Read our guidance giving providers Support for NHS 111 health advisor homeworking.
Practice Plus Group (PPG)
August 2023
Summary
PPG have offered homeworking since April 2020. It is offered on a hybrid basis. Following successful trials, it is now a permanent offering to health advisors who are eligible. Although PPG have not yet reported a significant impact of homeworking on their recruitment rates or wellbeing of staff, they are now offering a more flexible working offer to health advisors, in line with post-pandemic, new ways of working.
What was the initial aim/problem?
Initially homeworking was introduced as physical space in the contact centre was limited whilst adhering to government social-distancing guidelines during the Covid-19 pandemic. Having lower numbers of people in the contact centre because of homeworking would help keep contact centre based staff safe and offer opportunities for shielding health advisors to continue working.
Why homeworking?
Homeworking was successfully trialled at PPG and is now offered permanently to health advisors who meet the eligibility criteria. It was found to be useful for additional occupational health reasons, such as enabling people with caring responsibilities or people with disabilities to continue working in a way that better met their needs.
How does it work practically?
Calls are routed to homeworking health advisors in the same way as they would in a contact centre, to the next available operator. There are steps which PPG take to ensure that patient data is secure and IT security is maintained in a remote setting. For example, staff log into the system via a VPN. PPG operate a ‘no paper’ policy, which means note-taking is prohibited and printing is disabled. Health advisors must sign confidentiality agreements and consent forms prior to commencing homeworking.
PPG have criteria in place to ensure the working environment is quiet and free from disturbances. They are supplied with tested and compliant IT equipment and office equipment such as a desk and chair.
Health advisor homeworkers receive the same communications about training and wellbeing resources as contact centre workers. They meet virtually with managers on site via teams have monthly on-site 1:1s with their manager.
What were the challenges?
PPG initially found it challenging to replicate the office environment for homeworkers. It required additional resources and costs, such as IT equipment and software. One of these challenges was to enable access to immediate remote clinical support if required.
If any staff are underperforming, they are required to return fully to the contact centre.
PPG found difficulty obtaining support from their commissioners and NHS England, due to this being a completely new way of working which had not been done with this kind of work before.
How did you overcome them?
PPG implemented a ‘virtual panic button’ to address challenges around access to emergency clinical support and provided the technology and kit to replicate the office environment.
As PPG trials for health advisors working from home were successful, and as homeworking is now expanding across NHS 111 providers, NHS England is working with PPG and others to support homeworking in practice.
What were the results?
PPG now offer hybrid working as standard for all health advisor staff as a permanent offer, if they are performing to standard and meet the eligibility criteria.
PPG have not found any significant impact on staff recruitment and or wellbeing / staff satisfaction. However, they are keeping in line with post-pandemic new ways of working and are improving flexibility at work for health advisors.
There have been no adverse effects reported to date when health advisors have been working from home, such as patient complaints or serious incidents.
What were the learning points?
PPG have found it a challenge to scale up homeworking for health advisors. As current NHS Pathways Licencing requires that they need to be tier 2 audit to work from home, this equates to a smaller number of staff.
NHS Pathways will continue to review and refine the most safe and effective time in which health advisors can move into tier 2.
Next steps
PPG plan to continue offering homeworking to health advisors and will continue to review its impact going forward.
Integrated Care 24 (IC24)
August 2023
Summary
IC24 began trialling homeworking for health advisors in November 2021. This is now offered on a permanent home basis or hybrid basis, splitting time between contact centre and homeworking. Originally homeworking was introduced to increase recruitment. Homeworking was also implemented to offer an improved home/work life balance and more flexible working. They report that both recruitment and staff wellbeing has improved since homeworking has been offered to health advisors. They are now trialling homeworking for service advisors.
What was the initial aim/problem?
Homeworking was first introduced in November 2021 as part of IC24’s strategy to address recruitment issues of contact centre based staff, an impact of the resignation which began in early 2021 in the wake of the pandemic. As part of this strategy, IC24 were also exploring how to improve the work/life balance for health advisors. In turn, this could expand their recruitment pool by offering more flexible working options.
Why homeworking?
In November 2021, IC24 started their first trial of homeworking for health advisors, on a hybrid basis. While homeworking health advisors continue to split their time between remote working and contact centre work, IC24 are also trialling homeworking for service advisors, from the start of their employment. Over the period April to June 2023 an increasing number of service advisors started working solely from home.
How does it work practically?
IC24 have IT and tech criteria which homeworking health advisors must adhere to, and they provide all IT equipment. Homeworkers are required to have a broadband speed of 20MBPS download and 4MBPS upload.
IC24 conduct a ‘Homeworking Risk Assessment’ twice a year to ensure that it remains safe for both staff and patients. They also have a homeworking ‘check list’ which must be reviewed regularly and adhered to throughout. The Information Governance (IG) team were part of the design and implementation of the health advisor homeworking pilots, to ensure that all IG processes were accurate. Homeworking health advisors must complete IG training, complete an IG assessment of their work environment and sign an IG agreement prior to homeworking commencing. Homeworking health advisors must provide their own paper-shredder to dispose of any confidential information or notes.
Audit is undertaken virtually via Webex and Nexidia (audit system, sentiment analysis functionality). IC24 have staff trained as Pathways Trainers who support home workers. Homeworkers are also paired with a ‘buddy’ for support and help if needed. Digital communication systems such as Webex and MS Teams further support remote communication. Trauma risk management process (TriM) is in place for homeworking health advisors who have handled a traumatic call.
What were the challenges?
IC24 found that homeworker access to IT support was difficult if it could not be resolved remotely. Some issues require in-person troubleshooting, delaying working time trying to solve remotely.
How did you overcome them?
IC24 ensure that their IT kit is collected from the contact centre via courier and delivered to the health advisor in advance of their first homeworking shift. They must also liaise with the IT department to ensure their internet speed test is completed before their first shift, and that it meets minimum criteria. The IT set-up guide is provided as part of mandatory homeworking training.
The amount of IT equipment required steered towards a ‘bring your own device’ approach where health advisors are able to use their own computer, subject to meeting minimum standard, and be provided with additional tech, essentially giving them a remote, secure digital desktop.
What were the results?
IC24 have seen a notable improvement in staff recruitment and satisfaction as a result of homeworking. There has been no significant difference in serious incidents or patient complaints for health advisors working from home and those in a contact centre.
What were the learning points?
IC24 conducted a ‘B-heard’ survey for health advisors working from home to gather feedback on homeworking. Following the results of this, they organised a face-to-face roadshow to understand further how homeworking is working in practice, and ideas on how to improve the offer for these staff groups.
IC24 also found that due to the costs of supplying IT and expenses/travel incurred from initial face-to-face training, homeworking is more expensive per head than a contact centre based health advisor. However, money saved from retention may off-set initial costs over time, compared to turnover recruitment and training of new staff.
Next steps
IC24 plan to continue offering and improving homeworking for service, health and clinical advisors.
Hertfordshire Urgent Care (HUC)
August 2023
Summary
HUC have been offering homeworking to health advisor staff since June 2020. Homeworking is displayed as a future option in job adverts to improve recruitment success, and as a retention initiative for current staff. Homeworking is offered to HUC health advisors as a hybrid option, with staff splitting their work time remotely and physically within a contact centre. HUC feel their model is successful and plan to continue to develop homeworking into the future. They are currently trialling dental-only service advisors working from home.
What was the initial aim/problem?
Homeworking was initially introduced at HUC during the Covid-19 pandemic. This was to free up physical space in their contact centres while social distancing measures were in place, and to support and enable those who were shielding/isolating to continue working. Since then, as part of their recruitment improvement plans, they offer homeworking in job adverts as a potential future option for experienced, suitable staff. This is also a retention initiative for existing staff, and to increase the ability for eligible health advisors to pick up additional short notice shifts.
Why homeworking?
HUC are still utilising homeworking to free up desk-space in their contact centres for new staff. HUC offer homeworking opportunities to health advisors that have passed probation, are on NHS Pathways tier two auditing and fulfil the criteria set out in HUC’s local Standard Operating Procedures (SOP) for productivity and performance. If eligible, the option of homeworking is typically offered to health advisors after six months working in the contact centre.
All homeworking health advisors have hybrid contracts. As well as staff wellbeing and maintaining relationships, this is to ensure that experienced health advisors are present to provide support to new members of staff as they become more experienced.
How does it work practically?
Health advisors that are offered the option to work from home are experienced members of staff with high productivity rates. For example, their call-response rates are high, they have exemplary audits and have no performance issues. HUC also expect health advisors to have low numbers of inappropriate ambulance and clinician referral rates to be eligible.
HUC provide all IT equipment to homeworking health advisors, such as a laptop, mouse, cables, and headset.
All homeworkers must declare that they have a suitable working area for making calls to patients. Photographic evidence of the Health advisor’s workstation set up is required before homeworking can commence, and regularly thereafter.
Calls are routed in the same way to the next available health advisor, regardless of whether they are working remotely or from a contact centre.
Team leaders communicate with homeworking health advisors via a MS Teams chat to ensure they are aware of any updates or changes happening in the contact centre. Audits, training and support are offered in the same way to homeworkers as to those working in the contact centre.
If a health advisor has any concerns while working remotely, they can initially raise this to the Shift Manager. If there is anything more serious, they contact the Contact Centre Manager. They can also log issues on Radar (incident reporting) and have access to a ‘Freedom to Speak up Guardian’.
There are dedicated clinical and non-clinical floorwalkers for homeworkers. Clinical and non-clinical advice can be accessed remotely via the telephone system. Homeworkers can share screens with the clinical advisors using MS Teams. For immediate assistance, there is access to their ‘Little Green Button’.
What were the challenges?
The need for health advisor homeworking arose before HUC as an organisation was fully prepared. The transition would have been smoother in response to the pandemic if they had the clinical support and practicalities of homeworking already set up. If a health advisor is not performing to the standard expected of them while working from home, then they can be re-called to the contact centre at any time.
How did you overcome them?
Since the initial pandemic response, there has been time to develop the homeworking offer for health advisors fully. If a health advisor starts homeworking but feel it does not work for them, they can return to full contact centre work whenever they like.
What were the results?
HUC found that retention is higher for health advisors who have been working for six to nine months. Health advisors working in hybrid roles have a better work-life balance as homeworking reduced their commute, while maintaining social benefits of the contact centre. Homeworking enables them to pick up additional hours, extra pay and shorter shifts that they previously would not have been able to if they had to commute.
What were the learning points?
HUC have found that health advisors working from home must be self-sufficient and confident with IT, so they are able to troubleshoot immediate problems and understand how to engage with the technology.
Homeworking is not suitable for all health advisors. Some members of the team prefer the support of a contact centre environment. Homeworking selection criteria should be well documented. If a health advisor is deemed as ‘unsuitable’ for homeworking, reasons for refusal must be fair and appropriate.
HUC have seen no impact on patient complaints or serious incidents since homeworking has been introduced. Any member of staff involved in an incident or complaint (and at fault) would have homeworking revoked until performance improved.
Next steps
HUC are looking at issuing homeworkers with a whiteboard so all notes can be erased.
In August 2023, dental-only service advisors started working remotely from the start of their employment. If successful, HUC may consider extending the remote service advisor model.
HUC routinely update their homeworking SOP to ensure that it is fair and offers homeworking opportunities as early as possible and when safe to do so.
HUC are working with their telephone provider to implement live audits remotely.
South East Coast Ambulance Service (SECAmb)
August 2023
Summary
Homeworking for health advisors has been in place at SECAmb since April 2020. It was first introduced as a trial during the Covid-19 pandemic. It is now a permanent offer on a hybrid basis with the majority of time spent working from home. Health advisors were offered homeworking as a retention tool when SECAmb closed its existing contact centre and moved location. Homeworking is a means to enable an improved home/work life balance and flexible working. Initial results from a survey of homeworkers are positive and SECAmb would recommend homeworking to other providers.
What was the initial aim/problem?
Homeworking was first introduced by SECAmb in April 2020, initially as a trial during the Covid-19 pandemic to allow colleagues shielding, or positive (but asymptomatic) to continue working. When SECAmb closed its primary NHS 111 contact centre and moved to a new location, homeworking was offered as a retention tool to mitigate against high turnover.
Why homeworking?
Following the trial, homeworking has been offered to health advisors under a hybrid model with most of the time spent working from home. SECAmb have seen financial benefits from homeworking. Health advisors have a better work-life balance and they have retained those who may have otherwise resigned when their jobs were relocated due to the primary contact centre closure.
How does it work practically?
All health advisors working from home must complete an assessment form to confirm their home environment is suitable. They must also pass a Display Screen Equipment risk assessment and sign a confidentiality agreement.
SECAmb provide all IT equipment which must meet a minimum technology criterion. All records are computerised in line with SECAmb’s information governance policy. SECAmb report that the initial cost to set up homeworking for health advisors is high due to the kit required and their Avaya Product license. Contact centre staff use Avaya OneX software for call taking through CM platform. This was upgraded to Avaya Workplace/ CM10 in 2023.
Health advisor homeworkers have access to a designated health advisor team leader or on duty manager when their designated contact is not on duty. Homeworkers also have access to a 24/7 number if required, in-line support telephony during calls and line managers/ clinicians can take over or join a call if needed. For immediate support, an ‘orange flag’ alert system escalates homeworkers to a front desk number and the management team.
Homeworkers can access mandatory training in the same way as contact centre staff. Performance and quality are monitored through ongoing tracking and benchmarking of incidents and complaints, line manager feedback and regular audits.
If performance is inconsistent or there is cause for concern, homeworkers are required to return to return to site and are provided with training and development, including mentoring and shadow shifts where relevant.
Homeworkers have access to a well evolved Wellbeing Hub providing access to physical, mental, financial, and work-related wellbeing advice and there is also support from nominated wellbeing advocates. For emotional support, all staff can access a mental health practitioner virtually or on site.
What were the challenges?
The main challenge has been managing expectations when there are issues or concerns requiring the homeworker to return to the office.
How did you overcome them?
SECAmb ensure there is clear feedback, support through team meetings, union meetings and the leadership team.
What were the results?
SECAmb have undertaken a survey of homeworkers to feed back on their experience. They are yet to analyse these, but initial feedback from staff is mostly positive. Whist the impact of homeworking on recruitment is yet to be determined, attrition and sickness is lower than contact centre staff. Handover to clinical advisor is slightly higher and volume of calls taken are marginally lower.
What were the learning points?
SECAmb reported the importance to ensure all homeworkers understand the requirements of homeworking and are clear on the consequences if these are not adhered to.
In the future SECAmb would like to conduct a webinar or virtual workshop (without time constraints) for potential health advisor homeworkers. They would also like to deploy homeworking more gradually.
Next steps
SECAmb would recommend offering homeworking as an option to other providers and plan to expand the offer in the future so new homeworker recruits have mentor support from an already established homeworker.
Publication reference: PRN00732