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Introduction

Railway medical assessments are now undertaken by all levels of clinicians to ensure medical fitness to work in a safety critical environment and comply with legislation.

Guidance published by the Office of Road and Rail states that the railway company has responsibility to use the services of a competent doctor and all occupational health providers maintain clinical governance over their services to the industry.

ARIOPS recommends that railway clinicians are classified into three groups to align with ORR, London Underground and Network Rail requirements: –

  • Recognized Doctors” are those on the ORR List who take overall responsibility for train or tram driver medical assessments under the Train Driving Licences and Certificates Regulations 2010 (TDLCR).
  • Responsible Doctors” are those who take overall responsibility all rail and infrastructure workers as well as those who work on behalf of London Underground, Network Rail and heritage railways etc.

  • Medical Examiners” are those who perform rail medical assessments under the delegated authority of a Recognised or Responsible Doctor and may include doctors, nurses or technicians.

The following are recommended as minimum competency requirements for these three groups.

It is the duty of any doctor, nurses and technicians practising railway work must gain an understanding of the environment of the individuals and organisations for which they provide advice. All doctors should follow the principles and procedures contained within Guidance from the Faculty of Occupational Medicine and follow the Good Occupational Medical Practice”; FOM; August 2010.

Recognised and Responsible doctors and nurses should be able to produce evidence of development of knowledge and experience in all the areas described below as part of a rolling 5 year programme of Continuing Professional Development and Revalidation for doctors. For both Recognised and Responsible Doctors – the senior practitioner in health providers should adopt the role of clinical governance and periodically undertake audits.

ARIOPS will not audit or certify compliance with these recommendations. However, ARIOPS recognises that the recommendations may be referred to by rail duty holders or regulators when assessing the competency of railway medical advisors.

It will become an ARIOPS recommendation for all Responsible and Recognized Doctors and nurses to attend the forthcoming railway health training course.

Competency recommendations for Recognized Doctors

Requirements either;

  • Accredited Specialist in Occupational Medicine

  • Specialist Registrar in an approved training post whose supervisor is also a railway Recognised Doctor.

  • AFOM

  • Diploma in Occupational Medicine as minimum qualification

  • Re-validated with the General Medical Council

  • Registered Medical practitioner with General Medical Council

RAILWAY KNOWLEDGE

Regulatory framework and structure of the Railway industry

  • Department for Transport

  • Office of the Rail and Road

  • Rail Accident Investigation Branch

  • Rail Safety & Standards Board (RSSB)

  • Main Trade Unions

  • The railway group: Network Rail, Train operators, Freight companies, Track renewals and

ancillary companies.

  • Where relevant, knowledge of comparable EU organisations

Requirements for the management of fitness for work on the railways

  • Regulations:

    • The Railways and Other Guided Transport Systems (Safety) Regulations 2006

  • Railway Group standards:

    • The Train Driving Licenses and Certificates Regulations 2010 Schedule 1

    • RIS-3451 TOM issue 1 –Train Drivers

    • RIS-3452-TOM issue 1 – Train Movement

    • GO/GN 3655 Guidance on Medical Fitness for Railway Safety Critical Workers

  • Fitness standards owned by the rail duty holder

  • RSSB good practice guidance

  • Professional guidance notes:

    1. DVLA At-a-glance guide

    2. ARIOPS guidance on specific issues

    3. Occupational Health Provider’s own guidance

Drugs & Alcohol in relation to Railway Work

  • Transport & Works Act offenses

  • RSSB guidance on Drugs & Alcohol

  • Drugs & Alcohol policy of the duty holder

  • Role of the Medical Review Officer

 

EXPERIENCE

Medical

  • 2 years full-time equivalent in occupational medicine

  • 1 year full-time equivalent as a rail Medical Examiner undertaking periodic medicals and management referrals under supervision of a Recognise/Responsible Doctor.

  • Clinical Governance experience

Railway operations

  • Undertake Periodic Driver Medicals i.e. 10 per year
  • Cab ride to understand fitness requirements for train drivers
  • Observe train staff on board.

  • Visit a track maintenance depot

  • Visit a train-care depot or freight yard; climb into a train from track level; observe shunting procedures.

  • Observe working of rail staff in a station including gateline, travel center, customer care and train dispatch.

  • Understand the working of train managers

  • PTS requirements

UNDERSTANDING OF RAIL INDUSTRY

  • Interfaces with other parts of the railway system managed by the duty holder and how a lack

of medical fitness may undermine these management systems

  • How knowledge and experience may be applied in the assessment of risk of significant

impairment in ability to perform railway work tasks posed by general health conditions.

  • How knowledge and experience may be applied to advise railway employers on possible

safe systems of work where a significant risk has been determined

Competency requirements for Medical Examiners under Recognized Doctor governance

REQUIREMENTS

  • Full registration as a medical practitioner with Diploma in Occupational Health.

  • Occupational Health Adviser is an NMC registered practitioner with recognized degree

  • Health Surveillance nurse working to written rail protocol with training and supervision registered with the NMC.

  • Occupational Health Technician is a non-medical person working to written rail protocol with training and supervision.

KNOWLEDGE

Railway standards

  • The Train Driving Licenses and Certificates Regulations 2010 Schedule 1

  • RIS-3451 TOM issue 1 –train drivers

  • RIS-3452-TOM issue 1 –

  • RSSB good practice guidance

  • Professional guidance notes

    1. DVLA “At-a-glance” guide

    2. ARIOPS guidance on specific issues

    3. Occupational Health Provider’s own guidance

  • Fitness standards owned by the duty holder

    1. RSSB guidance on Drugs & Alcohol

    2. Drugs & Alcohol policy of the customer

EXPERIENCE

  • 1 year full-time equivalent rail experience after gaining full registration for doctors and nurses.

  • A suitable and appropriate period practice in the railway industry, supervised directly by the Recognised/Responsible Doctor.

Railway operations examples include;

  • Cab ride to understand fitness requirements for train drivers

  • Observe rain staff on board.

  • Complete PTS classroom training

  • Visit a track maintenance depot

  • Visit a train-care depot or freight yard; climb into a train from track level; observe shunting procedures.

  • Observe working of rail staff in a station including gateline, travel center, customer care and train dispatch.

  • Understand the working of train managers

  • PTS requirements

UNDERSTANDING

Medical Advisers should have a level of understanding appropriate to their delegated authority. They should also have ease of access to advice from the nurse supervisor or Recognised/Responsible Doctor.

Network Rail Competency

Responsible Occupational Physician (Recognized Doctor)

An Accredited Specialist in Occupational Medicine on the GMC Register.

They are competent to give advice on fitness for railway work in general and safety critical work in particular. Such a specialist will be able to show current evidence of knowledge, experience, skills and understanding relevant to occupational health practice in the railway industry.

Medical Examiner:

Occupational health technician, nurse, advisor, or occupational physician who is responsible for performing medical assessments on behalf of the Responsible Occupational Physician

Clinical governance for medical examiners:

All approved occupational health providers shall have a Responsible Occupational Physician.

The Responsible Occupational Physician shall make arrangements to assess the competence of Medical Examiners, audit their work and provide Medical Examiners with advice in case of doubt.

The occupational health provider shall make and document arrangements for quality assurance and clinical governance that reflect current evidence based guidelines and national guidelines.

This shall include the following:

a. processes for the management of competence, recruitment, supervision and continuing professional development of staff;

b. occupational health professionals shall carry identification cards for all site visits detailing their name, job role and the name of the approved occupational health provider they work for;

c. a defined management structure for the delivery of clinical protocols, risk management, internal audit and review of their delivery; and

d. arrangements to detect and address, as early as possible, unacceptable clinical practice and concerns regarding a member of staff’s conduct, performance and health.”

Transport for London London Underground Medical Competency

Providers of Medical Assessment for Track Certification and other Safety Critical Certification Purposes

Medical Competence

Medical assessments must be conducted by or under the supervision of an occupational physician on the GMC specialist register as a specialist in Occupational Medicine (and must hold the MFOM or European equivalent as a minimum qualification) with an understanding of the hazards of the London Underground track-side environment, who shall be designated the ‘Responsible Doctor.

The Responsible Doctor shall ensure that persons conducting medical assessments or tests are fully competent to do so and that they maintain records of a relevant programme of ongoing professional development.

Mandatory attendance at the LU Familiarization and Track Appreciation training course is required of all persons who will be conducting or supervising medical assessments prior to such being undertaken by them. The training covers the requirements of the standards and the clinical guidelines required to carry out assessments within the LU railway environment, and also provide awareness of the LU track environment.

Where nurses are acting in a supporting role in the assessment of employees i.e. the individual is ultimately physically seen by a doctor then it is accepted that they need not attend training.

Where nursing staff are undertaking the examination with the doctor making an assessment on information provided by the nurse and not physically seeing the client, nursing staff must attend the familiarization course.

The LU Familiarization & Track Appreciation training course must be attended every 2 years.

In the event of changes in staff employed (including agency staff or locums), the Responsible Doctor shall ensure that such persons are fully competent to do so, and must attend the LU Familiarization & Track Appreciation training course and that they maintain records of a relevant programme of ongoing professional development. This includes staff who transfer between service providers.

Records shall be kept of such training. LU may also audit these records from time to time.

LU has the right to terminate the service provider’s accreditation