The only absence management service that can save employees’ lives

Main themes

– 24/7 access to registered nurses
– Life-threatening 'Code Red' calls
– Unique NHS-approved telephone triage protocol

NB: this article was written before FirstCare rebranded to GoodShape on 30.10.21

There are two types of urgent calls that come through to the FirstCare Contact Centre. Firstly a 'Code Red' call where the Absence Adviser transfers it immediately for urgent medical attention. The second situation is where the Nurse Adviser identifies Red Flags during their triage assessment. It is what all our nurses are trained to identify. It requires all their years of experience to read the signals… and potentially save lives. As soon as three red flags are identified – suggesting a serious health concern – the caller is advised to dial 999 or attend Accident and Emergency at their nearest hospital.

And it occurs in around one in every 750 of the calls answered by the Nurse Advisers in our contact centre.

It’s all part of the Complete Support service from FirstCare, the only absence management specialist to offer a nurse-led facility, where employees phoning in sick can receive advice from a trained medical professional.

The service provides a range of benefits, with the wellbeing of the employee being at the top of the list.

One caller, a physiotherapist as it happens, told us: “Your advice saved me a lot of pain and possibly from getting very ill. There is no way I would have gone to A&E. I just thought I had a bad stomach ache.”

She had told our nurse she had severe abdominal pain and – after answering some key questions – was advised to go straight to Accident and Emergency. She was quickly admitted and put on the list for emergency surgery, where it was discovered she had a perforated appendix.

Our service is designed to help employers, HR departments and employees. It’s also incredibly effective when it comes to reducing absence levels and speeding up the return to work.

Multi-skilled team maintain the highest standards

We have an experienced team of 36 registered general nurses in our contact centre, all with a minimum of two years’ post-graduate experience. In fact, they have 600 combined years’ experience between them. 

• Our multi-skilled team includes those with a background in occupational health, Accident and Emergency workers, nurses who have trained as NHS 111 triage consultants and many more. 

• Every nurse on the team completes a two-week induction course, as well as monthly in-house topic training and an annual refresher – this role requires a highly specific skill set, as you lose 55% of your communication skills when you’re unable to see a patient face-to-face. 

• All our nurses are actively encouraged to attend two study days every year to extend their training.

To maintain the highest standards, all of our calls are recorded, and every nurse has three calls audited per month. Annual appraisals, midyear reviews and monthly one-to-ones with the Team Leaders ensure we’re able to deliver the best service consistently. 

The service makes a significant difference to our clients. For example, Anne Stunell, Human Resources and Organisational Development Manager at Dacorum Borough Council, told us the nurse-led service was a big attraction. 

Anne said: “Bringing FirstCare on board is just one of the measures we’ve taken to dramatically reduce absence. Its nurse-led service and comprehensive range of reporting and monitoring tools played a central role in the council’s decision.” 

And another client, Clare Gowar, Health and Wellbeing Account Manager of health technology company Philips, said: “In the right environment and the right sector, this is an incredibly effective service. When you speak to a medical professional, it limits the temptation to self-diagnose.”

Nurses use a triage care pathway

Our Nurse Advisers’ role is to provide a triage care pathway to assess the caller’s symptoms, providing self-care advice where appropriate or directing them to the appropriate medical services. A typical shift for one of our nurses involves fielding between 40 and 50 calls. 

At the outset of any call our nurse will undertake Data Protection Act checks to ensure we’re compliant. Following that, he or she will begin our triage pathway, STRAWS: 

• S – Set the scene.
• T – Triage using the red flag app – written by the A&E consultant at the Chelsea and Westminster hospital, this app is kept up to date by the Company Medical Adviser and the Clinical Governance Officer.
• R – Reassure.
• A – Advice.
• W – Worsening Advice.
• S – Signpost. 

Once the triage is complete, the nurse will then log the reason for the absence, record the lost time and discuss a return to work (RTW).

Benefits for employers

The nurse-led service delivers numerous benefits for employers. From highlighting when an absence is work-related to ensuring early intervention, our service is designed to reduce unnecessary absence, signpost for additional treatment and negotiate the employee’s safe return to work date.

At FirstCare we have the most comprehensive data set for understanding workplace absence issues in the UK. Through our clients in the private and public sector, we cover 192,000 people and have been measuring absence since 2004. 

We commissioned the Centre for Economic and Business Research (Cebr) to take our data, weight it for the UK economy and give us a cost of absence for the country.  It calculated the cost to be a staggering £18 billion per year in lost productivity. 

The potential cost-savings are, therefore, significant for employers using our absence management services. The employers are also sending their staff a strong message that they care about health and wellbeing, which is strongly motivating. 

Both employers and employees gain from the procedures that smooth the path to return to work or seek medical care. For example: 

• The training our Nurse Advisers receive ensures they ask appropriate questions during the discussion about the employee’s return to work. They use their knowledge and experience of expected recovery times from an illness, sickness or accident to guide and advise, and they leverage evidence-based information from such sources as the Working Fit website and NHS Choices. 

• We have an Estimated RTW Nurse Led Protocol – which references past medical history, history of the event, infection control and whether the caller’s job is sedentary or manual – to guide Nurse Advisers during the process.
  
  
• If it seems appropriate, our Nurse Advisers ensure that the employee is directed to the correct support service, whether that’s a pharmacist, the GP or Accident and Emergency – or to an Occupational Health service or Employee Assistance Programme. 

If, at the end of the call, the employee feels that they need to take more time off than the nurse adviser believes necessary, our opinion and advice are documented in their clinical notes. 

Julie Holt, Deputy Head of Human Resources at Warrington Borough Council, has been impressed with the nurse-led system. She said: “It gives employees early advice and support in relation to their illness when phoning in sick. The system ensures that there is on-going and pro-active contact with staff.”

Saved from permanent disability

On average, our Nurse Advisers take 5,800 calls each month. Eight of those calls are urgent, code reds or red flags, which require the caller to attend Accident and Emergency or dial 999. 

Another example of an employee who will be “forever grateful” for our “Red Flag” advice was a man who was told by an A&E doctor that he had just hours to save him from permanent disability. 

It isn’t just in emergency situations that users of our nurse-led service benefit from help, care, advice and support. When they phone in, employees know they’ll be speaking to a trained professional who will understand their situation. 

• This is particularly relevant when the reason for absence is sensitive – a mental health issue, for example – which they might not feel comfortable discussing with their manager. 

• It also has a positive impact on team morale, as your employees will know that the reasons for their colleagues’ absence are genuine.

Some of the feedback we’ve had illustrates the impact that our nurses have on the day-to-day lives of our service users. 

For example, one council employee said that her Nurse Adviser delivered advice and information that was “more helpful than anything she’d received from her doctor or dentist”. She added that she prefers to speak to us rather than contact her manager when she’s unwell. 

The fact that our service is available 24 hours, seven days a week also generates positive feedback. A service user expressed her surprise and gratitude for the advice she received over a weekend. She said: “I was worried I wouldn’t be able to get through to my doctor. The fact that I could have a quick chat with one of your nurses was very impressive and reassuring.” 

Essentially, it’s like having a private 111 service. Whilst we manage our call handling times if there’s a serious mental health call at 3am that requires 45 minutes, under our duty of care that’s what we’ll deliver.

Prevention of chronic illness

Our nurse-led service also makes life easier for HR teams. The benefits include: 

• Removal of pressure from managers, who can find it awkward to speak to employees about health issues. 

• Early intervention is facilitated, which can prevent chronic illness. 

• Helping employees to return to work avoids “Sick Building Syndrome” – where the longer an employee is off work, the harder it is for them to go back. 
• The service is fully integrated, meaning it’s easy to monitor employees and assess the impact of treatment pathways. 

We’ve been providing our nurse-led service, as well as regular, reliable real-time reports to North Middlesex University Hospital NHS Trust since 2006.

Christina Pavlou, Deputy Workforce Planning & Information Manager, said: “The absence reports are constantly tweaked and developed to ensure that the relevant areas of the trust have access to the information they need and can act on it.” 

St Albans City and District Council is another organisation that has benefited from the service. Organisational Development Manager Jane Pearce said: “What we really liked about the FirstCare offering was the potential impact of a clinical nurse on employees.” 

The impact of our Complete Support nurse-led service can, indeed, be significant and there is nothing comparable that can save employees’ lives and employers’ costs. “Code Red” or not, our team is on call 24/7 to ensure employees gain health advice and support in returning to work.