Moving to positive work capacity certification

Welcome to our web page on work capacity certification, in which we cover how ACC is working with GPs and Nurse Practitioners (NPs) to help their injured patients to safely recover at work or return to it quickly and safely.

We’re focussing on supporting GPs and NPs to make informed clinical decisions on medically certifying patients for time off work, through PHO-based services that deliver certification training programmes and through providing review and guidance to individual GPs and NPs on certification practice.

In addition we’re making it easy for them to talk to us to get access to the vocational rehabilitation services their patients need to quickly ands safely get back to work and everyday lives.

In October 2012, GPs and NPs will have access to these services, and over time we expect to see a shift in certification patterns in favour of fit for selected work as they move towards best practice certification.

Why we are doing this

Where clinical circumstances require, time off work is appropriate. But ACC data shows that many patients are being ‘signed off’ as fully unfit for work when returning to work would be of more clinical benefit.

For example, between March 2010 and April 2011, 12,419 claims remained certified as fully unfit for work (FUF) for 60 days (8 weeks) or more and 7,882 of these claims were being certified unfit where the duration of disability exceeded the Medical Disability Adviser (MDA) maximum duration guidelines. In many cases, these durations were not clinically justified. Certification practice therefore seems at variance with best practice durations for a range of injuries.

This has significant implications for patients because being off work creates a barrier to workplace rehabilitation, and research shows personal consequences can be significant. Initial time off work can quickly give way to loss of motivation, disengagement from everyday life, tight finances and, sometimes, loss of a job. Longer term, being off work can lead to increased morbidity.

There is a growing acceptance within the medical profession that this is the case, both in New Zealand and internationally. The 2010 Royal Australasian College of Physicians position paper on the issue Realising the Health Benefits of Work, endorsed by all significant medical professional groups in New Zealand, compellingly sets out the research on the health benefits of work. It can be found at the Royal Australasian College of Physicians website.

What we are we doing

ACC wants to minimise the health consequences of being out of the workplace. But to do so, we need the co-operation of GPs and NPs who, through work capacity certification, largely control when clients can return to work.

We are working with the medical profession and GP professional groups in particular, to bring about a cultural shift. We want to facilitate a shift from the current focus on what an injured worker can’t do – which leads to time out of the workplace – to a focus on what they can do – which promotes workplace recovery or early return to work.

New services

The outcome of this work is two new services:

Clinical Review of Fitness for Work (CRFW)

Focuses on providing expert clinical certification support for individual GPs/NPs in the form of a clinical review of selected patients which require more focus to achieve a successful return to work.

General Practice Support Services (GPSS)

Focuses on working with PHOs to build understanding of best practice certification among GPs/NPs and effect a shift in certification patterns that support early return to work.

Both services reflect ACC’s objective of raising medical awareness of the clinical importance and relevance of accurate determination of fitness for work as the cornerstone of successful, early and safe return to work.

More information on these services and the background to them is contained in the updates section below.

Updates on service design

Regular updates on these initiatives will be available on this site.

Background to proposals for positive change

Our starting point in the culture change process was the development of a package of integrated initiatives clustered around the idea of making it easy for GPs to change: using smart forms, activating support services for GPs and providing feedback to them on their certification practices. When seen as a whole, it’s a compelling package that should help transform certification practice.

The key elements of the package were to:

Introduce richer, smarter forms that can activate services – developing simple but effective forms that make it easy for GPs to engage with return to work. So we’re reviewing the claim form (eACC45) and the medical certificate (eACC18) to make them user-friendly and focussed on return to work.
Provide return to work support for GPs where it’s needed – GPs need the confidence that ACC will quickly help patients if they certify them as fit for selected work. We will progressively introduce changes to the eACC18, and introduce an eACC45 which will enable GPs to directly request help with return to work services. Specialised staff at ACC will review and act on these requests. The pressure will be on ACC to perform.

Similarly, GPs will be able to request help with certification. It’s an acquired clinical skill, so we’re going to make expert resources available to GPs who need advice on how to help a patient back to work. The service will be called clinical review, and will use practitioners with experience and knowledge in occupational medicine.
Give detailed feedback on certification patterns – it’s important to keep GPs and their PHOs abreast of certification practices so they can compare their performance with their peers. We’ve resumed individual feedback reports to GPs on their certification patterns; we’re also going to provide them for PHOs and use the information to recommend/provide training on certification where it’s needed.

Sector response

These initiatives were discussed in October 2011 in ACC Forum – Implementing the Health benefits of Work, where they received general stakeholder support from the range of stakeholders invited to the discussions.

These included representatives from the New Zealand Medical Association, the Royal New Zealand College of General Practitioners, District Health Boards, the Accident and Medical Practitioners Association, the New Zealand Orthopaedic Association, Maori Medical Practitioners Association and PHOs.

To recognise the broader relationships involved in return to work, Physiotherapy New Zealand, the New Zealand Association of Occupational Therapists, the New Zealand Occupational Health Nurses Association, Business New Zealand and the New Zealand Council of Trade Unions were also invited.

There was general support for the direction of the initiatives. The consensus was that, when combined, they could provide a co-ordinated set of ‘levers’ that could positively support and influence certifiers’ approach to time off work and trigger the process of enabling an early return to work for their patients.

In December we discussed three of the initiatives in more detail – request for return to work support, clinical review and feedback – with GP organisations as part of the development process. Stakeholders were generally favourable, and we are working on building their comments into the final design of the initiatives.

Implementation of the initiatives

The positive stakeholder feedback we’ve received makes us confident we are heading in the right direction. We will continue to work with the stakeholders on the details of our proposals, and we will provide updates for the sector through this web site and directly to professional organisations.

Our goal is to implement these initiatives in late 2012.

More information

Publications

Overview from Dr Kevin Morris

Read the article Making a difference through positive certification, by ACC’s Director of Clinical Services, Dr Kevin Morris, about the new approach to certification.

Last updated: 23 May 2012