The OH unit at Bradford Metropolitan District Council (BMDC) has introduced a pilot scheme where local GPs collaborate with OH advisers, HR staff and line managers to cut down on sickness absence among the authority’s employees.
The pilot began when the HR department commissioned an audit that looked at the effectiveness of the OH department, as part of a drive to reduce sickness absence levels at the council.
A report and subsequent action plan recognised that OH has a significant role in the management of attendance and that the OH team’s effectiveness and the referral process to OH needed examination in more detail.
The success of managing attendance (of which referral to OH is the first stage) depends on effective collaborative working between the individual, the manager, the HR adviser, OH and external professional support.
It is widely acknowledged that absence is a complex phenomenon and the factors that influence an employee to be absent from work are varied. Managers at BMDC felt the OH department slowed the absence management process down, due mainly to the length of time it had to wait for medical reports to be provided.
The OH department recognised that to provide a more efficient and effective service to both employees and managers, it needed to change its approach and become more business aware. The council felt this would result in OH as a department covering medical issues, management and employee responsibilities, and at the same time assisting in protecting the local authority from litigation.
To track the effectiveness of referrals, the authority decided that OH advisers would complete a database of their own appointments, which would then be audited.
The database looked at the following points:
The first day of sickness and the length of time absent before the line manager referred to OH
The length of time from receipt of the referral by OH to the appointment date with an OH adviser
The date that OH requested a medical report and the date it was received.
The results, in brief, showed that OH was providing a service that was mostly within the parameters of good practice. The audit showed 49.22% of referrals reached OH between 20 and 69 working days of absence (20 working days being recognised as long-term sickness absence), 20.49% of referrals reached OH after 70 working days of absence, and the longest referral was after 155 working days of absence.
Other results showed that following referral to OH, 38.94% of employees were seen by an adviser within 10 working days, 44.89% were seen within 11 to 20 working days, and 16.17% after more than 20 working days (usually due to cancellations by the employee).
Equally, the results for medical reports showed that OH received them back from doctors at a rate of 45.51% within 15 working days, 43.54% between 16 and 40 working days, and 10.95% over 40 days.
Following the audit, the OH department implemented a different system of working and a more business-like approach, recognising that early referral to OH has a positive impact in reducing the overall length of time an individual will have off work.
Equally, the research highlighted that OH could work more collaboratively with GPs by sharing the management of patients employed by the authority.
The OH department noted that the GP usually acts as the patient’s advocate and their report often supports the absence unequivocally. Furthermore, the GP only has the patient’s version of events to refer to.
OH decided to introduce a scheme that would enable GPs (with the consent of the patient/employee) to refer directly to the OH unit. This would enable the OH department to deal with any workplace issues and look towards adjustments and interventions to rehabilitate employees back into the workplace, while the GP would retain management of the medical aspects of the case, including treatment and sicknotes.
It is anticipated this will have a positive effect for GPs in that they will not use up valuable appointments trying to resolve occupational issues, particularly in relation to stress and back problems. The intention is that this system is used if the patient has not been referred to OH by management or made a self-referral to OH.
The OH team contacted local GPs, offering an incentive to take part in the approach, which pointed out that the OH unit offers a range of services, including:
Referral for psychiatric opinion
Referral for counselling, life coaching, neuro-linguistic programming and cognitive behavioural therapy.
Referral to fast-track physiotherapy
Referral to mediation services
Referral to access to work.
OH explained to GPs that these services were not intended to replace NHS referrals, but that managers will fund these interventions when it is anticipated there will be long delays.
Several GP practices contacted the OH unit after receiving the letter, and a series of meetings took place between interested GPs and an OH adviser to discuss the feasibility of the initiative in more detail. Another letter was then sent out with the purpose of instigating the initiative and proposing the pilot scheme.
Those taking part felt that excessive amounts of administration for either party would have a detrimental effect on the proposed initiative so a simple template was designed to offer direct referral as an option via e-mail or post.
The referral form was very simple but it made clear in writing that the employee, once they had signed it with their GP, was agreeing to OH involvement and also agreeing to the OH adviser contacting their manager. It was felt that this was particularly important when the sickness absence was caused by work-related issues that only management involvement could bring to a conclusion.
The advantages of this system are that it will produce very early referrals without removing managers’ need to refer. Each GP was issued with referral forms to fill in, so that at the first point of contact with the employee, the OH department had some medical information to work with.
In some cases, further reports may be required. The system enables the GP to be fully appraised of the work situation and this should assist them when writing reports as they will have knowledge of more than just the employee’s perception.
The response from GPs with regards to this new system of working has been positive. Furthermore, the approach is in line with government recommendations in the Health Work and Wellbeing strategy.
Research has also highlighted that the relationships between the GP and the employer, coupled with the attitude of the employee to early rehabilitation, represents the most significant barrier to effective management of sickness absence and, at its worst, can undermine all attempts by the employer to assist the employee. Bradford Council’s approach should help remove this barrier.
The OH unit intends to continue to collect data that reflects the timescales involved in the referral process, and it will also disseminate information that reflects where sickness absence is occurring and also the type of absence that is occurring. This data will be shared with HR and managers and it is envisaged that it will be available quarterly.
Spending to save
While OH is not in a position to influence NHS waiting times, the new approach encourages managers to be proactive and examine the merits of the business case when considering whether to fund treatment leading to early return to work. The sicknote is not a treatment and spending to save on prolonged absence is more cost-effective.
So far, 16 GP surgeries have requested the referral form and the pilot service has been set up. To monitor its effectiveness initially, the service is co-ordinated by one named OH adviser.
It is too soon to provide any conclusions but the response so far is looking promising, and direct contact between GPs and the OH department has increased.
Julia O’Reilly is OH nurse adviser and Susan Gee OH manager at BMDC Health and Wellbeing Unit.
Butt, M, Improving Staff Attendance – improvement review (2006)
Luz, J and Green, M D (1997) Sickness Absenteeism from Work – a critical review of the literature. Public health review 25:89-122
Health, Work and Wellbeing – Caring for our future, HMSO, 2006
GP and employee resistance slows OH impact on absence, Occupational Health, July 2007, Vol 60, p5
When Bradford Council set out to reduce sickness absence among its staff it collaborated with local GPs. Julia O’Reilly and Susan Gee outline how the scheme works.
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