Choosing an occupational health provider

Choosing an occupational health provider

Choosing the best occupational health provider for your organisation can be challenging. There are so many considerations.

One of the things I would always advise, no matter how big your contract, is to avoid using a tendering company at all costs. In my experience, tendering companies over complicate the process to make themselves appear necessary in the selection process. In truth, it’s more about speaking with a few providers and understanding their capabilities, strengths, weaknesses and pricing structures. If they’re anything like us, they will be very honest about all the above.

I have heard so many tales about organisations who selected their new provider using a tendering company and portal, that arbitrarily precludes suitable providers, and recommends unsuitable ones, because they have been creative with their pricing to make themselves appear cheap. Tendering portals don’t consider the helpfulness of the client team, the simplicity of the portal you would use, the friendliness and competence of the clinical staff or the reputation of the provider.

So, to help you choose your provider, we have put together a guide below for some of the things to watch out for. And don’t worry, this isn’t a thinly veiled sales pitch. As a company, we’ll always be honest if we feel that your requirements fall outside of our expertise and will recommend an alternative provider to you.

1 Turnaround speed

When we interview for new staff, we always ask the following question: is it better to do a job well and on time, or perfectly but late?

I tell people that there is no right or wrong answer, but of course there is an answer that we prefer as a business, and that’s the former. According to our culture, the second option is a paradox, because if something is late, then it’s not perfect. Worse still, it could even be pointless. We strive for absolute perfection as an organisation, but recognise that a perfect service is also a fast one.

With occupational health, the chances are that if you have referred a member of staff to the service, there is a degree of urgency. So timescale is important, and from the outset, you should have in writing what the provider’s predicted timescales are for appointment availability and report turnaround time. And if the provider isn’t willing to guarantee these timescales, look elsewhere, because if the service is too late, then it’s meaningless. It may even cause you more damage than not using the service at all.

It’s also worth checking what the appointment availability is like. How much choice will the provider be able to give you for appointments? When can these be expected? How does the member of staff book their appointment?

2 Quality control process

The opposite to ‘perfect but late’ is ‘rubbish but fast’, which is an equally useless service. Quality is important, whether it’s the relevance of the advice, the practicability of the recommendations or the comprehensiveness of the assessment.

Therefore it’s worth asking your prospective provider about how they ensure a quality service, and what their quality control procedure is. A few things you may wish to consider asking:

  • Does every report get audited? If so, who by? Another clinician or an administrative member of staff?
  • If not, what other measures do you have in place to prevent mistakes and ensure quality?
  • What level of qualification are your clinicians? (See next section.)
  • How long are your staff given for a consultation? We have seen organisations give their clinical staff as little as 44 minutes to complete an assessment for a sickness absence case, and produce a report addressing all questions. Safe to say the quality of these reports is going to be lacking somewhat.

3 Clinical staff, qualification level and experience

It seems obvious to say, but an occupational health professional should have a good understanding of your organisation’s work. If they don’t, it can be very difficult to provide sensible advice, and fully assess fitness to work. For example, someone may be perfectly fit to undertake office based administrative duties, but not fit to carry heavy items, climb ladders or drive a van. This is particularly important for stress and mental health, because it can be the finer intricacies of a job role that need to be understood in order to ascertain the causes of stress and identify how this can be managed by an employer in the future.

So it’s always worth checking what experience the clinicians have in your industry. What similar clients do they have?

Also confirm what the qualification level of the clinicians are. It’s not as simple as ‘they are a nurse’ or ‘they are a doctor’ because there are differing levels of qualification. This is particularly important if the situation were to result in serious disciplinary issues, dismissal, retirement or a tribunal.

Occupational health nurse / occupational health advisor

Simplistically, to be a nurse you have to achieved a specific level of qualification. These days it’s a degree. However to be called an occupational health nurse, you need to have a further qualification called a ‘specialist community public health nurse’ in OH – SCPHN(OH) for short. Ensure that all any occupational health nurse (sometimes called occupational health advisors) have this qualification.

Occupational health doctor / occupational health physician

This is slightly more complicated, because there are more variations and tiers of doctor. Again, simplistically, you should be looking for someone with a minimum of a DoccMed qualification for simpler cases, and an MFOM for more serious ones.

A DoccMed, short for Diploma in Occupational Medicine, is a doctor who works part time in occupational health or has an interest in it. This is usually a GP undertaking additional work in occupational health, but can’t be considered a specialist.

An MFOM, short for Member of the Faculty of Occupational Medicine, or FFOM, short for Fellow of the Faculty of Occupational Medicine, are consultant level doctors specialising in occupational health. These are the most specialist types of occupational health physician, and will provide the most robust opinion if challenged in legal / professional proceedings.

4 Outsourced vs in-house

This is an important point to raise, because occupational health seems to be one of those sectors that relies heavily on using ‘network’ clinicians. Unfortunately, the word network can be a euphemism for ‘we’ll sign you up, then worry about finding you a local clinician when you need it’. To ensure this isn’t the case, if a provider says that they use network or contract staff, get all the details of the clinicians who will be managing your contract. Similarly, it’s important to ensure that the contract provides a level of consistency, so that you aren’t being moved between different contractors as they become available.

I would stress that network clinicians aren’t necessarily a bad thing, because they can help to provide greater convenience and flexibility to a client too, but they just come with additional risks, quality control being the primary one. If the member of staff doesn’t work for your organisation, and you have limited prior experience, their quality can’t be verified. They won’t be trained in the same way of working as your internal team, which means reports will be written differently, tests and assessments won’t follow your company protocol, and they may not follow the same procedures around consent. If not handled right, this can be a very serious issue.

One of the ways to maximise quality control of staff is to find a provider who will be using their own internal staff on your contract rather than network staff wherever possible, or who use contractors frequently and train them to the same standards as internal staff. If you’re looking for a national, and face-to-face service, this is pretty much impossible because no company can be everywhere, but if you just require a local service or recognise the benefits of remote (telephone and video) assessments, then this is perfectly achievable and should be expected.

Internal and remote, trumps network and face-to-face any day of the week as far as I’m concerned.

5 Systems

Having a good system is one of the most important and overlooked elements to selecting a good occupational health provider, and is rarely covered in tenders.

However this is vital, because in most instances the system will be your first stop when interacting with occupational health, whether it’s to make a referral, download a report or access a client area.

It’s sad but true, that as a sector occupational health can be a few steps behind when it comes to technology. Its amazing how many companies I see still using paper records and filing cabinets. Not only is that environmentally unfriendly, it’s also slow, labour intensive and high risk.

For those who do use online systems, many will use ‘off the shelf’ products. I’m not going to name any names, but some of those are truly woeful. In my opinion this is because they try to be a ‘one stop shop’ when it comes to software, achieving many things badly instead of one thing well. I’ve always assumed this is because occupational health is a relatively small sector, and there isn’t enough profit to be made by selling your software only to occupational health companies, so they have to make their product fit for lots of different industries.

Unfortunately for the client, this means the systems can be lacking function, and can’t be easily amended to improve client experience.

There are some providers out there, us included, who have developed their own systems. The upsides to this are that the systems are entirely fit for purpose, as they have been built specifically to do what it is you would like it to do. It also means that if you have any specific requests, such as custom branding or tailored management information, this can be produced very easily. Of course one of the downsides to a custom built bit of software is that it isn’t as ‘tried and tested’ as an off the shelf solution, so you may get the occasional issue with it.

For someone not used to researching technology, choosing a provider with a good system is tricky because you won’t be able to see a lot of it. However there is nothing at all to stop you asking for a demonstration of the online systems, an example of how to make a referral, maybe even being given a dummy login of a client area. A provider confident in their systems will always offer this.

6 Customer service

It goes without saying, but customer service is vital. Occupational health is a service industry, so it’s the quality of all communications and the experience with the company that you’re paying for, as well as the advice and recommendations. If this isn’t up to scratch, then it’s probably time to find another provider!

Occupational health is a highly specialist industry, because we don’t just need to be health care professionals, we also need to be specialists in your type of work, to understand the challenges, risks and health implications. It’s unlikely that many organisations will understand the full details of all the work we do, or the legislation around consent, the equality act or the health and safety at work act, so you need an organisation who will provide clear customer service that explains these things in a helpful, friendly and useful way.

Similarly, a provider is unlikely to know all the implications of their work on your organisation, and should never take anything for granted, so needs to keep you, the client, informed throughout the process. Communication and a fast, helpful response should be a prerequisite not a luxury. In fact, it should be written into any service level agreement that you sign up to with a new provider.

It’s worth understanding who your main point of contact will be, and what the expectation is around communication. This includes opening hours, a guarantee to be informed of certain key events (such is providing consent, booking an appointment etc), how quickly phones will be answered, a point of escalation for serious queries or concerns, and of course guarantees for failure to deliver.

7 Price

Price is always going to be a factor in your decision. It’s very likely that the provider with the best price is going to be looked on most favourably. But here’s a word of warning; if it looks too good to be true, it probably is!

We have picked up an extraordinary number of clients who went with a provider who looked cheap, but had priced themselves so low that they weren’t able to deliver on their promise and were letting clients down all over the place.

We’ve heard of providers promising on-site day clinics for £300, where an occupational health advisor will see eight members of staff and conduct absence management reviews, writing a report and releasing it to the employer on the same day. Sounds great, but take a moment to consider both the cost and the practicalities there.

Firstly, assuming an eight hour working day, that’s one appointment per hour, meaning one hour to prepare for an appointment by reading the referral and background information, see an employee, gain their consent, assess them, answer any queries, write the clinical notes, write the report, check the report, password protect it and send it to the employer. And there’s no audit or quality control process in place there. This doesn’t account for toilet breaks, drinks breaks, and is to be done eight times a day. This model makes so many assumptions it’s untrue, such as every employee being on time, an occupational health advisor being able to read and digest a referral in no time at all, that they will have no queries with management before conducting the appointment, the employee will provide their consent immediately, and that a clinical member of staff can produce perfect work under these circumstances.

Then think of the price. Out of that £300, the advisor needs paying, travel needs paying, and administrative expenses need paying. One thing’s for certain, the provider will make a financial loss on the day.

So something would have to give, and without fail, this will be the quality of the service. Wouldn’t you rather pay a little more to know that the job is being done properly?

You also need to consider the pricing model. If you want to avoid cost approval every time, is it worth signing up for a subscription style service where you can use the provider as many times as you require without incurring any additional cost? Any provider who wants to see you get maximum value from their service should be offering this pricing model.

Finally, the adage ‘you get what you pay for’ also doesn’t always apply. Don’t assume that expensive means good, we have seen so many instances where we have been able to improve on the service a client has received, and save them money in the process.

8 What’s included?

This and price are very intricately linked of course. If it seems too cheap for a company to be provider to be operating this way without making a financial loss, then all is not as it seems, so look very closely at what is included in the service you’re signing up for. What does the price include?

If you choose to use occupational health services it’s very likely that you will have or need more than one interaction with them, so you may find it more cost effective to purchase some sort of package, or series of credits up front, to ensure best value. The benefit of doing this is that you can find out from the outset exactly what is included in the service you’re signing up for without incurring any extra costs.

The difficulty with a ‘pay-as-you-go’ style subscription, is that effectively nothing is included, so the company will continue to charge you. They may also be reluctant to support you any further for fear of incurring more costs, or because approval hasn’t been given.

When comparing packages or subscriptions between providers, also consider what’s included in those. The cheapest may be priced so competitively, because very little is included and you have to pay for extra bits and pieces along the way, making it ultimately more expensive anyway. For instance, a package that included an unlimited amount of occupational health assessments is going to be more expensive than buying a small quota of occupational health assessments, but over the course of a year you may find it to be considerably more cost effective because you can write it into your absence management policy and make a high volume of referrals for no extra cost.