The target operating models for occupational health (OH) units is a suggestive delivery tool for use in forces contemplating design work/restructure of OH depts. This guidance provides a framework of service delivery models and links to the OH standards.
Introduction to the target operating models for occupational health units
The clinical governance group OH team is delighted to introduce the target operating models for OH units guidance. Recent and ongoing benchmarking and OH standards work has indicated the need for operating models guidance.
As stated in this guidance there is no one-size-fits-all model for occupational health (OH) provision. Additionally, there is no statutory requirement for an employer to have OH provision, nonetheless, doing so, particularly in high health risk employment, makes good business sense to do so and meets some of the obligations of employers.
The guidance introduces the concept of models in OH services giving information, comparing, and contrasting the different types of OH service available. This guidance provides a framework of service delivery models, and links to the OH standards.
Ultimately it is down to forces to procure services according to need, however it is hoped that this page will provide information and guidance.
The remit of the OH team is to engage with forces to improve their OH services and the team is happy to receive comments or queries.
Background
The National Police Wellbeing Service (NPWS) has led on the creation of a set of occupational health (OH) standards for police forces in England and Wales.
Published in 2019, these standards are intended to establish a benchmark for the structure and functions of OH service that will be a springboard for future development. They are intended to put in place the building blocks for services that will be understood by their host forces and which will deliver quality assured services that reflect local OH needs as well as the national agenda.
The ongoing work in this area has identified that a supporting target operating model (TOM) aligned with the three levels is required.
Occupational health models
There is no one-size-fits-all model for occupational health (OH) provision. Additionally, there is no statutory requirement for an employer to have OH provision, nonetheless, doing so, particularly in high health risk employment, makes good business sense to do so and meets some of the obligations of employers, as outlined within the scope of statutory provision such as the Health and Safety at Work Act.
Policing is subject to specific regulations and is indeed a high health risk profession. The predominant aim of an occupational health function, in any organisation, is to:
- prevent ill health through the effects of the work being undertaken
- provide health advice in relation to work related health matters
- provide advice and activities in relation to risk mitigation from the effects to health from work
- advise managers and workers in relation to fitness to work
- recommend adaptations and suitability to work
- support and or lead on health prevention and / or promotion activities
- act as public health specialists
There is no one definitive model of how an organisation should establish and deliver its OH service. There are indeed various drivers mostly associated with:
- organisation size
- type of work carried out
- risks
- financial considerations
Target operating models for occupational health units aims to set out a framework of ‘best practice’ for police forces in England and Wales and will guide the reader through, what can be described as a core service, through to an enhanced, or well developed multi-disciplinary team function. The approaches suggested throughout link to both the foundation and enhanced and advanced OH standards for police OH.
In the main, there are three models of OH provision:
- In-house: Directly employed OH staff by the host force (for example nurses, administrators, physicians, physiotherapists, and counsellors).
- Outsourced: All OH staff provided by an organisation (often commercial but can be another public sector service) external to the host force with a contract manager/responsible person in-house to oversee performance.
- Blended/Mixed: Some directly employed clinical and administrative staff and some externally contracted services. The external contracts are managed within the OH service. Each model presents advantages and challenges.
In-house model
Advantages:
- better continuity of staff
- better placed to contribute to strategic development
- retained knowledge and understanding of local force hazards and controls
- rapid response to unanticipated / emerging needs for health advice (for example COVID–19)
- ability to redirect resource in the event of public health emergencies (for example disease outbreaks)
- flexible to changing business needs
- greater depth of professional knowledge of the host force, and wider sector, specific health issues
- allows for easier dialogue with key stakeholders such as line managers, HR, Federation, trade unions to ensure a proportionate management response, avoids unnecessary risk control
Disadvantages:
- smaller units may lack depth of knowledge and can be harder to recruit to
- clinical governance or revalidation may be costly to achieve
- in-house units may be driven by the personal investment of key personnel
- staff can become typecast and unwell to progress
Outsourced model
Advantages:
- a larger pool of staff (for example to cover absence)
- recruitment and retention are the providers responsibility to manage
- easier to alter the service provision without the contractual constraints of directly employed staff
- possible wider range of professional skills and other third-party suppliers available
Disadvantages:
- little control over staff recruitment or retention
- late identification of emerging needs
- focused on standard activities of service provision rather than rapid bespoke reactivity
- rarely resourced for strategic interventions
- access difficulties if located off site
- no evidence that costs are lower
- less knowledge of local safety arrangements or local key stakeholders such as. Federation / trade unions
- relative lack of sector-specific knowledge about hazards and risks
- lack of continuity of provision
- without clinical oversight may be inclined to sell “unwanted / unnecessary” services
Blended/mixed model
Advantages:
- continuity of retained staff
- occupational physician input requirements titrated to need rather than post
- regular access to occupational physician advice and opinion without the additional costs associated with retained staff
- allows specialist practitioner nursing staff to develop and use their potential fully and participate in more strategic delivery
- outsourcing of more functional aspects of OH allows those retained staff with in-depth knowledge to focus on force health priorities
Disadvantages:
- possible occupational physician availability issues in response to unplanned situations
- less occupational physician availability or resource for strategic input
- organisation will need an understanding of governance issues (for example revalidation) to assure compliance of occupational physician
- less inter force relationships with other agencies e.g. HS and risk management teams
Recommended models
Whichever OH model is chosen; forces need to engage with their OH service positively to get the best outcomes. In partnership, they should also set out the strategic aims of the OH service and incorporate this into a service business plan.
Table 1 provides a framework of service delivery models, and links to the OH standards. It is down to forces to procure services according to need.
Recommended staffing groups
Table 2 describes the clinical and non-clinical/support roles as displayed in Table 1 above.
Safe staffing levels in occupational health
To provide a legitimate service guidance suggests a ratio of 1 qualified specialist OH nurse for every 1000 employees (Faculty of Occupational Medicine 2006) to provide all the necessary services required. However, where other clinical staff such as practice or clinic general nurses are used the ratio can be adjusted.
Example: a force of 5000 may have 1 senior OHN, 2 OHNs and 2 general nurses.
It should be noted that a force must always employ at least one qualified specialist OH nurse to provide clinical governance and oversight.
A small OH team may result in the team not being able to flex for different scenarios for example an unexpected increase in recruitment. Adequate staffing levels should allow sufficient resilience to ensure business continuity.
Service delivery: Recommended occupational health and wellbeing services
Attendance (case) management / fitness for work
This area of an OH service concentrates on what is commonly termed referral work, it includes consulting with individuals to assess their current level of functionality and fitness for work. This work also incorporates obtaining consent to write to an individual’s GP/specialist to obtain clinical information for use during consultations and case conferences (where appropriate). This activity may be face to face or via telephone assessment or a blended approach of the two. Case management is usually carried out by OH nurse advisors with aces and input to OH physician(s) as appropriate.
This can include onward referral for specialist treatment/investigation(s) rehabilitation.
Recruitment of new starters
This area of an OH service provides health screening for a prospective police officer and police staff roles.
Health screening/health surveillance
This part of the service provides preplacement screening and statutory/APP related health screening.
Counselling and psychological support
Counselling, employee assistance, and/or enhanced psychological support services this service could be delivered in-house or as an outsourced/third party contract.
Physiotherapy and occupational therapy and DSE assessments
Physiotherapy assessment and treatment services, occupational therapy and DSE assessments - these services could be delivered in-house or as an outsourced/third party contract.
Occupational vaccinations
This area of the services administers appropriate vaccination programmes for the agreed identified posts. This could be Hepatitis B vaccinations for a number of operational staff or several different vaccinations for DVI and extradition teams. This service could be delivered in-house or as an outsourced/third party contract.
Clinical incident support (critical/major)
This could be the management of a contract to provide critical incident support or OH staff being involved in this activity.
Redeployment/ill health retirement – injury award
This is the provision of clinical assessments and the obtaining of medical reports for the purposes of H1 and Ill health retirement. It also incorporates onward referral to the selected medical practitioner.
Initial injury awards, redeployment, and deferred benefits are also included.
Post-accident/incident follow up
This is following-up accidents/incidents where additional occupational health input may be necessary, for example following exposure to a blood borne viral infection. This service could include assessment post exposure as well as immediate prophylaxis as well as follow up or onward referral to specialist NHS services.
Strategic advice/guidance and horizon scanning
The provision of strategic advice and guidance on matters requiring an occupational health input, this is often attendance at a gold group meeting. Strategic development of health and wellbeing organisational plans, policy or strategy documents.
Contract management
The management of external contracts with suppliers providing health related activities. This could include the management of an EAP contract.
Health promotion/wellbeing work and activities
Provided by OH nursing and/or HCAs or technical staff to provide health awareness and health promotion campaigns to improve the health of officers and staff utilising existing public health frameworks for health promotion and those developed by the National Police Wellbeing Service (NPWS).
Research
Participates in or leads on research activities independently and/or on behalf of or in partnership with external affiliates for example Faculty of OH Medicine, Society of OH Medicine, Oscar Kilo, the NPWS, and the College of Policing.
Overall service delivery
Depending on the force’s requirements it is recognised that many services may be delivered in-house, through outsourced provision or a blended approach.
Technology
- Utilises technology appropriate to tasks carried out by administrative and clinical personnel – basic telephone and IT systems to support appointment booking and access to the service by service users.
- Integrated systems with main force such as email, intranet.
- Secure systems in place for example use of police networks not external.
Premises
- Has adequate temporary or permanent premises for the purposes of conducting confidential assessments and securing equipment and records.
- OH appointment rooms should be away from operational police areas.
- Adequate and appropriate signage.
- Disabled access.
Plant (equipment)
- Has a suitably secure records management system in place which is only accessible by suitably qualified personnel. If a paper records management system this should be lockable at the end of each working day.
- Electronic records management systems must have evidence of a secure back-up functionality.
- Records management policy.
- Setting out GDPR compliance.
- Conducts testing and calibrating on clinical equipment.
- Basic first aid provision for staff and users.
Technology
- Utilises bespoke (OH system) technology appropriate to tasks carried out by administrative and clinical personnel – basic telephone and IT systems to support appointment booking and access to the service by service users.
- Integrated systems with main force such as email, intranet.
- Secure systems in place for example use of police networks not external.
Premises
- Has adequate permanent premises for the purposes of conducting confidential assessments and securing equipment and records.
- OH appointment rooms should be away from operational police areas.
- Adequate and appropriate signage.
Plant (equipment)
- Has a suitably secure records management system in place which is only accessible by suitably qualified personnel. If a paper records management system this should be lockable at the end of each working day.
- Electronic records management systems must have evidence of a secure back-up functionality.
- Records management policy.
- Setting out GDPR compliance.
- Conducts testing and calibrating on clinical equipment.
- Basic first aid provision for staff and users.
Technology
- Utilises bespoke (OH system) technology appropriate to tasks carried out by administrative and clinical personnel – telephone and IT systems to support appointment booking and access to the service by service users.
- Integrated systems with main force such as email, intranet.
- Secure systems in place for example use of police networks not external.
- Makes use of internal communications platforms such as intranet, to promote and detail the role of OH and/or wellbeing services delivered by the service.
Premises
- Has adequate permanent premises for the purposes of conducting confidential assessments and securing equipment and records.
- OH waiting area should be private and appointment rooms should be away from operational police areas.
- Adequate and appropriate signage.
- Separate work areas for clinical and administrative staff.
- Disabled access.
- Clinical assessment rooms appropriate to need and adequate number of rooms to meet demand and capacity.
Plant (equipment)
- Has a suitably secure records management system in place which is only accessible by suitably qualified personnel. If a paper records management system this should be lockable at the end of each working day.
- Electronic records management systems must have evidence of a secure back-up functionality.
- Records management policy.
- Setting out GDPR compliance.
- Conducts testing and calibrating on clinical equipment.
- Basic first aid provision for staff and users and access to ILS* equipment if giving medication/vaccines.
- Mobile screening or clinical services/off site clinics utilise tested and calibrated equipment.
*ILS – immediate life support – i.e. anaphylaxis kit, oxygen.
Technology
- Utilises bespoke (OH system) technology appropriate to tasks carried out by administrative and clinical personnel – telephone and IT systems to support appointment booking and access to the service by service users.
- Integrated systems with main force such as email, intranet.
- Secure systems in place for example use of police networks not external.
- Makes good use of internal communications platforms such as intranet, to promote and detail the role of OH and/or wellbeing services delivered by the service and provides a dedicated health and wellbeing page to support the force’s strategic health aims.
Premises
- Has adequate permanent premises for the purposes of conducting confidential assessments and securing equipment and records.
- OH waiting area should be private and appointment rooms should be away from operational police areas.
- Adequate and appropriate signage.
- Separate work areas for clinical and administrative staff.
- Rest/break areas for OH clinical and administrative staff.
- Additional consultation rooms for use by OH technicians/HCAs/other support or wellbeing staff.
- Disabled access.
- Clinical assessment rooms appropriate to need and adequate number of rooms to meet demand and capacity.
Plant (equipment)
- Has a suitably secure records management system in place which is only accessible by suitably qualified personnel. If a paper records management system this should be lockable at the end of each working day.
- Electronic records management systems must have evidence of a secure back-up functionality.
- Records management policy.
- Setting out GDPR compliance.
- Conducts testing and calibrating on clinical equipment.
- Basic first aid provision for staff and users and access to ILS* equipment if giving medication/vaccines.
- Mobile screening or clinical services/off site clinics utilise tested and calibrated equipment.
*ILS – immediate life support – for example, anaphylaxis kit, oxygen AED/defibrillator.
Appendix 1
An Indication of average staffing cost of the in-house service delivery model (this includes medical, nursing, technicians, and administration only).
The rates are calculated from 2020/21 police pay rates, private sector, and NHS. A scale mid-point is used, and the figures are exclusive of salary oncosts such as pension and national insurance. Market supplements and high-cost area supplements are also not included in the table.
Find out more
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