Employee health assessments

I'm Dr. Petra Simic, I'm the clinical director for primary care here at Bupa Health Clinics.

I'm responsible for the clinical delivery across all of our clinics across the UK.

Today I'm here to talk about our new health assessment proposition, which is a really exciting development for us, and to talk a little bit about how our team have worked with the other teams to try and make sure that clinical evidence and excellence has been put at the centre of the new proposition, as well as the exciting other developments that we've added.

Our new health assessments comprise of a number of different components, from the new digital journey to the ongoing relationship between Bupa and the customer after the health assessment.

But for us as a clinical team it was a great opportunity to examine every single clinical component of our existing health assessments to see whether we could improve it, whether we needed to keep it, or whether we needed to take it away, and really if there was anything else we could add to add to the experience for our customers.

When we were looking at all of the components of the tests, we looked at them with three main factors: Is this a test that there's a risk of what we call a false positive?

So, if this test comes back abnormal, is it possible that there may be nothing wrong at all - so you just get undue worry, concern, potential investigations which could be painful, worrying, or even expensive.

Could a test give you a false negative? So, say the test comes back saying it's normal, but then you find out later on that you actually did have a condition that that test did not pick up, which means we've missed an opportunity to make an early diagnosis.

And is a test what we call a legacy test?

So that's a test that we've done because we've always done it, and we've got no real reason why doing it adds anything, and it doesn't give the customer any additional useful information about their health.

So, we applied that logic to all of tests, and the eight tests that we've removed had either a false positive, false negative or a legacy reason why it was not best for our customers.

And almost all of them had at least two of those reasons, and some of them, all three.

The idea of the new health assessment is to really free up the doctor to have a very open and flexible approach to the customer in front of them, so that they come out feeling like the health assessment was tailored for them, for their needs, and was not a tick-box exercise.

When we looked at what we could add to the health assessment, it was a really exciting opportunity to consider what our customers ask us for currently that isn't included.

Really good example of that is the vitamin D test.

So, it's a commonly requested test in our current health assessments but is not currently included.

There's been lots of research about vitamin D deficiency, there's been lots in the public domain and we've gone through the evidence.

There's no evidence that testing everyone for vitamin D deficiency is a good idea, but for certain people who are higher risk, or showing symptoms, it would be a really sensible test to offer and combine.

We've added things like a coeliac screen, and that's in response to the fact that lots of our customers come to us with gut problems, so they might think they have irritable bowel syndrome, they're not sure.

We know that coeliac disease is under-diagnosed in the UK, so what a great opportunity to put in a test that for people that have symptoms, we could rule out coeliac disease where we've never been able to do it before.

There are other tests we've included, such as the further anaemia screen, so b12, ferritin and folate.

Where we currently test for anaemia in our haemoglobin testing, but right now our customers have to go back to their GPs to get that followed up, and we don't think that's a great customer journey.

So doing the second line of testing, so looking for those vitamins which can cause anaemia within the health assessment means that the customer doesn't then have to go back and try and get an appointment with their GP, or do further testing, which is inconvenient.

So, it's about trying to make the journey better.

And then we've considered whether some of the screens we do we need additional screens, so we've added some mental health screens to some of the tests that weren't included.

So really, we've tried to open our minds as to what might help people, but again, it's about giving the right people the right tests for the right reason, and we've been really clear about that in the way that we've set this up.

I often get asked about how innovative we are and how we use clinical innovation in our products and how equally we apply our clinical excellence to our products.

I think it’s quite an interesting conversation.

Clinical innovation - or innovation in any industry - is all about being new and being the most up-to-date and the most exciting.

The thing with medicine and clinical innovation is that often precedes lots of research, and certainly national or international guidelines.

And clinical excellence generally sits around What are the national guidelines?

What are the international guidelines?

What do the best big studies show?

And you can see how clinical excellence comes as a result of lots of work, and clinical innovation is at the beginning of the work.

So, it can be quite challenging to be both innovative and excellent at the same time.

In this health assessment program, we've really tried to take the best clinical evidence to be clinically excellent, but also trying to open our minds to where we can be innovative, where the risks are lower or where there are really exciting opportunities to try some of the newer things.

A great example of that is our heart rhythm screening which is with a product called Kardia.

It’s been on the market for a number of years, and actually does have a national guidelines, which is brilliant for me, because it’s both excellent and innovative, but it’s not been used as population screening before, and we know that Cambridge University currently trialling population-based screening, but it’s a good tool for looking for abnormal heart rhythms for condition called atrial fibrillation.

Atrial fibrillation is the biggest cause of stroke in the UK, and stroke is one of the biggest killers in the UK.

So, using this product, which involves you holding two sensors, it takes a rhythm strip of your heart and picks up atrial fibrillation, is a great innovation.

It’s also clinically excellent and I’m really proud that it's in our new clinical products.

When we looked at our existing products, we had to bear in mind two main things from our team's perspective: what are the highest causes of mortality?

And then, what are the highest causes of people’s absence from the workplace or inability to enjoy their lives?

So, we looked at things like high-risk cancers, cardiovascular disease, lung disease and stroke disease as the commonest causes of early death and as a result of that we looked at our current products to see where we could improve.

So we improved things like our cardiac risk scoring, we’ve gone for the most up-to-date cardiac risk score called QRisk3, we've improved our screening for atrial fibrillation, which is the heart rhythm problem that can lead to stroke; we have upgraded our cancer tests, particularly our bowel cancer and cervical cancer screening.

We've gone for the most up-to-date versions of those that we can.

And then we looked at the conditions where we see the highest absence from work, so particularly mental health.

We’ve got the most comprehensive mental health assessment that we've ever had in health assessments in the new proposition, it’s really exciting.

We’re not just asking people if they’re depressed or anxious, we're asking about their general well-being, we're asking about their previous mental health problems and any family history of mental health problems.

We know that those things can increase your risk, and instead of just treating people when they’re unwell, we are giving them information about how to stay well whilst they’re well, which I think is really exciting.

One of the other biggest causes of absence from work are MSK conditions, so musculoskeletal conditions, joints, aches, and pains and dysfunction.

We’ve developed with our physios an evidence-based tool to assess peoples' function and movement.

This is far superior to any tool that we've ever used before and is picking up joint problems sometimes before people are even realising, they’ve got restriction of movement.

Because we know if we get physio intervention early, we'll prevent people from not only having pain and dysfunction, but potentially losing time from the things that they enjoy, time with their love ones or even time from work.

And the third thing that we've looked at which is a common cause for absence are digestive problems and we’ve looked at that in both our modules.

So, we've got a module on gut health which our health advisors are delivering for people that think they need help in getting a healthier gut.

And we've addressed that with things like the coeliac screen in our additional tests.

So, by approaching the health assessment by looking at absence and illness, we think that we’ve covered it, in both improving our current tests, adding and adding tests that are needed.

The new health assessment is designed to be flexible and individualised and personalised.

The idea is that when you come in to see your doctor or your health advisor there's not just a fixed set of tests that we throw at you for them to get a fixed set of results.

The idea is that at the beginning you discuss with your health advisor and/or your doctor what it is that you want to gain out of the time that you’ve got with them.

The tests are very flexible, and the idea of that is that some people may need some tests, some may need very little in the way of testing but might prefer to spend the time talking about their mental health or well-being.

Some people may really want to focus on their musculoskeletal health and how to improve their flexibility or strength, and for some people it’s about lifestyle and fitness.

But certainly, some people have significant health concerns and it’s really good if they can spend that time with their GP in the health assessment discussing their next steps as they come out of it.

And what we hope is that at the end of the health assessment, everyone comes out feeling that the time was spent in a very specific way to them, that their action plan was very specific to them, and that the whole experience was a very individual one.

We thought long and hard about the pre-assessment questionnaire.

We wanted to make sure that we are asking relevant questions, we were asking questions that meant something, and questions that were evidence based.

So, we have taken out questions that we believe don’t add much value to the health assessment.

Because filling in a questionnaire is time-consuming, and peoples' time is very valuable.

We've added questions that we think will help us understand a customer's needs.

We've put in very general questions asking people about what they want to get out of their health assessment, to tell us about their health.

We've been much more focused when we asked them questions about their sleep, for example.

We're using an evidence-based tool to assess their sleep - just not asking them how many hours they’ve slept, because we know that sleep needs to be assessed in quality rather than quantity.

We've also used other tools in it, such as how to measure your alcohol intake, to make sure that we're asking questions that give us really evidence-based answers so that we can work with people to work on their lifestyle in the most focused way possible.

It’s a shorter pre-assessment questionnaire than we had historically, and it’s a layered pre-assessment questionnaire.

So, if you aren’t a smoker, you’re not then going to be asked 'how many cigarettes do you smoke a day?'

It's smart, and it’s a adjusts to your needs.

And so, for some people it might take only as long as five or six minutes to complete, but if you have an extensive medical history, or a number of mental health problems, it may take as long as 15 minutes.

But all that information is then transferred to your clinician so that they have that information in front of them when you come to visit and so that you don’t have to repeat yourself every time you see a new person on the journey.

If you have tests that aren't on back on the day and come back later on, normally our doctors will just send you the results.

But sometimes we do need to speak to you if they are serious, or it’s not cut and dried whether you need to do something.

And so, it's not uncommon for us to have to phone you, or contact you via email, to speak to you in person around your results.

We’ve been doing this for years and it works really well.

One of the other huge benefits of a health assessment is that you have access for the whole year to our 24/7 Anytime HealthLine nurse line.

That means that you can ring at any time for health advice, and it doesn’t need to be related to your health assessment, and it can be for your love ones, to speak to an experienced nurse to get advice.

I think it’s invaluable and it can be really helpful, especially when you may be struggling to get in touch with other services.

One of the wonderful things about our health assessments is the quality of the doctors that we have that deliver them.

We have really strict recruitment criteria, and we have great doctors.

Our doctors are hugely experienced, they come from many different walks of life, they work all around the UK.

Many of them are established GPs, running their own practices, that come and work for us a couple of days a week, so they come with an enormous amount of knowledge and experience.

That makes them perfectly well placed to spend up to an hour with you talking about your health concerns.

I’m really proud of the doctor community we have, and I’m really confident when you come to see them, you’ll be thrilled with the quality of the advice that you receive.