Thor-gP clinical guidelines

Clinical Guidelines for THOR-gP reporting

New cases, diagnosed by you in your general practice clinic during a specified month as being caused or aggravated by work exposure or working environment should be recorded. Cases diagnosed by you outside a specified month should not be reported, as this would lead to an overestimate of cases.

Please note that you do not need to have made a "specific" diagnosis in order to report a case. We rely on the physician's clinical judgement for many case reports.

Amongst the groups of doctors that we have studied, for most the decision on whether a disease is work-related depends on the clinician’s judgement on the balance of probabilities (whether it is more likely than not).

In reaching this judgement many doctors consider

  • Whether the disease would have occurred in the absence of work exposure,
  • Or whether work exposure was a major factor in causation,
  • Pre-existing illness in which work conditions made a substantial difference to severity may also be included in the consideration.

Frequently reported conditions

Examples of conditions frequently reported in other THOR schemes are:

Date patient seen Diagnosis/ Symptoms Job Industry Task/ suspected agent
June 2006 Contact Dermatitis- Allergic Hairdresser Beauty Hair dyes
March 2007 Depression/ Anxiety Secondary school teacher Education Workload and bullied by colleagues
August 2008 Hand arm vibration syndrome Grinder Steel Vibrating Tools
January 2009 Asthma Paint Sprayer Manufacturing of motor vehicles Isocyanates

Occupational disease or injury

Major groups of occupational disease or injury are outlined below:

Musculoskeletal

Including disorders affecting:

  • Back or neck,
  • Upper limbs (including shoulders, elbows, wrists and hands),
  • Lower limbs (including hips, knees, ankles and feet).

The following should be included: carpal tunnel syndrome/tendonitis/writer's cramp/vibration white finger/hand arm vibration syndrome/occupational injuries e.g. lacerations, fractures, muscle strains, etc.

Stress/mental illness

  • Anxiety/Depression: Include cases with symptoms of either disease (please specify if possible, or say "mixed"),
  • Post-traumatic stress disorder: Include cases where the event or causal circumstances occurred at work,
  • Other work related stress: associated with work: include distress and disorders relating to adjustments or change in work-related circumstances,
  • Alcohol or drug abuse: cases where the illness is either the result of working conditions or where access to substances at work have helped precipitate or sustain the illness,
  • Psychotic episode: where cases caused or precipitated by work (including toxic exposure),
  • Other problems: agoraphobia, obsessive/compulsive disorder etc. (if caused or aggravated by work).

Skin

  • Contact dermatitis: allergic, irritant, mixed or unknown,
  • Contact urticaria: denoted by immediate hypersensitivity,
  • Inflammatory: for example, folliculitis,
  • Infective: for example, tinea, warts, scabies,
  • Traumatic: dermatitis and callosities caused by mechanical trauma,
  • Neoplasms: skin neoplasia (keratosis, BCC, SCC, melanoma) caused by radiation, occupational sun exposure or chemicals,
  • Nail problems: chronic paronychia and dystrophies caused by physical or chemical occupational contact,
  • Other dermatoses: include low humidity dermatitis, scleroderma-like disorders and ulceration.

Respiratory

  • Asthma: cases where the agent acted either as a sensitiser or an irritant (please specify which, if known),
  • Inhalation accidents: denoted by acute respiratory systems due to inhalation of toxic gas or fumes,
  • Bronchitis/emphysema: includes cases in which occupational exposure is believed to be an important factor,
  • Infectious disease: for example, TB acquired through work,
  • Non-malignant asbestosis related pleural disease: includes plaques, diffuse thickening, effusions,
  • Mesothelioma: report all cases with or without evidence of occupational exposure,
  • Lung cancer: includes cases in which occupational exposure is considered an important contributing factor, regardless of smoking habit,
  • Pneumoconiosis: includes pulmonary fibrosis due to coal, asbestos, silica, talc, etc,
  • Other respiratory illness: for example, building-related illness, byssinosis.

Hearing loss and other ENT conditions

  • Occupational deafness (defined as "sensorineural hearing loss due to occupational noise amounting to at least 50dB, being the average of hearing loss at 1, 2 and 3 kHz frequencies"),
  • Rhinitis due to occupational exposure: agricultural workers, florists, etc,
  • Dysphonia / speech disorders relating to work: teachers, professional singers, etc,
  • Any other ear / nose / throat disorders relating to work.

Miscellaneous (this includes infection not elsewhere mentioned)

You are encouraged to report other serious diseases which, in your clinical judgement, were caused by work. These might include:

  • Cancers (e.g. bladder cancer associated with work exposure),
  • Blood dyscrasias,
  • Nephritis,
  • Hepatitis (e.g. health care workers),
  • Leptospirosis (e.g. agricultural workers).

We also are interested in receiving information on other or suspected new diseases caused by work, for example those relating to "new" industries or exposures.

Additional (non-clinical) information

Please input the following details for each case onto the web form:

Diagnosis (see above) - please provide as much detail as possible, however in reality this may not be very specific (e.g. elbow pain relating to packing boxes in an office worker).

The reference number YOU assign to the case - this is to help you to identify the case.

Age - age when diagnosed.

Postcode - please give the first half of the postcode if possible (e.g. M13), or postal town if not.

Job - type of work (e.g. florist or welder). Be as specific as possible (machinist, assembler, process worker can be difficult to code without more detail).

Industry - the industrial group of the patient's employer. Be as specific as possible (e.g. for engineering we need to know the product manufactured and for cleaning we need the site of work, such as hospital).

Activity/Event/Agent/Exposure - please be as specific as possible, e.g.

  • 'Chicken de-boning' rather than 'repetitive work',
  • 'Interpersonal difficulties with line manager' rather than 'work stress',
  • If giving proprietary names, please try give the active agent if known.

Sickness Absence and Fit note information

Please specify the patient's fitness for work, by selecting one of the three following options

  • Yes,
  • No, sickness absence certified,
  • Yes, but adjustment recommended.

If sickness absence has been certified, provide any available information on the certification (issue and duration) and days absent (e.g. self certification) prior to consultation with you. Please could you also inidcate whether, when issuing certification, you would expect the condition to be resolved at the end of the duration of the certificate (e.g. if issuing a note for 2 weeks, whether you expect the patient to be able to return to work at that time, or whether you have issued a 2 week certificate as you wish to review the individual in 2 weeks time).

If Fit note advice has been given, select as many of the options (see below) in the Fit note section as required

  • A phased return to work,
  • Amended duties,
  • Altered hours,
  • Workplace adaptations.

Any information on other adjustments recommended, or other comments can be given in the 'Other adjustments/conditions or comments'.

Specialist referral - please indicate if you have referred the patient to a specialist. Please report the case even if you think that it might also be reported by a specialist (for example, a dermatologist might report the same case if you referred a patient with work-related contact dermatitis).

Pattern of exposure - is the problem related to a single event or to repeated exposure?

Nothing to report - if you have no relevant cases to report in a reporting month, it is important to let us know this information by entering the relevant month and year and returning a form indicating "no cases to report". This should be done at the end of the month.

If you have any queries about any of the above guidelines please do not hesitate to contact the THOR-gP team for further information. We welcome any queries or suggestions about these guidelines, as we constantly seek to improve them.

Further information