Information for appointed doctors

Background

Under the Health and Safety at Work etc Act 1974, the HSE Employment Medical Advisory Service (EMAS) has a wide range of duties and responsibilities. One of these is the periodic medical supervision of employees who work with specified hazards under certain conditions. These conditions are outlined in relevant regulations and where the nature of the work brings employees within those regulations, monitoring their health is called ‘statutory medical surveillance’. This is synonymous with ‘occupational health surveillance’.

HSE appoints registered medical practitioners to undertake statutory medical surveillance. This is done by issuing a Certificate of Appointment under the appropriate regulations. It authorises the appointed doctor to conduct medical surveillance under specified regulations for a stated period.

The standards for conducting medical surveillance are set out in general and regulation specific guidance for appointed doctors.

Although appointed by HSE, appointed doctors are not employed by HSE. The company requiring statutory medical surveillance is responsible for agreeing conditions of service and payments with the appointed doctor.

Appointed doctors are accountable to HSE for the work they carry out. They work under the supervision of the HSE Senior Medical Inspector who issued the Certificate of Appointment.

The appointment process

As an appointed doctor, you are responsible for achieving and maintaining your own competence as required by the General Medical Council (GMC). The GMC introduced a licence to practise and revalidation system to ensure doctors are fit to practise.

It is important for HSE to have appropriate governance arrangements to monitor competence for the specific role of an appointed doctor. This is reflected in the procedures detailed below for new applicants and review of existing appointed doctors. They update the procedures set out in the General guidance for appointed doctors. You should be familiar with this guidance as it contains further information on the role and responsibilities of appointed doctors in statutory medical surveillance.

As part of the appointment process, you should demonstrate you have access to appropriate facilities and equipment for conducting medical examinations.

You are required to commit time to visiting the workplace to familiarise yourself with the activities to which the regulations apply, the conditions in the workplace and the workers under medical surveillance. You should visit the workplace before undertaking medical surveillance and then periodically, particularly where there is a likelihood of identifying a health risk (eg by a blood test).

How do I apply for an appointment?

Where medical surveillance is required under relevant regulations, the employer duty holder is responsible for finding a suitable appointed doctor. In the first instance, the employer should consider using the services of a doctor already appointed by HSE. If an appointed doctor is not available, the circumstances may require the assistance of another doctor (eg, a local GP or a doctor in their own occupational health service) who will need to apply to HSE for an appointment (see moratorium on new applications).

To apply for an appointment, you should complete application form FODMS38AB (the employer should complete Part 1 of the form) and provide HSE with the following information:

• A copy of your CV.
• Evidence of registration and licence to practise from the GMC.
• A copy of your certificate for the Diploma in Occupational Medicine as a minimum qualification.
• For an appointment under the Ionising Radiations Regulations, an ionising radiation training certificate (see Training).
• For an appointment under the Work in Compressed Air Regulations, evidence of specialist knowledge in hyperbaric medicine (see Training).
• A copy of your last annual CPD certificate.
• A copy of the covering sheet of your last annual appraisal report containing the date of appraisal and signature of appraiser (do not send the full report).
• A copy of your professional indemnity.
• A description of the facilities where medical surveillance will be conducted (please provide digital photographs).
• For an appointment under the Control of Asbestos Regulations, a calibration certificate for the spirometry equipment.
• For an appointment under the Work in Compressed Air Regulations, calibration certificates for the audiometry and spirometry equipment.
• Details of medical and administrative support available for conducting medical surveillance, including numbers and grades of medical, nursing and administrative staff.

The application form and information requested above should be sent to: Corporate Medical Unit, Health and Safety Executive, Redgrave Court, Merton Road, Bootle, Merseyside, L20 7HS.

On receipt of a full package of information, an HSE Medical Inspector will assess your application. If successful, HSE will issue you with a Certificate of Appointment, normally for one year in the first instance, and a Schedule containing company details. During this period, you cannot work for more than one company under each set of regulations you are appointed. The certificate is not transferable and you are responsible for ensuring you do not work beyond the expiry date on it unless issued with a new certificate.

How does HSE review my appointment?

To ensure your ongoing competency for the role of appointed doctor, HSE will normally review your appointment before your certificate expires. This will be by paper review or face to face visit. You will be assessed against standards based on the regulation specific guidance for appointed doctors and the general administrative standards set out in Appendix 1 of General guidance for appointed doctors.

Paper review

When HSE notifies you that your review is due, you should submit the following information:

• Evidence of registration and licence to practise from the GMC.
• Any occupational health training specific to appointed doctor work since your last review, including copies of any certificates (eg ionising radiation or hyperbaric medicine refresher training).
• A copy of your last annual CPD certificate.
• A copy of the covering sheet of your last annual appraisal report containing the date of appraisal and signature of appraiser (do not send the full report).
• A copy of your professional indemnity.
• If appointed under the Control of Asbestos Regulations, a calibration certificate for the spirometry equipment.
• If appointed under the Work in Compressed Air Regulations, calibration certificates for the audiometry and spirometry equipment.
• A sample of medical records for at least three workers (copies only, do not send original documents), for each set of regulations under which you are appointed, including both male and female employees. You should provide records for both the first and last medical examination for each worker included. If appointed under the Control of Lead at Work Regulations, one of the medical records should be for the employee with the highest blood lead level recorded since your last review. Records should be marked ‘medical in confidence’ when sending by post.
• A completed Review of Appointment Declaration.

On receipt of a full package of information, an HSE Medical Inspector will conduct a review. If appropriate, HSE will issue you with a new Certificate of Appointment for 1-5 years.

Face to face visit

Under certain circumstances, an HSE Medical Inspector will require a face to face visit to review the appointed doctor. You will be contacted in advance if a visit is deemed necessary. In considering the need for a visit, the following will be taken into account:

• The nature of the work, including the hazard, risk and number of employees under medical surveillance.
• An unusually large or small workload. Ideally, established appointed doctors should conduct an average of at least 10 medical examinations a year to help maintain their competence.
• A need to inspect the facilities and equipment used to conduct medical examinations.
• Complaints or concerns about the appointed doctor’s performance.
• New appointed doctors undergoing their first review.
• Random visits to validate the performance of a sample of appointed doctors.
• Resources available to undertake the review visits.

Addressing inadequate performance

When conducting your review, the HSE Medical Inspector will record any issues of concern identified and inform you in writing. On receipt of the letter, you must respond within 10 working days confirming when and how you will address the areas of concern. The Medical Inspector will then decide what further action may be necessary. This could include:

• following your review with an immediate face to face visit to discuss in detail the areas of concern and proposed action plan;
• issuing a Certificate of Appointment with a reduced validation period (eg one year);
• requesting your next review is by face to face visit;
• recommending your Certificate of Appointment is revoked by the Senior Medical Inspector (see below).

If a Medical Inspector has serious concerns about your performance that require urgent action, they will initially contact you by telephone and subsequently follow the procedure outlined above.

Ultimately, the Senior Medical Inspector (who issued your Certificate of Appointment) has the power to revoke your Certificate of Appointment at any time, if your work as an appointed doctor is unsatisfactory.

How do I extend my appointment?

Established appointed doctors can extend their appointment to cover additional regulations and/or a new company. You should complete Parts 2 and 4 of form FODMS38AB, ensure the employer completes Part 1, and submit it to HSE Headquarters. An HSE Medical Inspector will decide whether the additional appointment is necessary. If appropriate, HSE will issue you with an amended Certificate of Appointment and/or Schedule.

How do I arrange cover for absence?

If you require short-term assistance because of holidays or other protracted absence, a temporary appointment may be required until you can resume your duties. To request a temporary appointment, you should seek an established appointed doctor and submit their name and PIN number to HSE Headquarters for verification. An HSE Medical Inspector will then decide whether to agree the temporary appointment.

Appeals

You may appeal against a decision:

• not to issue you with a Certificate of Appointment;
• to impose conditions on your appointment;
• to revoke your Certificate of Appointment.

If you wish to appeal, you should submit your request within three months of receiving formal notice of the decision. You should provide documentary evidence in support of the appeal and send the request to:

Chief Medical Adviser
Corporate Science, Engineering and Analysis Directorate
Health and Safety Executive
Redgrave Court
Merton Road
Bootle
Merseyside
L20 7HS

Complaints

If there is a verbal complaint made about your work as an appointed doctor, HSE will request written confirmation. To investigate a formal, written complaint, HSE may ask you to provide written comments in response. Alternatively, an HSE Medical Inspector may visit you to gather evidence on which to base their judgement.

Training

To provide medical surveillance for workers exposed to ionising radiation or work in compressed air, appointed doctors must undertake specific training and maintain up to date knowledge. Completion of an initial training course in itself does not guarantee that HSE will grant an appointment.

Ionising radiation

The doctor must complete an initial one-day course followed by a one-day refresher course at least once every five years. The following organisations can provide suitable courses (inclusion in the list does not imply HSE approval or accreditation):

Healthy Working Lives Group
Public Health and Health Policy Section
Faculty of Medicine
University of Glasgow
1 Lilybank Gardens
Glasgow
G12 8RZ
Tel: 0141 330 3719

Institute of Naval Medicine
Training Division
Crescent Road
Alverstoke
Gosport
Hampshire
PO12 2DL
Tel: 023 9276 8091

Robens Centre for Occupational Health and Safety
4 Huxley Road
Surrey Research Park
Guildford
Surrey
GU2 7RE
Tel: 01483 686690

Wellwork Ltd
Wingrove House
Ponteland Road
Newcastle upon Tyne
NE5 3DE
Tel: 0191 286 9927

Work in compressed air

A doctor appointed to provide medical surveillance in relation to work in compressed air should have the same level of training as an HSE Approved Medical Examiner of Divers (AMED).