Occupational Medicine 2014;64:126–132 Advance Access publication 29 January 2014 doi:10.1093/occmed/kqt163

Standards for ‘Health for Health Professionals’ services in the UK D. Cohen1, N. Marfell1 and G. Greene2 1 Centre for Psychosocial Research, Occupational and Physician Health, Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff CF10 3AT, UK, 2South East Wales Trials Unit (SEWTU), Institute of Translation, Innovation, Methodology and Engagement, School of Medicine, Cardiff University, Cardiff CF14 4YS, UK.

Correspondence to: D. Cohen, Centre for Psychosocial Research, Occupational and Physician Health, 53–54 Park Place, Cardiff CF10 3AT, UK. Tel: +44 (0)2920 870686; fax: +44 (0)2920 870196; e-mail: [email protected]

Aims

To develop consensus about standards for ‘Health for Health Professionals’ (HHP) services in the UK through a modified Delphi study.

Methods

We conducted a two-stage Delphi study over 6 months. The questionnaire development took place during the UK Association of Physician Health (UKAPH) meeting in London in 2012, an invited meeting for clinicians with a specific interest in the area of physician health. The final questionnaire was disseminated via the UKAPH database.

Results

Forty-four people took part in round 1 and 40 in round 2.  Participants were mainly GPs, occupational physicians and psychiatrists. Consensus was reached on major criteria for HHP services, with greatest consensus (45% agreement or greater) for four statements concerning the clarity and transparency of the services offered and one statement that anyone working within the service should have received suitable training in physician health. Consensus about some statements varied among the three specialities.

Conclusions This study will assist discussion about providing and improving consistent services across the UK, while recognizing the flexibility required in view of geographical differences. Key words

Fitness for work; harmonization of standards; health services; mental health; physician; sick doctors.

Introduction Physician health is an emerging field. Doctors who become ill require appropriate support, sensitive to the needs of a regulated profession. Ill-health can affect performance and consequently patient care and safety. Understanding doctors’ health needs and how best to support them is a high priority if we are to deliver safe and effective health care systems. Doctors often have complex needs that relate to the interaction between their health, their performance and the regulatory response to their presenting and underlying problems [1,2]. The prevalence of ill-health in doctors is not markedly higher overall than among the general population but doctors

are more likely to suffer from work-related mental illhealth than other similar high demand professions both in the UK and internationally [3]. Mental health problems and substance and alcohol misuse predominate as health issues for doctors [4] and the behaviours doctors adopt when faced with their own ill-health can influence how their ill-health is managed. Doctors are known to self-manage, self-prescribe and delay seeking external help until relatively late and often resort to ‘corridor consultations’ [5,6]. Doctors in work tend to have a poor understanding and distrust of occupational health services [7,8] and may conceal their reasons for absence from work [9]. Some may present with a performance concern rather than a health problem [5,7,8,10,11]

© The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: [email protected]

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Background Doctors are more likely to suffer from work-related mental ill-health than other professions in the UK and internationally. Services to support doctors with health problems are emerging in the UK and have diverse models of delivery and funding. Services should be able to demonstrate agreed standards of practice for those who wish to commission, develop or access them.

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Methods A Delphi study is a method of structuring group communication, the key characteristics of which are the use of experts, anonymity, organized feedback and consensus [15,16]. We undertook a Delphi study with two rounds over a 6 month period. Figure 1 illustrates the stages of development and implementation of this study. The first stage was the development and testing of the questionnaire. Criteria and questionnaire development took place during the UK Association of Physician Health (UKAPH) meeting in September 2012 in London. The UKAPH is for health professionals with a specific interest in physician health. The UKAPH steering group met and constructed potential major criteria for the questionnaire prior to the meeting. Through both small working groups and large group discussion, these criteria were discussed and agreement was reached. The agreed major criteria included: accountability, scope and description of the service competencies of professionals. Through further small group discussion, the participants were asked to construct statements that reflected the most important areas within each of the three criteria. Following the meeting, the research team reviewed the statements and commonly identified themes. Each theme was defined as a ‘domain’. The domains under each of the criteria are shown in Table 1. The statements were refined and underwent cognitive debriefing. The final questionnaire was uploaded to Bristol Online Survey (BOS) and is shown in Table 2 (available as Supplementary data at Occupational Medicine Online).

Figure 1.  Stages of development and implementation of a two-round Delphi study.

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and, in common with other health professionals, doctors display high levels of presenteeism [12]. It is now accepted that health professionals who provide care for ‘doctor-patients’ should receive training in managing ‘physician health’. They must be able to manage the tension between support and/or treatment for the ‘doctorpatient’ and the requirements of working in a regulated profession. To support this initiative, the Royal College of General Practitioners, the Royal College of Psychiatrists and the Faculty of Occupational Medicine have developed ‘competencies’ for their respective specialities to guide the personal development of clinicians working in this field, which has become known as ‘Health for Health Professionals’ (HHP). Services to support doctors with health problems are emerging in the UK [6] due, in part, to the introduction of revalidation, which requires employers to provide support for doctors found to be impaired or ill. Emergent services, however, have differing models of funding and delivery. To be effective and encourage early help seeking, barriers to obtaining support must be recognized and removed where possible. Doctors accessing support must feel confident that they are provided with advice and treatment from a suitably qualified source [13]. Such services must be evidence-based and, like any other clinical service in the UK, should follow recognized standards of practice. Studies to date have considered the management of doctors presenting with ill-health [14]. This study set out to develop consensus about services for these doctors by conducting a modified Delphi study to build standards for future HHP services in the UK.

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Table 1.  Final agreed criteria and domains for the Delphi questionnaire on standards for HHP services Domains

Accountability

Audit, outcomes and feedback Confidentiality Information sharing Transparency Regulatory Who the service is for What the service offers Accessing the service Professionals providing the service Training Continual professional development (CPD) Accreditation and standards

Scope and description

Competencies

Round 1 of a Delphi is the first dissemination of the questionnaire. Members of the UKAPH who gave consent to take part in the study were emailed the questionnaire. In keeping with the Delphi methodology, participants were asked to disseminate the questionnaire widely, including to individuals who work in this field but were not members of the UKAPH. Participants were asked to consider statements in each domain and first rate how important they considered each statement was as a requirement for a HHP service, from 1 (not very important) to 5 (very important) and then to rank their top three statements in order of importance. The responses from round 1 were then analysed. The percentage of people who ranked each statement as first, second and third for each of the domains was calculated. The percentage of people who rated each statement as very important was also calculated for the three highest ranked statements. For the rating exercise, the average rating given to each statement was calculated. For the ranking exercise, the total score for importance each statement received was calculated. This total score was weighted to reflect the importance given to those statements ranked first. This method allows a simple form of weighting responses with a similar distribution to those using rank order centroid weights by Edwards and Barron (1994) [17]. The score was weighted as follows: a statement ranked first was given 5 points; when ranked second, 2 points and when ranked third, 1 point. The percentage score was then calculated for each statement within its respective domain using the calculation below: The total weighted score the statement received Percentage = score Total applicable score for the domain (number of paarticipants × 8) The higher the percentage scores for a statement, the higher the level of agreement there was across the group

Results Table 3 shows the breakdown and number of participants across the two rounds by speciality. Forty-four people took part in round 1 and 40 in round 2. Seventy per cent (31) of participants in round 1 and 65% (26) in round 2 had undertaken training in practitioner health specific to their speciality. Ninety-one per cent (40) of participants in round 1 and 90% (36) of participants in round 2 currently provided a specific service for health professionals. Not all participants completed both rounds. However, the two populations were similar. The rating participants gave to each statement was analysed and the average importance rating each statement received was calculated. In round 1, the average ratings for statements ranged from 2.4 to 4.9. Only 5 statements in round 1 (8%) and 12 statements in round 2 (18%) received an average rating of 30% of the score for the domain. If the domain had five statements, then 20% of the total score for each statement would be considered chance, thus 30% would demonstrate a level of agreement over and above the level of chance. The study was approved by the Cardiff University School of Medicine Research Ethics Committee (SMREC Reference Number 12/45). Consent to take part in the study was obtained from the experts attending the UKAPH meeting. For the online questionnaires, participants were asked to complete an online consent form before being allowed to continue.

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Table 3.  Delphi study participants by speciality Speciality

Round 1

Round 2

Anaesthesia Management General practice Occupational health Psychiatry Other Total

2 2 8 15 12 5 44

1 2 8 13 10 6 40

Discussion The principal finding of this study was that consensus was reached on major criteria for physician health (HHP) services and a number of specific statements

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However, the highest ranked statement remained the same across both rounds. For the statements where agreement was highest (that is the highest percentage score) in that domain, the change in agreement ranged from

Standards for 'Health for Health Professionals' services in the UK.

Doctors are more likely to suffer from work-related mental ill-health than other professions in the UK and internationally. Services to support doctor...
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