CPD

CONTINUING
PROFESSIONAL
DEVELOPMENT

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study. One article
in each issue is
accompanied by
a set of questions
and answers.
These have been
devised by Anne
Harriss, associate
OH professor at
London South
Bank University,
and are designed
to help you reflect
in a structured
manner on what
you have learnt.

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in our continuing pro
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Occupationalhealth&wellbeing

P hone a s s e s s m e n t HEALTH M A N A G E M E N T

Telephone health
assessments:
good practice

Telephone health assessments can be a

useful way to provide a fast and effective
OH service. C ath erin e D arcy-Jones
and A nne H arriss look at good practice,
in the third and last in a series on
management reports in occupational health.

ccupational
health as a speci
ality has had to
respond to the
changing face
and demands of
business, especially wi
of long-term sickness absence
(LTS) impacting on businesses
financial bottom line.
There is increased pressure on
agreed sickness key performance
indicators (KPIs) for OH to have
assessed the employee and given
the advice in a written format with
in a quicker time frame.
LTS absence and its costs have a
huge impact on businesses. In
2014, sickness absence equated to
an average of 2.8% of working time
per year (6.5 days) per employee
costing 11-16 billion.
Prevalence of sickness absence
was noted as being higher within
the public sector than the private
sector. In 2015 alone, long-term
absence equated to 1 billion in the
manufacturing sector (EEF, 2015).

May 2016

27

HEALTH MANAGEMENT Phone assessment

This focus has gained increased
im portance when it comes to the
services OH provides, as practition
ers respond to business demands
and become more aware of the com
mercial pressures placed on them
to deliver added value.
One way to address this increased
business pressure is to move away
from the more traditional face-toface assessm ent typically carried
out by OH advisers to offering tele
phone assessments for advice.
It can be argued that this is a
more efficient use of an OH advis
e r s tim e as it m eans you can
deliver more assessments over the
telephone than face to face.
Clinical information entered on
to sta n d ard tem plates for both
clinical notes and reports reduces
the wait for a separate administra
tor to type up a dictated report.
If a face-to-face assessm ent is
required, the telephone assessment
acts more like a triage service and
the assessment can be progressed
on to this, therefore more effec
tively using the dim inishing OH
adviser resource.
More than 80% of a diagnosis is
form ulated from the clinical his
to ry tak en (Gray and Toghill,
2000), but there is growing evi
dence th a t th is history can be
gained just as effectively through a
telephone assessm ent as it can
through the traditional face-to-face
approach (Burton et al, 2013).
T here are com m on concerns
linked to telephone assessm ent
from all parties - the employer, the
employee and the OH adviser - but
if the telephone assessment is car
ried out within an evidenced-based
format, it can successfully address
all or some of the OH needs.

How should a telephone

health assessment
be conducted?
The O H adviser must have the skills
to enable the employee to discuss
their health symptoms and issues
with someone that they have never
met and cannot see.
Therefore, it is important that the
initial contact with the employee is
professional, with all the necessary
checks surrounding employee iden
tification and consent carried out
as per NMC guidance.
Especially important is that the
employee is in an environm ent
where they feel comfortable to talk
on the telephone about confidential
health m atters. They should be
expecting the call within a desig
nated appointment time frame, so
calling the employee within this
parameter goes some way to reduc
ing the anxiety of receiving a call.
The skill in carrying out a tele
phone appointm ent is to gain a
2 8 M ay 20 16

The skill in carrying out a

telephone appointment is to gain a
quick rapport with the employee
quick rapport with the employee.
However, as the time for the assess
ment will be allocated in your diary,
it is im portant to establish early
boundaries in regard to time alloca
tion for the appointment.
This can be done by informing the
employee of the process the assess
ment will follow, including the time
frame, outlining all the areas you
will cover so the employee is confi
dent that you will be taking all the
factors into consideration.
It is the OH advisers role to guide
the employee through the assess
ment process at a steady pace and
in an em pathic way, with the dis
closure of personal inform ation,
but keeping the focus on the OH
aspect of work and health. One of
the most difficult aspects of a tel
ephone consultation is keeping the
employee on the point you are dis
cussing and to move them on when
you have gained enough clinical
information to make your decision.
For some employees, talking dur
ing a telephone assessment can be
cathartic so it is the role of the prac
titioner to make them feel listened
to while directing them on to the
next set of questions. It maybe ben
eficial to tim e check w ith the
employee half way through the
appointm ent, informing them of
the tim e left for the assessment.
This will assist with keeping the
discussions and answers focused.

What tools are there

to help?
Occupational health, unlike other
forms of diagnosis, relies 100% on
assessing an employees functional
capability w ith regards to the
impact of work on health and health
on work.
As with any OH assessment, it is
good practice in telephone consul
tations to use a set of evidencedbased tools against which you con
duct your assessment. These should
cover both m usculoskeletal and
mental health tools and include a
system, such as the flag system, to
easily identify any causes for con
cern. There are plenty of evidencebased tools to use (Anderson and
Cocchiarella, 2 0 0 9 ; A m erican
Medical Association, 2011). The
P a tie n t H ealth Q u estio n n aire
(PHQ-9) is particularly useful for
assessing depression.
Such tools allow the OH adviser
to make a judgem ent call as to

whether or not they can continue

to assess the employee over the tele
phone, or if the case needs to be
progressed to a face-to-face ap
pointm ent or moved to an appoint
ment with an occupational physi
cian. Whichever situation arises,
that means the telephone method
is n ot ad eq u ate to assess the
employee further, consent for this
forw ard assessm ent should be
gained during the telephone con
versation and clearly documented
in the clinical notes.
The style of questioning is key to
obtaining th e m ost appropriate
information from the employee to
make your clinical decision. There
should be a mixture of closed and
open questions.
There is caution attached to the
open style of questioning as this may
allow employees to talk at length,
and although you want to gain as
much information, it is advisable to
bring the employee back to the next
question once you feel sufficient
information has been gained.
This boundary is easier in a mus
culoskeletal case th an a m ental
health case, b u t the skill is to rec
ognise within a mental health case
if counselling is a more appropriate
forum for the employee to talk and
progress to this. The telephone
assessm ent in th is way can be
viewed as a signpost to ensure the
employee is progressed to and re
ceives the most appropriate input
for their health situation.

What are the advantages

and disadvantages of
telephone assessments?
As with any system of work, there
are advantages and disadvantages
to be considered on different levels,
from the OH practitioners perspec
tive, and the em ployer and the
employees point of view.
For the OH practitioner, a tele
phone assessment could be seen as
advantageous, bringing an element
of convenience to the role. This
could include working from home,
although an efficient IT system and
clinical back-up to check decision
making is a necessity.
Systems such as writing straight
into templated clinical records and
reports will ease the administrative
side of telephone assessments for
a company and ensure a standard
assessment approach for the cus
tomer. If this is used, there needs

to be a robust IT system that allows

safe transfer of data under the Data
Protection Act 1998 to enable the
clinical report to be sent securely
to the employees manager.
Working in this way would incur
less travel costs to the company and
is therefore more cost effective from
a business perspective.
One could also argue th a t the
nature of telephone health assess
m en ts w ould en h an ce an OH
practitioners communication and
questioning skills w hen talking
with a client to enable all the rele
vant inform ation to be obtained
during the assessment.
However, working in this way can
be lonely and isolating for the prac
titioner. It is essential the appropri
ate clinical support is in place if
assistance is needed on a decision
to be made or to discuss a clinical
position with another colleague.
E m ployers u sin g te lep h o n e
assessm ents may find there is a
quicker turnaround in delivering
Occupationalhealth &wellbeing

Phone assessment HEALTH MANAGEMENT

Employees will find th a t it is
often more convenient to choose
and fit an OH appointm ent into
their day around existing medical
appointm ents or when they are
functioning best in the day.
They are more likely to attend if
they have a mobility issue or have
a workplace stress issue restricting
their perceived ability to cross the
workplace threshold.

When would you not use

a telephone assessment?

clinical reports to the customer,

therefore meeting or even exceed
ing expectations of the agreed OH
service. This enhances custom er
satisfaction with a quicker tu rn a
round for the KPIs and less waiting
time for the OH appointments.
It also means that if the employee
is not at their home address then an
OH assessment can still take place
and the timely advice can be sent to
the referring manager.
The quicker delivery of an OH
service will have a knock-on effect
on the customers budget as they
are able to im plem ent the OH
advice quicker because they have
received the clinical report on the
day of the appointm ent and they
can reduce the financial cost of LTS
on their bottom line.
Where the OH referral has been
made on a proactive basis, it can
also be more cost effective for the
employer as the employee does not
have to have time away from work
to gain OH advice. The employee
Oecupationalhealth&wellbeing

can take a call during work time if

they can talk in a quiet confidential
environment. Working in this way
means that OH is being apprecia
tive of and responsive to changing
business needs.
For the employee, the impact of
a telephone assessm ent would
m ean less travel to OH appoint
ments, either in or out of work time.
Although some employers may offer
tra n sp o rt to assist em ployees
attending OH appointments, on the
whole, many employees have to
organise this themselves, and there
may also be the cost factor of attend
ing the appointments while on sick
pay that affects attendance.

There are situations where the tele

phone is not the most appropriate
form of assessment. These could
include where there is the need for
a physical examination or if there
is a difficulty in understanding the
employee over the telephone. The
employee may also need an inter
preter or a signer to assist their
understanding of the assessment.
It could be that consent for the
telephone assessment is refused at
the outset of the appointment or at
the point of referral by the m an
ager. It m ust be remembered that
if consent is refused, the employee
may be happy to attend a face-toface assessment instead.
One of the main clinical reasons
a telephone assessment would not
be appropriate would be where there
is an inconsistency in the clinical
reporting from the employee. As an
OH practitioner you are aware of
many of the causes, as well as treat
m ent and recovery, of clinically
treated conditions.
During any assessment, there is
an unconscious reference between
the employees treatm ent for their
presenting symptoms and recovery
and the standard treatm ent and
recovery of such conditions.
If during the telephone assess
ment it becomes apparent there is
a vast difference between the two
then it would be necessary to meet
in person to allow an OH adviser to
assess with sight as well.
A telephone assessment is only
as good as the questions asked, and
if th e ap p ro p riate inform ation
cannot be gained to give a sound
clinical decision, then the further
medium of visually assessing how
som eone is walking, sitting or
standing m aybe required.
There is a place for telephone
assessments, as in other areas of
health care such as cognitive behav
iour therapy, GP appointm ents,

The impact of the telephone

assessment would mean less
travel time to OH appointments

and physiotherapy assessm ents,

where it is being increasingly used
more widely. Research conducted
by the DWP in 2013 concluded that
telephone assessm ents can be as
effective as the face-to-face method
if conducted appropriately for the
right conditions (such m usculo
skeletal or m ental health). How
ever, the research highlights the
importance of strong telephone and
clinical skills, supported by focused
training and the use of standardised
protocols to refer to.
Used effectively and with the cor
rect case types, telephone assess
m ents can be a safe and efficient
way of providing OH advice to busi
nesses in a timely fashion.
OH advisers are able to add
additional value to businesses and
the increased demands of business
efficiency with the advantages it
brings. However, th e approach
should be chosen as the preferred
assessm ent type with the restric
tions of the service in mind so the
correct level of service can be
secured for both the employee and
the business.
Catherine Darcy-Jones MSc,
BSc (Hons) Nursing, BSc (Hons)
Occupational Health Nursing,
RGN is an occupational health
adviser at OH Assist. Anne
Harriss MSc, BEd, RGN, OHNC,
RSCPHN, NTFHEA, PFHEA,
CMIOSH is associate professor
occupational health and reader
in educational development at
London South Bank University.

References
>American Medical Association
(2011). American Medical
Association Guide to the Evaluation
of Work Ability and Return to Work.
Chicago: American Medical
Association.
>Burton K, Kendall N, McCluskey S,
Dibben P (2013). "Telephonic
support to facilitate return to work:
what works, how, and when?"
London: DWP.
>Anderson GBJ, Cocchiarella L
(2009). Guides to the Evaluation of
permanent impairment, 6th edition.
Chicago: American Medical
Association 2001.
>Gray D and Toghill P (Editors)
(2000). Introduction to the
Symptoms and Signs of Clinical
Medicine: A Hands-on Guide to
Developing Core Skills. London:
Hodder.
>Sickness Absence Survey 2015.
Sponsored by Jelf.
>Sickness absence rates revealed
in UKs largest survey. Occupational
Health & Wellbeing. Available online
at www.personneltoday.com/hr/
sickness-absence-rates-and-costsrevealed-in-uks-largest-survey
May 2016 29

HEALTH MANAGEMENT Phone assessments

CPD activity: Conducting telephone health assessments

Lifelong learning and continuing professional development (CPD) are the processes by w hich professionals, such as nurses, develop
and improve their practice.
There are two ways to address your CPD: formally, by attending courses, study days and w orkshops; or informally, through private
study and reflection.
Reading articles in professional journals is a good way of keeping up to date with what is going on in the field of practice, but reflecting
on w hat you have learnt from the articles is not always easy.
These questions are designed to help you identify what you have learnt from studying the article on the previous three pages. They
w ill also help you to clarify what you can apply in practice and what you need to explore further.

1>A ccording to EEF, in 2 0 1 5 long-term

a b s e n c e in th e m an u factu ring s e c to r
e q u a te d to:
a) 1 million
b) 1.5 million
c) 1 billion
d) 1.5 billion
2 ) W h a t p e rc e n ta g e o f a diagnosis is
fo rm u la te d from th e c lin ic a l history?
a) More than 80%
b) Less than 65%
c) More than 75%
d) Approximately 50%
3 ) W hich o f th e follow ing w rite rs
hig h ligh t evid en ce th a t te le p h o n e
h is to ry ta k in g can be as e ffe c tiv e as
tra d itio n a l fa c e -to -fa c e approaches?
a) Black et al
b) Kloss et al
c) Burton et al
d) Dady et al
4>For so m e people, tele p h o n e
a s s e s s m e n t pose d iffic u ltie s to th e
OH p ra c titio n e r as som e clients:
a) Find it cathartic - it is challenging for the
practitioner ensure the client feels listened too
while gaining a robust history
b) find it cathectic - they are very suspicious of
the motives of the OH adviser - the practitioner
will find it difficult to gain a satisfactory history
c) Are reluctant to give as full a health history
by telephone as they would if they could see
the practitioner
d) Believe that the OH provider prefers to

conduct a telephone interview as the Data

Protection Act 1998 does not apply.
5>W hich of th e fo llo w ing options
ap ply should a te le p h o n e a s s essm en t
be in a d e q u a te in assessing th e
em ployee:
a) A second-stage appointment must always
be undertaken by an occupational physician,
but no further consent is required if this takes
place within 15 working days
b) A second-stage appointment must always
be undertaken by an occupational physician
and consent is required irrespective of the
timing of that appointment
c) A further second-stage assessment may be
undertaken by either a physician or a nurse.
Consent should be gained and clearly
documented in the clinical notes
d) A second-stage face-to-face interview is
planned, which does not require the formal
consent of the client. The OH adviser
must gain the clients consent to request
a report from the clients GP prior this
face-to-face interview.
6>Telephone a s s e s s m e n ts a re an
e ffic ie n t and c o s t-e ffe c tiv e ap proach
to gaining h e a lth in fo rm a tio n , as:
a) The employee does not have to travel to OH
appointments either in or out of work time
b) There is a quicker turnaround in delivering
clinical reports
c) There is less waiting time, enabling the OH
provider to achieve or exceed their service
level agreement
d) All of the above

7 ) An p a rtic u la rly im p o rta n t skill

w h ic h is unique to c a rry in g out a
te le p h o n e in te rv ie w is th e a b ility to:
a) Adapt quickly to a range of IT technology
b) Gain a rapid rapport with the employee
without the opportunity to gain feedback from
body language
c) Base the employees history on
evidence-based practice
d) Conduct a telephone interview, complete
the report template and then submit the
management response within 15 minutes
8>Of p a rtic u la r im p o rta n c e w h en
u n d e rta k in g a te le p h o n e co n su ltatio n
is th a t:
a) The client is able to undertake this within
their own office
b) The employee is not expecting the call,
in order that they can be caught off guard
c) The client agrees for a specific time to take
the call as this is both courteous and goes
some way to reducing any anxiety
d) None of the above is of importance

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Resources for your research needs

This YouTube clip gives an overview of
telephone approaches to occupational health
assessment:
>w w w .y o u tu b e .c o m /
w a tc h ? v = 2 s W x ta q d Z P w
Read these articles on the use of the flags
system for health assessment. Once you have
read them, consider how you may incorporate
these principles within your history taking
during telephone or face-to-face consultations.
>w w w .p erso nn eltod ay.com /h r/cp d p sychosocial-flags-system /
'w w w .c s p .o rg .u k /fro n tlin e /a rtic le /
re d -a le rt
>h ttp ://ken d allbu rton .co m /F lag s/
fla g s in d e ta il.h tm l
(Accessed 8 March 2016)
30 May 2016

Use the link below to access the Mental

Health Screening Tools for Primary Care
resource. This document provides an overview
of a variety of tools that can be used to assess
mental health. It includes information regarding
their psychometric properties. Many of these
tools are for use with children and young adults
but there is reference to tools such as Patient
Health Questionnaire (PHQ-9) for use with
people of working-age.
>w w w .aap .o rg /en -u s/ad vo cacy-an dp o lic y /a a p -h e alth -in itia tiv e s /M e n ta lH ealth /D o cu m en ts/M H
S c re e n in g C h a rt.p d f
Identify a client with whom one of these tools
would have been helpful. Reflect on how you
managed the case. Would you handle the case

differently now? If your approach would change

why is this the case?
(Accessed 8 March 2016)
Telephone consultations are not unique to
occupational health. The Hewitt, Gafaranga
and McKinstry (2010) paper uses a qualitative
approach to compare face-to-face with
telephone consultations. Download, read and
reflect on the outcomes within the paper:
Hewitt H, Gafaranga J, McKinstry B (2010).
Comparison of face-to-face and telephone
consultations in primary care: qualitative
analysis. British Journal of General Practice. It
can be accessed from this link:
>w w w .n c b i.n lm .n ih .g o v/p m c/articles/
P M C 2 8 5 85 5 2 /
(.Accessed 8 March 2016)

Occupationalhealth&wellbeing

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