Dr Richard Preece believes cuts are unavoidable, but they do not need to be painful. He explains some options to save more money.
The focus on reducing costs has rarely been keener. Almost all OH units face the challenge of doing more with less and most believe that this is not possible without increasing pressure on the team or losing services. In reality this is usually not the case.
Why is it that our GP colleagues manage the illnesses of their patients in a 10-minute consultation and we often take 45 minutes to look at only the occupational perspective (albeit in more detail)? Why is there so much variation in the cost of services broadly doing the same things (see NAO 2003 report)?
Where do cost efficiencies lie?
1. Get the right people doing the right things
Make sure that computers are producing letters, healthcare assistants are doing surveillance and immunisation, specialist nurses are managing a case load independently, and specialist doctors are dealing with only the most complex issues.
2. Change the skills mix
There is virtually nothing in OH for which we need medical registration (such as for Health and Safety Executive appointed work). Specialist nurses prescribe, do surgical procedures and manage complex disorders. Why then employ so much medical time and why engage any medical time for doctors without specialist registration? Make sure that OH nurses are properly trained in specialist/advanced practice and reduce medical costs.
3. Pay the right amount
Don’t overpay specialist nurses that aren’t doing or capable of doing truly specialist work and don’t underpay proficient staff so you end up employing cheaper but incompetent ones. If you don’t need a full-timer, then employ only part time. If this means a partial redundancy then so be it.
4. Re-engineer pre-employment assessment
Mostly it’s a waste of time, some of it is illegal. Anyone or any computer can check that the “no” boxes are ticked. Change the process to one that’s both evidence-based and efficient.
5. Produce shorter letters
Say in 10 words what you previously said in 100. Don’t tell managers things they already know (like the job of their member of staff).
6. Write your own letters
Learn to touch type or use dictation software. Consign the dictaphone and secretary to history. Clinical resource has far more value than someone transcribing your letters when a computer can do this for next to nothing.
7. Reduce operating hours
Nine-to-five service is nice but is it really needed? Nine-to-four for four days, and nine-to-one on Friday is 20% less.
8. Channel work
Make it easy for customers to make it easy for you. Insist on electronic referrals that are quicker, cheaper, and easier to store.
9. Target non-attenders
Make sure patients know upfront that appointments are costly. Send them SMS text and email reminders. Encourage managers to take action against repeated non-attenders (even charge non-attending patients a fee as one organisation does).
10. Reduce appointment duration
Make 45-minute appointments into 40-minute appointments and improve productivity by 10%. Do the same for all others and manage the diary sensibly by scheduling at convenient times. Nobody minds getting the train at 10:18 so why should round numbers matter in clinic?
11. Increase teleconsultation
There’s no travel between clinics, no need for a reception desk, no delaying exchange of pleasantries, no dull monologues, and a keener focus on purpose.
12. Improve meetings
Be selective about those you attend and then make sure that those have an agenda and agree meaningful actions. Reduce travel to meetings by using teleconferencing, videoconferencing and webinars.
13. Make do
Be relaxed about the result. Few people expect or pay for the perfect output and rarely does it matter that much. Aim for “good enough” and “fit for purpose”.
Cutting a swathe through OH service costs may be personally painful – nobody wants to argue themselves out of a job – but far better that the process is led by ourselves than others. If you can’t take 10% to 20% out of OH costs then someone else will.
NAO (2003) A Safer Place to Work.
Dr Richard Preece is a consultant occupational physician.