The recent editorial encouraging the integration of occupational health and primary care1 was inspirational but seems a long way from any reality in England.
When Dame Carole Black reported her findings and proposals on work and health it was difficult to resist the rhetoric. Work is good for you in determining your self and worth as long as the work is ‘good'.
Charles Handy2 describes the characteristics of organisations and individuals in organisations using four dimensions, four Greek Gods as their embodiment, and how the cultures they represent interact and have impact upon individuals within the organisation. He describes how social values and expectation have changed from the post war acceptance of authoritarian structures/organisations (The God Apollo). Increasingly we all want to be valued and have a share in the ‘fruits' of our collective effort (The God Dionysius).
In the context of health and work, he describes how the great efficiency driver of Apollo, the bureaucratic organisation, so devalues the members that they resort to disruptive behaviour and demonstrate ill health. In Apollonian organisations, where members have little control or discretion about the work, the impact cannot be good, that is, good work is squeezed out. This undermines Dame Black's central tenet. If getting clients back to work is to succeed the work has to be good or else it results in further dysfunction and ill health. The challenge of her work requires a revolution of workplace culture to humanise the workplace without compromising its viability.
This editorial reinforces my experience in general practice that change will not be achieved by indoctrinating/forcing GPs to fill in a different form (Med3) in the hope that employers will do what is right and good for the client.
- © British Journal of General Practice 2013
