safety} Inspector Calls…’,
producing a practice safety statement, stress management for GPs.

Publications, articles, interviews and reviews in Forum, Irish Medical Times, Irish
Medical News, Medicine Weekly, national papers, national and local radio stations.

The Health in Practice web pages of the ICGP website has much information on the
area of doctor’s health.

The Healthcare Support Networks (HSN) are facilitated by but independent of the
ICGP, and provides healthcare for GPs within an independent, therapeutic,
confidential relationship with an individual Network provider of their choice, who may
be from an area distant to the GPs home if the GP wishes to assure themselves of
privacy.

The networks consist of 52 GPs, 21 Occupational Physicians (many are practising

GPs), 13 Psychiatrists and 34 Counsellors / psychologists and psychotherapists.
ICGP members may access all networks directly (with the exception of psychiatrists
which should be by formal referral from a GP). Names and contact details for the
networks are listed in a county by county directory and are available direct to
members from the HiPP section of the College website, or by request, in confidence,
from Margaret Cunnane, HiPP Administrator, and from myself. Family members and
colleagues of GPs are encouraged to request the directory for distribution to their
colleagues.

Programme Timetable

For milestones of HiPP 2000 – 2004 see ICGP website.

2004 - 2005
Support of Networks; 2nd Annual HiPP Seminar; publications, presentations and
workshops; 1st National Conference on the Health of Doctors.

Programme Milestones/Deliverables/Outputs

2003 - 2004
HiPP’s outputs involve direct contact through the Education and Information Service,
workshops, presentations, Forum articles, website, publications etc.

The activity of the Networks is evaluated through ‘Network activity questionnaires’. It

is vital to stress that nobody knows who contacts the networks except the network
provider and the individual service user. As director, I need to know that the service
is being used, so the information required simply includes actual numbers seen and
broad categories of presenting problem e.g. cardiology, dermatology, mental health.
As the medical community in Ireland is small, no information is sought or given on
gender, age, area of residence etc of any user. Given that HiPP encourages the
option of attending network providers away from your own area if extra privacy is
important for you, this adds another layer of confidentiality.

Statement of Achievements/Outcomes to Date

As per annual reports to date.

For 2004 2005:

§ The Management Committee of HiPP consists of representatives from each

of the four network groups, the HiPP Director and Mr Dermot Folan, Assistant
CEO and Director of Management in Practice Programme. This committee
was set up in 2002 to provide advice on ethical and management dilemmas
encountered by HiPP Networks. In 2004, the committee met to review the
scope, content and delivery of HiPP services. Much discussion took place on
a proposed conference on doctors’ health. Arising out this, the views of the
medical council were sought regarding broadening the remit of such a
conference to include all the medical specialties.
§ The First National Conference on the Health of Doctors took place in
February 2005. This was jointly hosted by the ICGP and the Medical Council
and has been regarded as an important landmark in the history of Irish
Medicine – representatives from the various medical specialties, training
bodies, employers and the department of health came together to explore the
issue of doctors health and to seek ways of addressing the overall health
needs of the profession, including illness prevention. Mary Harney TD,
Tanaiste and Minister for Health and Children officially opened the
conference. Dr Paul Farnan, Clinical Director of the Physician Health
Programme of British Columbia, Canada, delivered the Keynote address.
 Other presentations outlined the activities of the Medical Council’s Health
Committee, the ICGP’s Health in Practice Programme the HSE’s Medical
Manpower Managers. Small group workshops were held on topics of doctors’
experiences of being patients, on doctors who treat doctors and the issues
arising for the spouses and families of doctors in supporting doctors with ill
health and in obtaining objective healthcare. The first outcome of the
conference was a position statement on developing health supports for all
doctors in the country. To follow this, meetings are planned between the
representative bodies of the profession, and associated institutions and
stakeholders in the coming year.
§ Presentations and workshops at CME meetings, annual clinical society study
day, CME Tutors workshop, Bereavement Support Meeting for GPs and the
Midland GP Training Programme. The venues included counties Donegal,
Dublin, Kilkenny, Limerick, Waterford and Wexford.
§ Presentations and workshops to external institutions: First Year Medical
Students at UCD on ‘Doctors can get sick too!’; Irish Centre for Continuing
Waterford; UCD Higher Diploma in Occupational Health September 2004.
§ Attended conference: “Fit for Practice” in Manchester to of UK supports for
doctors. ICGP received recognition for HiPP Networks structure and
achievements during the meetings discussion and later follow up. UK doctors
have a telephone advisory helpline, but do not yet have a system of doctors
for doctors’ healthcare as we do in Ireland.
§ Publications and News section of Forum; media links on behalf of ICGP for
general media queries e.g. prescribing of benzodiazepines, use of OTC
medication in the general public, pregnancy at work, and suicide; article on
‘The Therapeutic Space’ in Eisteach, the Journal of the Irish Association of
Counsellors and Psychotherapists, outlining the role of the general
practitioner in patient care.
§ Member of Board of Faculty of Occupational Medicine of the Royal College of
Physicians in Ireland. My role on this board has enabled links to be forged in
creating a distance learning qualification in occupational medicine for doctors.
Commencing in September 2005, the ICGP’s Distance Learning Unit will
provide this two-year course leading to LFOM in collaboration with the Faculty
of Occupational Medicine.
§ ICGP representative on National Council of Sick Doctor Scheme. Facilitating
and follow –up of treatment of doctor’s from all medical specialties with
problems of substance misuse and addiction.
§ ICGP member of the Steering Committee & Clinical Guidelines Sub-
committee for the ICGP/ ERHA project on Mental Health in Primary Care.
§ ICGP representative on HSE Mental Health Act 2001 Implementation Project,
which is a multidisciplinary group set up to look at health service providers’
roles and responsibilities in implementing the Act, and how this may affect
clinical time and resources.

Upcoming Events/Activities

3rd Annual HiPP Seminar for Network Providers, June 2005 will focus on the theme
of Stress Management for GPs. Speakers will include Dr Abbie Lane, Consultant
Psychiatrist, St John of God’s Hospital Stillorgan and Dr Patricia Murray,
Organisational Psychologist, Health and Safety Authority. The seminar will explore
how we can best harness the skills and resources within HiPP to deliver a
programme of stress management initiatives for use by GPs, to include time
management, self awareness, and measures to improve personal effectiveness in
order to achieve better work-life balance and overall wellbeing.
Invitations have been received to deliver presentations to GP training Schemes and
other meetings for later in 2005.

Future Plans

HiPP strength is its proactive and reactive approach to members needs.

§ Awareness: Arising out of the publicity of the 1st National Conference I had
increased contacts in particular from GPs family members who admitted they
had not been aware of HiPP. This has confirmed the benefits of marketing.
Feedback from presentations I made regionally have highlighted the need to
target the spouses / partners and families of GPs with information about HiPP
as a means of increasing the uptake of services by GPs.
§ Continuous and ongoing need for education and information on how to
prepare ourselves to withstand the risks to our health arising from the type of
work we do. HiPP may hold little relevance to GPs who feel they are healthy
today, but they may be in need of assistance tomorrow and need to know
what to do and who to contact for themselves or for a colleague without
undue delay. Marketing the services of HiPP is required on an ongoing basis
and every possible avenue must be used to maintain GPs awareness of
HiPP.
§ Promoting the cultural change from the medical professions ethos of
‘Physician heal thyself’ is inevitably going to be a slow process, we must build
on our success to date. This past year has shown the value of personal
contacts to instil trust and confidence in GPs and their families to use the
supports available. To this end I will be seeking the assistance of GPs and
HiPP Network providers to promote their own services locally. The ICGP’s
other national / regional networks will be asked to regularly highlight the role
of HiPP verbally and through distribution of flyers.
§ HiPP has a role in supporting the existing manpower in general practice, by
helping ill doctors back to good health and to productive work and by helping
to keep healthy doctors healthy. During the coming year it is hoped to focus
on health promotion and practical ways of improving the occupational and
personal well being of GPs.

Administrative Resource

I would like to pay a personal tribute to Ms Margaret Cunnane for her hard work and
support throughout the past year, and to Fiona Brophy and Niamh Killeen who
assisted with the heavy administration involved in delivering the successful 1st
National Conference on the Health of Doctors.

Dr Andrée Rochfort, Programme Leader