Occupational medicine in the National Health Service.

For many doctors working within the National Health Service (NHS), occupational medicine remains a specialty on the fringe of their awareness. Undergraduate exposure to the subject is limited in most medical schools and at postgraduate level health and safety training in relation to medical work is given little emphasis. The fact that the majority of those who work in occupational medicine are employed outside the NHS in commercial enterprises or government departments has tended to isolate them further from the mainstream of medical activity. During the past 15 years much has been done to overcome these barriers. The establishment of occupational medicine as a specialty within the framework of the Joint Committee for Higher Medical Training (JCHMT) has been one major advance which has led to the creation of posts considered acceptable for training and of a standard equivalent to other medical disciplines. There are now over 100 senior registrars working in approved training posts of this kind, most ofwhich are outside the Health Service. In tandem with this development, the Faculty of Occupational Medicine within the Royal College of Physicians of London was established in 1978 with three major objectives: to promote the advancement of knowledge in occupational medicine; to act as an authoritative consultative body; and to develop and maintain high standards of training, competence and professional integrity. These two initiatives have done much to raise the profile of occupational medicine and already many doctors are being attracted into an emerging specialty which combines clinical skills with a strong emphasis on health promotion and the prevention of ill health in the workplace. Within the NHS itself a further major development is taking place through the gradual establishment of Occupational Health (OH) Services for NHS staff, including medical staff, in hospitals and the community. This more direct interface with the profession may help to enable better understanding of the main aims ofOH activity and achieve higher levels of professional collaboration than have existed in the past.