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Acute Services

Medical Workforce Plan2017 - 2018

2 Acute Services Medical Workforce Plan

Contents

Section One: Background to the Medical Workforce Plan . . . . . . . . . . . . . . . . . . . 31.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Section Two: Medical Workforce - Demand Drivers and Service Changes . . . . 52.1 Acute Service Division Drivers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52.2 Seven Day Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62.3 Introduction of maximum 7 day consecutive shift working . . . . . . . . . . . . . . . . . . . . . . . 62.4 Shared Services Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.5 Changes to the General Practice Training Scheme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.6 Realistic Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82.7 Shape of Training Review (Greenaway) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82.8 Expansion of training Grades within NHS Scotland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Section Three: The Acute Services Medical Workforce . . . . . . . . . . . . . . . . . . . . . 103.1 Medical Workforce Costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103.2 Current Establishment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103.3 Locum, Bank and Agency Spend . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123.4 Turnover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Section Four: Key Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144.1 Ageing Workforce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144.2 Absenteeism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154.3 Increase in Less than Full Time Training Grades . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174.4 Unsustainable medical staffing rotas and clinically unstable working practices . . . . 184.5 Over Specialisation of the Medical Workforce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194.6 Consultant Productivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Section Five: Supplying the Required Workforce . . . . . . . . . . . . . . . . . . . . . . . . . . 215.1 Recruitment & Retention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215.2 Trainees gaining Certificate of Completion of Training (CCT) . . . . . . . . . . . . . . . . . . . . 225.3 Learning & Education for the NHSGGC Medical Workforce . . . . . . . . . . . . . . . . . . . . . . . 23

Section Six: Implementation, Monitoring and Review . . . . . . . . . . . . . . . . . . . . . 246.1 Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246.2 Monitoring and Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257.1 Appendix 1: Sector/Directorate Local Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257.2 Appendix 2: Implementation Plan: Short, Medium and Longer Term Actions . . . . . . 317.3 Appendix 3: Summary of retiral projections by specialty . . . . . . . . . . . . . . . . . . . . . . . . 357.4 Appendix 4: Glossary of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Acute Services Medical Workforce Plan 3

1 Section One: Background to the Medical Workforce Plan

1.1 Introduction1.1.1 The Medical Workforce Plan describes the current medical workforce challenges facing the

Acute Division in delivering clinical services in 2017/2018. The plan takes into consideration key Acute Strategy documents including the Acute Division Delivery Plan and Strategy for Acute Services.

1.1.2 The Medical workforce plan has been developed by the Human Resources Medical Staffing team with input from the Chiefs of Medicine. As the Plan is developed we will consult further with clinical leaders and professional organisations to ensure that all stakeholders contribute to the final plan.

1.1.3 The Workforce plan focuses on Acute Medical staffing workforce issues and will form part of an overarching plan which will include other elements of the Acute workforce including Nursing and Midwifery, Allied Health Professionals and all other NHS staff groups. Significant work has already been undertaken in Nursing and Midwifery in indentifying the workforce challenges with further work for AHP staff and non-clinical roles underway. All workforce plans will form part of a comprehensive Board Workforce Plan and link to National workforce plans.

The aim of the Medical Workforce Plan is to support the Acute Division’s commitment to:“Deliver effective and high quality health services, to act to improve the health of our population and to do everything we can to address the wider social determinants of health which can lead to health inequalities”. The Medical Workforce Plan will focus on

¡ Medical staff recruitment and retention ¡ Creating a stable medical workforce by reducing medical locum usage ¡ Developing the current and future medical workforce ensuring access to clinical skills

training and leadership development for clinical leaders ¡ Improving medical workforce productivity through application of the ALLOCATE job

planning tool and review of EPAs across the Acute Division ¡ The ageing medical workforce and the impact of this changing demographic for the future

medical workforce ¡ Shared Services and how this will impact on the future Medical Workforce

1.1.4 It is recognised by all stakeholders that the redesign and service change plans set out in this workforce plan are at varying stages of development and implementation. In addition a number of the projects are still the subject of continuing discussion with staff side and therefore outcomes may change as consultations are completed. This flexibility is reflected in the narrative of the plan. Some of these plans will change in response to external influences and events and this may affect projected workforce change.

1.1.5 Regular updates on progress against the aims and targets set out in the Workforce Plan will be provided to the Senior Management Group (SMG), Acute Partnership Forum (APF) and other stakeholder forums.

1.1.6 The Scottish Government has set out its vision for the NHS in Scotland in the strategic narrative for 2020.

“Our vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting. We will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self management. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of readmission”.


1.1.7 Underpinning the narrative is the Quality Strategy, with the three central ambitions that care should be:

¡ person centered; ¡ safe; ¡ effective.

1.1.8 In this Workforce Plan we will outline our actions to support the 5 priorities identified within Everyone Matters

1.1.9 The overall priorities for action in NHSGGC focus on the following: ¡ Creating a healthy organisational culture developing and sustaining a healthy

organisational culture to create the conditions for high quality health and social care. ¡ Establishing a sustainable workforce by changing the health workforce to match new

ways of delivering services and new ways of working; ensuring that people with the right skills, in the right numbers, are in the right jobs; promoting the health and well-being of the existing workforce and preparing them to meet future service needs.

¡ Maintaining a capable workforce by ensuring that all staff are appropriately trained and have access to learning and development to support the Quality Ambitions and 2020 Vision for Health and Social Care.

¡ Developing an integrated workforce ensuring that the workforce is more joined-up across primary and secondary care, across Boards and with partners across health and social care.

¡ Effective leadership and management ensuring that managers and leaders are valued, supported and developed. Managers and leaders are part of the workforce and have a key role to play in driving service and culture change.

1.1.10 Workforce Plan Governance & Partnership Engagement NHSGGC is committed to agreeing and delivering workforce plans in consultation with a wide

range of stakeholders, including staff, trade unions and professional organisations. Processes and structures have been established to achieve this.

The evolution of partnership working between employers and trade unions/professional organisations at both local and national level has helped to ensure that plans are consistent and realistic.

NHSGGC has a Recognition Agreement with the British Medical Association (BMA) which establishes a Partnership Framework for negotiation and consultation to reach internal agreements through the Medical Staff Forum (MSF). The MSF acts as the Forum for consultation, negotiation, involvement and information exchange. The MSF will be a key stakeholder in developing the medical workforce and provide a forum for developing policies and guidance to support the necessary workforce developments.The Medical Workforce Plan will be reviewed by the following groups:-

¡ The Strategic Management Group ¡ The Chief Executive and Chief Officer’s Group ¡ The Medical Staff Forum ¡ The Acute Partnership Forum ¡ The Staff Governance Committee

Healthy organisational culture

Sustainable workforce

Capable workforce

integrated workforce

Effective leadership and management

Our 2020 vision for H

ealth and Social Care

2020 Workforce Vision


2 Section Two: Medical Workforce - Demand Drivers and Service Changes

2.1 Acute Service Division Drivers 2.1.1 The Acute Division Delivery Plan and Strategy for Acute Services both describe the need for

acute services to change with a focus on developing the services provided by GPs in helping reshape our system of care. The Acute Division Delivery Plan describes how the Acute Division will deliver safe, high quality and effective clinical services and highlights the need to engage with the Medical workforce in the redesign agenda. The main service redesigns changes which impact on medical staff are summarised as follows:Beatson clinical support: the review outcomes of the model of clinical support to the Beatson;Transition Care for Diabetes: A new model of care which will offer better care for young people up to the age of 25 years;Specialist disability and acquired brain injury: a full review of this service is underway. There are early changes to deliver including ensuring Clyde patients have access to specialist advice; testing the potential to cohort patients to improve acute care to challenging patients ensuring patients fit for discharge are flagged to enable HSCPs to develop appropriate commissioning; Centre for integrative care: reshape the service to deliver ambulatory care enabling the current bed capacity to be used to deliver the new national pain service;Lightburn: establish access for the North east to new bed capacity at GGH replacing beds at Lightburn and reshape the outpatient and other services to enable the closure of the site;Community midwifery units: transferring the delivery services to the RAH and QEUH while retaining the full range of ambulatory services;Drumchapel rehabilitation: transferring services to Gartnavel General enabling the closure of the site;Paediatrics at RAH: reshaping the service to continue to provide outpatient and ambulatory care with inpatient services provided from the RHC;Cleft lip and palate surgery: plan the implementation of a single surgical service for Scotland and take responsibility for the delivery of specialist input to outreach care across Scotland;GP Out of hours service changes: the transfer of Drumchapel OOH to Gartnavel and conclude work to consider further changes to OOH services and delivery on Vale and IRH proposals;Bariatric surgery: Consolidating and developing the service to ensure that we can deliver the required volumes and quality;In addition to these service changes in 2016/17 we have a number of reviews underway which should be completed in time to begin implementation in 2017/2018. These are described in the rest of this section.Cancer plan: we need to respond the developing direction of the National Cancer Plan. Urological and colorectal cancer services are being prioritised for improvement, with NHSGGC investing £1.2 m in creating two new diagnostic hubs across the health board.Unscheduled care: a whole system review of unscheduled care is underway with the aim of implementing a series of changes to enable services to operate more effectively from the autumn of 2016.Scheduled care: we are working to develop a detailed assessment of the gap between demand and our funded capacity for scheduled care. As the detailed attachment illustrates there are major issues in a range of specialities to meet our current targets. Linked to this Scottish Government (SG) are establishing a planning process for their proposals on scheduled care centres.Breast surgery: there have been various discussions about the future arrangements for breast surgery and also how to improve our approach to immediate reconstruction we need to conclude these process and deliver a plan for this service.


Gynaecology: a planning process is underway to develop a Divisional approach to subspecialisation; to make proposals for a regional approach to endometriosis and specialist obstetrics and to propose changes to the configuration of inpatient services.Stroke: we are not consistently delivering the clinical standards for stroke and there is unjustifiable variation in the care which we offer on different sites. A review of stroke services is underway to develop proposals to address these issues.Transition from adult to childhood in a range of services: lack of integration of care pathways between paediatric and adult services creates challenges for clinicians, patients and parents, this work is should establish clear pathways in a number of services, including cerebral palsy and cystic fibrosisITU at IRH: there are major challenges with the provision of ITU at the IRH. The Clyde team is working to find a solution to deliver a fit for purpose facility. All of these changes will require clinical involvement in redesigning the services and leading changes in how Acute Services are delivered.

2.2 Seven Day Services2.2.1 Both Scottish and UK Governments are committed to working with NHS Boards to ensure

patients access high quality and safe care during evenings and weekends. There is a clear link between poorer outcomes for patients and uneven service provision at the weekend. This includes access to diagnostic tests which are not consistently available in all hospitals during evenings and weekends. The published research shows that patients are 16 per cent more likely to die if they are admitted on a Sunday compared with Wednesday (Department of Health).

2.2.2 Across our Acute Specialties the vast majority of junior doctors already work shifts with Consultants being able to opt out of non emergency work at the weekends and in the evenings.

2.2.3 In some Acute specialties local services have developed an extended working day model with Consultants participating in a shift pattern during evenings and weekends. These include Emergency Medicine at the Queen Elizabeth Hospital and a pilot in Radiology also at the Queen Elizabeth Hospital. In both examples there has been an investment in additional Consultant staff to provide cover during the evening and weekend rotas whilst ensuring that medical staff receive appropriate rest.

2.2.4 NHS Greater Glasgow and Clyde recognises that the further development and extension of 7 day services will be based on patient demand, available funding and is influenced by contractual negotiations to determine remuneration and terms and conditions for 7 day working.

2.3 Introduction of maximum 7 day consecutive shift working2.3.1 The Temple Report (June 2010) looked at the impact of the 48 hour week on the quality of

training that is necessary to ensure continuing supply of a world class workforce, able to deliver high quality services to patients.

2.3.2 Following the Temple Report, the Scottish Government stipulated that no junior doctor would be rostered to work more than 7 consecutive shifts. The target for completion was March 2016.

2.3.3 The reduced hours have resulted in changes to shift patterns in many specialties. This has resulted in a decrease in training opportunities as more time is spent out-of-hours where there is reduced supervision.

2.3.4 Seven day shifts also reduce trainer and trainee interaction because of the introduction of time off in core day time hours. The consequence is a requirement for more Doctors to cover out-of-hours care, an increase in the number of rota gaps and an even more challenging recruitment position. The Temple Report recommends that NHS Boards move away from using Junior Doctors to provide out of hours cover to a model which utilises the current trained workforce.

2.3.5 NHSGGC achieved 97% compliance however there remain some areas which are problematic. The Clyde Sector has been unable to revert to planned 7 day option as described below (Figure 1). Potential rota options have been given to the service and will be presented to the Consultants planning for proposed implementation at the February 2017 rotation.


Figure 1: 7 Consecutive Shift Compliance Report

Rota No

Site Specialty Shift Type

7 Day Y/N

If NO, why? current status.

CL11 RAH/VoL General Medicine FS N Rota options have been provided for final consultation and agreement with the intention of implementing for the February 2017 rotation.

CL12 RAH General MedicineGeriatric Medicine

FS N As CL11

CL13 RAH/VoL General MedicineGeriatric Medicine

FS N As CL11

CL14 RAH/VoL General Medicine FS N As CL11, also numbers of trainees currently at minimum level.

2.4 Shared Services Review2.4.1 Doctors and Dentists in Training (DDiT) rotate through a number of different clinical placements

in order to fulfil the requirements of the education and training curricula associated with their medical and specialty training programmes. Rotations can take place every 4 months (Foundation), every 6 months (Core) or annually. Rotations often involve DDiT moving between NHS Boards.

2.4.2 NHSGGC are participating in the National core working group seeking to implement a ‘Once for Scotland’ approach, with specific work commissioned to develop proposals to simplify, standardise and share approaches to:

¡ PVG / Disclosure. ¡ Contracts of Employment and (potential) Protection Issues. ¡ National arrangements for Management of Tier 2 Visas (NES). ¡ Personal and Employment Related Information Sharing across NHS Boards (e.g. Occupational

Health Passport approach). ¡ Establishment of a Single Payroll Number for DDiT. ¡ Standardised HR Policies and Procedures for DDiT. ¡ Development of an NHSS HR DDiT Workforce Information System (NES Turas System).

2.4.3 Work to standardise the approach to PVG/disclosure and Management of Tier 2 Visas has now been completed, with NES taking over these processes from December 2016 for all new applications.

2.4.4 The aim is to complete the development of the remaining strands and implementation of the new contract by August 2017.

2.5 Changes to the General Practice Training Scheme2.5.1 In response to the recognised national shortage of participants in the GP training scheme,

the Scottish Government have confirmed the creation of 100 extra 3-year GP training schemes. These are to be implemented in February 2017. This will take the total number of GP trainees in Scotland being employed each year to 400. It is expected that the financial impact of this on Health Boards should be cost neutral, with the costs to be met within current NES resource. As part of this plan it is also intended to phase out 4 year training schemes, converting them to 3 years.

2.5.2 With current trainees in 4 year schemes the full effect of this will take a further 3 years to implement. The majority of the 4 year training schemes at the moment (134) are within the West of Scotland and 71 of these are within NHSGGC. At present there are 123 GP vacancies which were left after Round 1 recruitment in 2016. 88 of these were on the 4 year scheme, 38 of which were in NHSGGC. It is projected therefore that by increasing the 3 year schemes it will


improve the recruitment rate as the 4 year schemes are proving to be unpopular and difficult to fill.

2.5.3 The full impact of this change is hard to predict and it is unclear how this change will influence specialty placements and where new posts will be established across Scotland. It has been confirmed, however, that 59 placements will be hosted in the West of Scotland and that NHSGGC has been allocated 30 rotations over 4 programmes.

2.5.4 The rotations are still to be defined but NES will work collaboratively with NHS Boards in creating the rotations. These posts should be valuable and attractive to potential applicants and provide quality training experiences. There will be 34 hospital posts over the next 2 years starting from February 2017.

2.6 Realistic Medicine2.6.1 The publication of the Chief Medical Officer’s Annual Report “Realistic Medicine” poses key

challenges for clinicians about the application of modern medicine within a dynamic and changing healthcare environment.

2.6.2 The report describes the limitations on the current healthcare model which does not always suit the needs of patients, their carers or the aspirations of the workforce. The report highlights the importance of effective patient and clinician communication; this theme is a key element of the Acute Delivery Plan and will require a focus on clinical leadership development and communication skills. Within NHSGGC this workforce plan will support clinicians to deliver person centred care.

2.7 Shape of Training Review (Greenaway)2.7.1 The Greenaway Report (2013) and initiatives such as Sustainability and 7 Day Services are

forming the basis of our approach to future workforce planning. 2.7.2 The new approach to medical training requires doctors who are more broadly trained in a

shorter time period. It implies that a re-balance is required in moving away from specialisation to a more Generalist model of training. The Shape of Training review will be implemented over the next 6-8 years.

2.7.3 The Board with support from NHS Scotland agreed to the option of developing one or two year International Medical Training Fellowships to assist Boards during the interim period. The proposal recognises the need for high quality educational governance and also the strategic direction outlined within the ‘Shape of Training’ towards increasing recognition of formal post Certificate of Completion of Training CCT/CST credentialed training opportunities.

2.7.4 The posts are aimed primarily at overseas doctors who have completed specialty training in their ‘home’ Country, but could also be available for post-CCT UK trained doctors. These posts will provide service delivery for NHS Scotland and educational experience for the post holders.

2.7.5 In the first year this has been successful with several specialties participating and we have successfully recruited to a range of specialties (Figure 2). The Scottish Government has now invited applicants for posts available in 2017/18.

Figure 2: IMTF posts 2016/17

Specialty Number of posts Start DatePancreatic 1 September 2016Oesophageal 1 September 2016Colorectal 1 September 2016Trauma and Orthopedics 1 December 2016Paediatrics 1 Deferred to July 2017Vasculitis 1 Deferred to February 2017COPD 1 Deferred to February 2017Total 7


2.8 Expansion of training Grades within NHS Scotland2.8.1 The Reshaping Project Board in January 2014 initiated an expansion in training posts for the

hard to fill specialties. In total an additional 58 trainee posts per year were allocated across Scotland; 29 of which were located in the West of Scotland.

2.8.2 During the period 2014 to 2017 the Scottish Government and NES contributed £0.9 million per annum to assist fund the expansion posts. The remaining costs were to be met by the individual Health Boards.

2.8.3 To date, not all of the expansion posts have been filled and therefore the financial cost to the Board has been less than originally forecasted. In 2014/15, 22 out of 29 posts were filled in the West of Scotland and In 2015/16, 18.25 out of 29 posts were filled. On average NHSGGC have had 10.5 posts filled each year.

2.8.4 In addition to the 58 posts defined above a further 32 expansion posts, across a number of specialties, were introduced and fully funded by NES.

2.8.5 NES will no longer provide funding for the 58 posts from 2017/18. A regional decision is yet to be agreed for 2017 on whether these posts will be supported in the longer term since failure to do so may create further vacancies and potential impact on clinical service delivery.

2.8.6 It is anticipated that no further growth in posts nationally will be necessary unless compelling evidence is presented for key specialties such as Radiology which faces key recruitment challenges. Within Radiology It is proposed to increase the number of Diagnostic and Interventional Radiology posts overall. The recommendation is to increase Diagnostic Radiology posts by 8 with a further 2 Interventional Radiology posts. The Interventional posts are expected to be hosted in NHSGGC. From a national and regional planning perspective, there needs to be careful consideration to expanding the trainee cohort within Interventional Radiology due to the impact on transfer of activity for other Board areas.


3 Section Three: The Acute Services Medical Workforce

3.1 Medical Workforce Costs3.1.1 The 2016/2017 budget for Acute Medical is approximately £340 million and all Directorates/

Sectors are overspent with the exception of Diagnostics totally £4.8m for the 6 months financial year to date. There are significant financial pressures across all sites within Acute in relation to medical salaries. The overspend is attributable to a number of conflicting pressures including the additional cost of dealing with shortfalls in capacity caused by long term vacancies and sickness absence in critical areas, the need to address demand and achieve HEAT targets through payment of Waiting List Initiative payments.

3.1.2 A comprehensive planning process involving all Directors and a wide range of managers had identified CRES savings schemes to address the financial gap totaling £43.5m full year effect (£34.5m part year effect). In addition, a range of “red rated” schemes have been identified, including some service redesign proposals, that require further work and consultation, totaling £11.5m full year effect (£8m part year effect).

3.1.3 Junior Doctors have been budgeted for centrally at month 6 and positively remain within overall budget available at this time. However changes to overall numbers, coverage and impending reductions in income from NES, in 2017, may adversely impact on this area moving forward.

3.1.4 Waiting List initiative payments, for the year to date, is £4.4 million and in 2015/16 the year end cost figure was £8.9 million (Figure 3).

Figure 3: Waiting List initiative spend (Month 6)

Directorate/Sector 2016/17 YTD 2015/16 – Out TurnSnr Var £000s

Jnr Var £000s

Tot Var £000s

Snr Var £000s

Jnr Var £000s

Tot Var £000s

South 1,719 0 1,719 3,255 280 3,535North 782 0 782 2,095 252 2,347South Clyde Sector 1,284 0 1,284 1,337 456 1,792Diagnostic 101 0 101 532 0 532Regional Services 242 0 242 228 31 259Woman & Children’s 845 0 845 102 292 395Totals 4,772 0 4,772 7,549 1,311 8,860

3.2 Current Establishment3.2.1 On 31st March 2016, the NHSGGC Acute Medical and Dental workforce comprised 1,288

headcount consultant staff supported by 175 other career grades. Trainee medical and dental staff accounted for 1,784 headcount (Figure 4A & 4B)). Although medical and dental training grades are employed by NHSGGC, funding for these posts is provided by NES Education for Scotland. These training posts are rotational and are therefore removed when calculating Board turnover figures.


Figure 4A: Medical and Dental Consultant and other grades Workforce broken down by grade and by Sector/Directorate (Headcount)

Grade North South Clyde Diagnostics Regional

W&C (incl Comm Paeds) Other Total

Consultants 177 323 153 189 190 230 26 1288Locum Consultants 8 13 12 10 12 22 1 78Honorary Consultants 12 17 0 11 11 8 5 64Specialty Doctors 10 25 30 5 14 22 17 123Associate Specialist 4 11 8 0 7 16 2 48Staff Grades 0 0 1 0 1 1 1 4Total 211 388 204 215 235 299 52 1605

Figure 4B: Training Grades Workforce broken down by grade and by Sector/ Directorate (Headcount)

Grade North South Clyde Diagnostics Regional W&C (incl Com

Paeds) GJNH Other2 Total

FY1 71 110 50 2 9 242

FY2 42 68 52 2 24 41 229

SpR 1 1 2

StR (core) 45 61 36 23 3 168

STR 110 170 82 95 109 178 10 12 766

GPST 34 44 24 7 29 138

LAT (core StR) 4 3 7

LAT (StR) 5 13 4 3 6 20 51

Clinical Fellow (Training)

10 10 9 3 9 41

Clinical Fellow (Service)

27 12 13 10 2 3 67

Senior Clinical Fellow (Training)

3 1 2 2 8

Senior Clinical Fellow (Service)

10 22 8 16 9 65

Total 357 516 281 100 202 303 10 15 1784


3.3 Locum, Bank and Agency Spend 3.3.1 NHSGGC’s overall spend for locum and agency in 2015/16 in Acute was estimated to be

£17.53 million. The most recent Finance report shows the estimated spend in Acute sits at £11.6m with £8.9 million of that total attributable to Agency costs and £2.65m to Bank/Locum costs (Figure 5A). This compares to a spend of £8,545k for the same period last year with the impact of activity, sickness absence, and capacity all being contributing factors. At a high level Junior Medical agency is up by £108k on last year and Senior Medical Agency spend has increased by £284k compared to the same period last year. These increases combined with significant levels of expenditure in WLIs and ongoing additional EPAs have created a level of pressure which has escalated from 2015/16. Figure 5B illustrates the month-on-month position for this financial year.

Figure 5A: Locum, Bank and Agency Spend by Area in Acute (Month 6)

Sector/Directorate £ Bank/locum £ Agency TotalClyde 351,678 3,677,287 4,028,965North 496,277 1,075,958 1,572,235South 197,208 2,428,499 2,625,707Diagnostics 254,734 715,343 970,077Regional 624,519 576,049 1,200,568W&C 636,521 463,492 1,100,013Corporate 79,147 0 79,147Total 2,640,084 8,936,628 11,576.712

Figure 5B: Medical Agency

Spend Trend for Agency across all Acute Directorates/Sectors in 2016/17 Month 1

£000’sMonth 2 £000’s

Month 3 £000’s

Month 4 £000’s

Month 5 £000’s

Month 6 £000’s

YTD Total £000s

Prior Year £000s

Senior Medical £933 £854 £727 £820 £756 £779 £4,868 £9,146

Junior Medical £510 £792 £853 £770 £554 £590 £4,069 £8,384

Total Medical Agency £1,443 £1,646 £1,580 £1,589 £1,310 £1,369 £8,937 £17,530

3.3.2 Whilst there is currently no overall downturn in the trend at month 6, from that experienced in 2015/16, it is encouraging that the reduction in Junior Medical Agency in months 5 and 6, following the rotational changes. If this is sustained then Junior Medical would see a reasonable spend reduction in 16/17 compared to the last financial year.

3.3.3 Within NHSGGC a Steering Group, led by the Director of Finance and the Medical Director has been convened to consider both the regional and national work streams alluded to above and to look at what steps could be taken locally within the Board to reduce spend on locums.

3.3.4 NHSGGC acknowledges that from time to time Medical Locum staff are a useful resource to cover unexpected short term roster gaps, or longer term hard to fill posts. While necessary in some instances, use of locum agency medical staff can be both an expensive option and less effective in delivering patient care than alternative measures. In light of that and in common with other NHS Scotland Boards NHSGGC needs to take steps to reduce the use of locum agency staff.

3.3.5 In order to ensure there is a consistent approach in the access of Locum/Agency cover, a guidance protocol has been drafted following engagement with both medical and managerial staff up to and including Director Level. This guide outlines what steps must be taken prior to accessing Bank, locum and agency staff and ultimately in dealing with locum agencies.


3.3.6 A range of national, regional and local initiatives are either in development or underway to reduce demand for, and spend on, locums, including:

3.3.7 Regional/National Capped rates of pay to locum agencies ¡ Establishing regional medical banks ¡ Regional Neutral Vendor initiative to manage locum agency suppliers ¡ Guidance on options for providing medical workforce cover

3.4 Turnover3.4.1 Turnover within NHSGGC for Medical Staff for 2015/16 was 9%. This is slightly down on the

2014/15 which was 10% (Figure 6)

Figure 6: A summary of turnover is shown belowMedical Staff Leavers 2010/11 to 2015/16Headcount Leavers by Sub FamilyMedical Sub Job Family

2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 Grand Total

Consultant 110 123 100 101 118 115 667

Specialty Doctor

31 27 33 25 38 56 210

Staff & Associate Specialist

25 20 13 19 16 0 93

Total 166 170 146 145 172 171 970


4 Section Four: Key Challenges

In discussion with the Chiefs of Medicine, the following have been identified as the primary medical workforce challenges faced by the service:-

4.1 Ageing Workforce4.1.1 The current age profile of the Medical Workforce is shown below:

Figure 7: Age Profile by grade

4.1.2 The graph illustrates 30% of the Consultant workforce are currently aged 51 or over, similar to the Other Grades, with Training Grades reflecting less than 1% aged over 51.

4.1.3 Looking ahead to the next five years there are major challenges in relation to key clinical posts with a number of senior medical staff projected to retire. The impact of age retirals will no doubt be compounded by changes to the NHS Pension Scheme which has resulted in turnover across key senior medical posts. In managing turnover and retirements individual staff discussions with regard to staff wishes in relation to retirement are essential and during these discussions consideration of flexible working arrangements e.g. part time working or phased retirement will be explored. Appendix 3 provides a full summary of projected retirements by specialty.

4.1.4 Whatever the age of an employee, discussing their future aims and aspirations can assist in planning the workforce requirements to meet future service needs. Whilst the Equality Act 2010 made it unlawful to discriminate against individuals approaching retirement age, it is still permissible to ask about future plans in general. Working in partnership with the LNC, Medical Staffing have developed a standardised letter to be sent out to all career grades to capture any plans regarding changes to their working arrangements e.g. reduction in hours, leaving the service.

4.1.5 The primary reason for Consultants leaving the workforce is Retirement and this is illustrated in Figure 8 below.

Figure 8 – Consultants’ Reasons for Leaving 2010-2016


4.1.6 Using the last 6 years of data NHSGGC has identified that Medical Consultants generally retire 5 years ahead of their default retirement age and that male consultants typically retire 1 year earlier than females.

Figure 9: Retirement Projections

Over the next 5 years Appendix 3 projects that there will be a high level of Consultant Anaesthetic retirals. Changes to the Pension scheme may further accelerate the numbers retiring amongst the pre-60 group. The North Sector currently has three vacant posts going to advert in early 2017 but there remain difficulties recruiting to vacancies as the last 2 consultant recruitment adverts failed to fill the vacancies.

The South has no Anaesthetists intending to retire within the next year however two are due to retire in 2017 and a further three in 2019.

Other factors which have contributed to turnover include the initial use of use of 9:1 contracts as part of the job application pack for new consultants. This is despite final Job plans being agreed which are related to individual experience and service needs.

4.2 Absenteeism4.2.1 Improving staff attendance at work is a priority for all Boards who work towards a 4% sickness

absence rate. The correlation between levels of staff attendance and patient outcomes is well established with high levels of attendance associated with improved patient experience and positive staff morale (Professor Michael West).

4.2.2 The overall sickness absence rate across the Acute Division for the month of September 2016 was 5.18%. The level of sickness absence comprises 1.84% short term absence and 3.34% long term absence.

4.2.3 Figure 10 below illustrates the sickness absence rate comparison between the three main medical grades; Consultant, Training Grades and Other Medical Grades. Consultant and training grades show a similar trend over the 22 month period below from January 2015 to October 2016. The Other Medical Grades peaked at 4.13% in May 2015, however this has reduced to 2% over the last 12 months. The overall sickness absence for medical staff is 1.2%. This compares favourably with a Board-Wide sickness absence figure of 6.1% in November 2016.

Figure 10: Sickness Absence Figures by Medical Grade


4.2.4 Other Leave Figure 11 provides an overview of sickness and maternity leave since January 2015 for Medical

and Dental staff

4.2.5 The average maternity leave peaks at 4% in July 16 with an overall average figure 2015/16 of 3.46%. The sector with the highest maternity leave (Figure 12) is Women and Children with Anaesthetics, Paediatrics, Obstetrics and Gynaecology specialties with highest average. This is reflective of the specialties with highest female workforce. A future workforce challenge will be providing greater flexibility in medical staff contractual arrangements for females returning from maternity leave who may wish to request flexible working as part of their working arrangements.

Figure 12 shows the episodes and days lost by sector directorate

Medical and Dental Maternity by Sector January 2015 to October 2016Area Sector Episodes Working Days LostAcute Clyde Sector 24 3,009.0 Diagnostic Services 16 2,085.0 Emergency Care & Medical Services 4 438.0 Non Paid Employees 1 226.0 North Sector 37 4,460.0 Regional Services 21 2,535.0 Rehabilitation & Assessment Services 2 251.0 South Sector 37 4,387.0 Surgery & Anaesthetics 6 786.0 Women & Children’s 57 7,143.5 205 25,320.5Other Functions Public Health 2 93.0 2 93.0Partnership East Dunbartonshire - Oral Health 1 130.0 East Dunbartonshire - Oral Health HSCP 6 365.0 Glasgow City HSCP 33 3,924.0 Inverclyde HSCP 1 18.0 Renfrewshire HSCP 2 359.0 West Dunbartonshire HSCP 2 100.0 45 4,896.0 Total 252 30,309.5


4.2.6 In analysing Medical staff absence, there is a requirement to review and improve how medical staff absence is recorded, monitored and reported across Acute Sectors and Directorates. In addition, there is potential to improve core attendance processes including return to work interviews and supporting staff on long term absence, including their phased return to work. A standardised approach to the recording, monitoring and management of staff absence is being developed by the Medical Staffing Team to be implemented in January 2017.

4.2.7 In order to address long term absence and absences due to stress and anxiety, the Acute Division continues to address staff health and well being by applying the iMatter tool and continued implementation of the Health and Safety Executive Stress at Work Tool.

4.3 Increase in Less than Full Time Training Grades4.3.1 Further to the August 2017 intake, there are currently 146 LTFT (89.6 wte) employed by NHSGGC

(Figure 13). This equates to 7.5 % of the total junior doctor workforce and has been steadily increasing year on year. In an effort to offset the impact, NES has introduced a national expansion of training numbers over the past two years focusing on those specialties with the greatest number of LTFTs.

4.3.2 NHS Education for Scotland (NES) provide Boards with funding to cover the basic salary costs, at mid point, for training grade doctors. Where a trainee doctor works less than full time, NES provide pro-rata funding for these posts. This has a two-fold impact on Boards. Firstly, the total deployable hours available to Boards reduces and secondly, the funding associated with lost hours is held by NES and not provided to Boards to support the sourcing of backfill to cover these gaps. For NHSGGC, the impact is equivalent to 56.4 WTE.

Figure 13: Summary of less than full time working for training grades (August 2016)

Sector/Directorate

0.5 WTE

0.6 WTE

0.7 WTE

0.8 WTE

0.9 WTE

Total WTE

Clyde 3 6 2 11 6.5North 1 4 2 5 12 4.3South 12 8 2 7 29 17.8Diagnostics 1 8 7 1 17 11.8Regional 1 5 6 12 5.6W&C 3 19 15 1 38 25.8Corporate 3 2 5 3.4Partnerships 5 7 1 8 21 13.8Oral Health 1 1 0.6Total 26 61 7 50 2 146 89.6


4.4 Unsustainable medical staffing rotas and clinically unstable working practices4.4.1 Pay Bandings across all rotas within NHSGGC have remained stable over the last 3 years with

the majority of rotas at a 50% supplement or less. The majority of rotas are ‘full shift’ and the lowest banding available is 1B (40% supplement) so little scope for any further financial savings.

Figure 14: - Number of doctors broken down by Banding Supplement

Contract Type Banding Supplement (% Uplift on basic pay)

No. of Trainees in receipt

Full-Time Contract 1C – 20% 117 1B – 40% 144 1A – 50% 363 2B – 50% 969 2A – 80% 83 3 – 100% 27Less than Full Time Contract FA – 80% 70 FB – 50% 46 FC – 20% 30

4.4.2 Currently there is limited scope in reducing this level as the banding supplements are dependent on specific numbers and out of hours working. All efforts continue to be made to ensure that the lowest banding possible is in place whilst delivering educational and service requirements.

4.4.3 The bandings remain vulnerable to gaps and increasing activity, as in most cases the rotas run close to minimum requirements and are always at risk of moving in to a higher banding bracket following contractual monitoring processes.

4.4.4 Clinical Fellows (CFs) (non standard grade which is allied to the junior doctor Terms and Conditions) support the rotas in several ways:

¡ Where there are training gaps which cannot be filled with Locum Appointments for Training (LAT).

¡ Locum Appointments for Service (LAS) are traditionally the next step in backfilling, however NHSGGC opts to advertise for CFs due to them being more cost efficient and more likely to be filled

¡ Board funded posts to cover service/rota gaps ¡ Out of programme research fellows employed by the University but who provide out of

hours rota cover4.4.5 With a possible National move away from employing ‘non standard’ grades this may cause an

issue for the Board where these would need to be filled in the main by LAS with an associated financial impact and challenges with recruitment and retention.

4.4.6 The following junior grade rotas are band 3 non compliant: ¡ SG25 QEUH Senior Stroke Medicine ¡ WC07 RHCG Paediatric Surgery – monitored at Band 3 ¡ RS04 QEUH Neurosurgery – monitored at Band 3

SG25 QEUH Senior Stroke Medicine The rota is currently remains Band 3 due to work intensity in the out of hours period. Rota

options have been sent to the service for discussion. Medical Staffing have met Consultant staff and they have reconfigured their rotas to support the stroke rota. The impact will be assessed before any further or permanent changes are introduced.


RS04 QEUH ST3+ Neurosurgery Neurosurgery is problematical as since there is a shortage of experienced trainees across

Scotland. Board funding has been agreed to increase numbers with Clinical Fellows but recruitment to date has been unsuccessful

WC07 RHCG ST3+ Paediatric Surgery Monitoring supports the non compliance with Rest in the overnight period and remains Band

3. There has been discussion on how to resolve this and rota options for supporting a junior tier rota in the out of hours rota have been developed. The implementation of this revised rota is dependent on funding to support LAS posts.

4.4.7 The rotas are typical of a number of Middle Grade acute specialty rotas which work with an On call from home working pattern. Increasing activity out of hours means that most acute working patterns are stretched to minimum requirements for an On call work pattern. The Medical Staffing monitoring team are working across the acute sector assisting with reorganising of work patterns where there is evidence that they are at risk of non compliance with regulations.

4.4.8 Anaesthetic cover at the West of Scotland Cancer Centre Following the ASR and transfer of High dependency from Gartnavel site there is a requirement

to provide critical care anaesthetic cover for the West of Scotland Cancer Centre. Middle grade junior doctor cover is not available because of educational /supervision requirements. A temporary solution is for Resident On call Consultant cover (this is high cost and unsustainable long term).

4.5 Over Specialisation of the Medical Workforce4.5.1 Over the past 10 years, modern medicine has moved towards an increasing specialised service

to improve the delivery of highly specialised care. To support the delivery of this service model, specialty training programmes through Modernising Medical Training (MMC) and subsequently Scottish Medical Training (SMT) has been developed.

4.5.2 The current training model may inadvertently disadvantage patients who present with multiple chronic diseases and are required to see a number of specialists to treat their conditions. This approach often results in multiple hospital appointments or increased length of stay.

4.5.3 The Greenaway report recommends that doctors are more broadly trained within a shorter time period. It implies that a re-balance is required in moving away from over specialisation to a more generalist doctor. The Shape of Training review will be implemented over the next 6-8 years. NHSGGC will require to review services in preparation for the changes.

4.6 Consultant Productivity 4.6.1 Job Planning From 2004 the most common method for producing job plans across NHS GGC was either on

paper or as an electronic document. This method created inconsistencies in the presentation of job plans and led to a variance in the quality of plans depending on the individual and time spent on job planning.

Changes within the Board have necessitated refreshing of the Job planning guidance to assist Managers and doctors in agreeing job plans which reflect both NHSGGC and individual objectives. The Guidance is currently under review in partnership by a short life working group, who will provide a final draft document to the MSF in early 2017.

In order to clarify and assist the process with the governance and Board objectives NHSGGC agreed to purchase and implement E-Job Planning software (Allocate) in April 2014.

4.6.2 The E-Job Plan system has been implemented in 3 Phases. ¡ Phase 1 commenced April 2014, included approximately 850 doctors who were affected by

the opening of the new Queen Elizabeth University Hospital, ¡ Phase 2 commenced in June 2015, included the remaining 500 doctors within the Acute

Sector (excluding Clyde Sector).the system was redesigned to incorporate changes to the Acute structure.


¡ Phase 3 includes the Dentists and the remainder of the Career Grade doctors (approx 550) from within HSCP and Corporate Directorates. The structures and information for these doctors has been added to the system and they will shortly be given access so they can add their Job Plan for review and agreement from 1 April 2017.

4.6.3 There are currently 1241 doctors within Phase 1&2 and 1066 (86%) have Job Plans published on the system. 813 of the 1066 (76%) have accessed the system and added detail to their Job Plan. The remaining specialties that do not yet have Job Plans published will be picked up as part of Phase 3 and will have job plans published by January 2017.

4.6.4 The benefits include: ¡ Standardised job plan, ensuring the format of a job plan, and the way PAs are calculated, is

consistent across the entire health board. ¡ Flexible and transparent job planning. The system encourages a ‘hub and spoke’ model

whereby the process can be monitored centrally and clinical managers drive the job planning process locally.

¡ Group job planning which allows managers and to create a Template job plan containing generic departmental activities.

¡ Improved reporting function and analysis. ¡ Accurate service planning ¡ The ability to monitor EPA activity to inform annual job plan review


5 Section Five: Supplying the Required Workforce

5.1 Recruitment & Retention5.1.1 There are continuing challenges with recruitment in some specialties notably Radiology,

Urology, Older People, Anaesthetics, Ophthalmology, Psychiatry and some Oncology services5.1.2 There are challenges recruiting to and retaining consultant staff in some of the specialities at

Inverclyde Royal Hospital due to its geography. It has been particularly difficult in recruiting to roles which cover the Royal Alexandra Hospital, Inverclyde and Vale of Leven Hospitals. This has resulted in significant locum and agency costs in Emergency Care, Critical Care and Older People Services.

5.1.3 The feedback from the Service highlights concerns that advertising Consultant Posts with a 9:1 split between DCC and SPAs may be making posts less attractive to potential applicants compared to similar graded posts advertised in other Board areas.

5.1.4 Recruitment difficulties across all sectors are reflected in the locum and agency spend and can also create an internal market when other sectors and Boards who are under pressure to recruit to a critical post attract employees from another area and adversely impact service delivery elsewhere.

5.1.5 The table illustrates, by specialty, the number of posts which have been classed as ‘hard to fill’ over the last 12 months. ‘Hard to Fill’ is where a post has been advertised and no applications received.

Figure 15: Summary of hard to fill posts by specialty (Consultant Grades)

Consultant Specialties No. Of PostsAnaesthesia 3Child & Adolescent Psychiatry 1Community Paediatrics 1General Adult Psychiatry 2General Surgery 1Genitourinary Medicine 1Geriatric Medicine 2Haematologist 1Microbiologist 1Neurologist 2Occupational Health 1Oral Medicine 2Otolaryngology 1Paediatrician with an Inherited Metabolic Medicine 1Physician in Respiratory & General Medicine 1Physician with an Interested in Rheumatology 1Urology 2Total 24


5.1.6 The same table split by Directorate is shown below:

Figure 16: – Summary of hard to fill posts by Directorate (Consultant Grades)

Directorate/Partnership No. Of PostsClyde Sector 3Corporate Directorate 1Diagnostics 1East Dunbartonshire CHP 2Glasgow City HSCP 3North Sector 3Regional 3South Sector 6Women & Childrens 2Total 24

5.1.7 A recent scoping exercise has shown an increase in turnover of medical staff across the Board; in part is due to a change to the rules on pension. This trend coupled with a number of hard to fill posts has put an over reliance on locum medical staff and an increase in waiting list initiative payments.

5.1.8 To gain a better understanding of the reasons why medical staff are leaving the service, the Acute Division is promoting the use of the Exit Interview process which is part of the Board-wide strategy Facing the Future Together. A new online Exit questionnaire has been developed which will be uploaded on to HR Connect by December 2016 and all staff are being actively encouraged to complete when exiting the organisation.

5.1.9 Moving forward it will also be important to capture the views of the training grade doctors who are reaching the end of the training to understand if NHSGGC is sufficiently attractive place to work for potential new recruits. The questionnaire which asks medical staff to outline their future career aspirations and retirement wishes will assist in identifying actions we can take to improve staff retention.

5.1.10 A standardised exit procedure applied effectively will enhance current strategies and working practices that relate to the successful recruitment, selection and retention of staff.

5.2 Trainees gaining Certificate of Completion of Training (CCT)5.2.1 A CCT confirms that a doctor has completed an approved training programme in the UK and is

eligible for entry onto the GP Register or the Specialist Register.5.2.2 Within Acute Services, the North Sector has highlighted that recruitment to Consultant posts in

Anaesthesia has been more challenging this year, than in past. In the short term, due to the low number (11) of trainees, gaining their CCT in 2016 this is likely to continue however from 2017 onwards there should be a sufficient number of trainees gaining their CCT in this specialty to meet local service need.

5.2.3 The same is true to some extent in Urology with only 5 due to CCT in total during the remainder of 2016 and 2017, however there an average of over 5 trainees per year due to CCT between 2018 and 2022 in this specialty.

5.2.4 Within Psychiatry the numbers due to CCT from 2017 onwards are due to increase substantially. This increase in the number of trainees gaining their CCT is timely as according to projected medical workforce figures, 17% of Consultants in Mental health specialties are predicted to retire over the next 5 years.

5.2.5 The effect of more CCT holders in the system should lead to more eligible applicants applying for Consultant posts, greater competition for posts at this grade and may in turn increase numbers applying for Specialty Doctor posts for those who are not successful in obtaining a Consultant post in the short term.


Figure 17: Projected number of CCTs across Scotland over the next 4 year

2016* 2017 2018 2019 TotalAnaesthesia, Intensive Care and Emergency Medicines

12 71 70 75 378

Diagnostics 5 40 50 42 228General Practice, Public Health Medicine and Occupational Medicine

36 311 334 287 1102

Medicine 19 95 106 135 581Mental Health Specialities 6 26 38 48 125Obstetrics & Gynaecology and Paediatrics 4 53 56 69 322Surgery 5 68 72 82 382Total 87 664 726 738 3,118

*August-December 2016

5.3 Learning & Education for the NHSGGC Medical Workforce5.3.1 In NHSGGC we are committed to ensuring that all our medical practitioners have access to

training, learning and educational opportunities which will help them further develop and ensure that they meet the professional standards set by the GMC.

5.3.2 Since 2012 it has been a statutory and contractual requirement that all licensed doctors can demonstrate on a regular basis that they are up to date and fit to practise in their chosen field and are able to provide a good level of care. It is the responsibility of the Board’s Medical Director (as ‘Responsible Officer) to make a recommendation to the GMC on a doctor’s fitness to practice - this process is called ‘Revalidation’. The Responsible Officer’s recommendation will be based on the outcome of a doctor’s appraisal over the course of 5 years, in conjunction with information derived from the local clinical governance processes.

5.3.3 Within the Board there are a variety of support measures to assist doctors to keep their knowledge and skills up to date. These can be accessed through the Core Mandatory Training Programme, L&E Training Calendar, e-learning. All doctors are welcome to apply for external courses both within and outwith the UK to support their CPD and personal development. The Board in conjunction with NES supports training grades by providing educational support in the form of courses educational sessions and protected study time.

5.3.4 The Board is currently reviewing existing development activity for medical staff with a view to developing a board-wide approach to planned development targeted at Clinical Director level in both acute and partnerships. The restructuring of NHSGGC during 2015/16 resulted in a significant changes to structure and ways of working and a number of Clinical Directors are new to a clinical leadership role resulting in a need for a planned and consistent approach to clinical leadership development.

5.3.5 A working group has been established to lead a specific programme of work to review communication skills training for medical staff in order to support an improvement in patient experience.


6 Section Six: Implementation, Monitoring and Review

6.1 Recommendations6.1.1 The implementation plan for the period 2017/2018 (Appendix 2) will be discussed at the Chief of

Medicine meeting in January 2017. The key actions are summarised below:- ¡ Maximise medical staffing recruitment and retention by ensuring NHSGGC is an attractive

Board to work in. Promote the ability to work flexibly to encourage applications from a wider pool, including part-time workers and retired consultants

¡ Identify the interrelationships across professional groups which impact on the Medical Workforce and take forward a detailed exercise regarding the role of Advanced Nurse Practitioners (ANP) and Physician Assistants roles across specialties to fill gaps in junior doctor rotas particularly within the Clyde area.

¡ To assist with future workforce planning contact all career grade medical staff, who are within 10 years of what has previously been viewed as a ‘normal’ retiral age, to enquire about any plans they may have regarding their working arrangements

¡ Promote the importance of job planning through Managing Consultant and SDAS Grade Job Planning events for medical managers, emphasising the responsibility of the Consultants/SDAS grade to produce evidence at the job planning review meeting to support maintaining status quo or planned change to the number of programmed activities (PAs) in the forthcoming year

¡ Continue to develop NHSGGC E-JobPlans to ensure a single, transparent and authoritative data source. This would enable the Board to have more robust control of job planning information, leading to better alignment of activity with both organisational and departmental objectives.

¡ Develop the current NHSGGC Medical Locum Bank to improve its capacity, and expertise to supply the temporary medical workforce required

¡ Implement the ‘Temporary Medical Workforce Guidance’ to ensure there is a consistent approach to the access of locum cover to ensure alternative ‘cost saving’ options have been considered in the first instance

¡ Increase the pool of career grade medical staff on the NHSGGC Medical Locum Bank by actively encouraging retired consultants and specialty doctors to join the bank upon leaving their substantive posts

¡ Promote the use of the Exit Interview process, part of the Board-wide strategy Facing the Future Together.

6.2 Monitoring and Review The Workforce Plan and its Actions will be managed and monitored via the Strategic Management

Group, the Medical Staff Forum, the Acute Partnership Forum and Staff Governance Committee.


7 Appendices

7.1 Appendix 1: Sector/Directorate Local Reports The information summarised below is an assessment of the clinical challenges which require

to be addressed as part of the Medical Workforce Plan. Each Chief of Medicine has identified a number of key issues which are specific to their own areas and in some cases pertinent to more than one Sector/Directorate. These are in addition to the key challenges detailed in Section 4 in the main workforce plan.

7.1.1 Women & Children’s Directorate

Paediatrics ¡ The Chief Nurse is developing a long term plan to fill junior doctor gaps within neonatology

and intensive care with ANPs. Work is also ongoing to increase the nurse establishment for this area.

¡ There is a plan to review the Metabolic Medicine service. There are two consultants employed one in Glasgow, one in Edinburgh. As this is a specialised service there are longer term plans to develop a national service delivered from GGC.

¡ The Chief of Medicine is reviewing the consultant paediatric on-call rotas which are very onerous (1:3/1:4). The service is finding it hard to recruit replacement consultants for this reason. The plan is to rationalise rotas to make them less intense by reducing the sub-specialisation in the out-of-hours periods.

¡ The Paediatric Cardiology service is expanding putting pressure on the current cohort of interventionalists. Discussions are ongoing with NSD to appoint a fourth cardiac surgeon to support this remit.

Gynaecology ¡ The Chief of Medicine is reviewing whether centralising Gynaecological services on to the

one site would increase support to the 3 sub-speciality areas (Gynae-oncology, ACS & Uro-gynaecology).

¡ The expansion of the Gyn/Colorectal service is also dependent on the centralisation of services and the requirement for additional Adult surgery theatre time, equivalent to approximately 3/4 PAs of elective work per week. Discussions regarding centralisation will need to give consideration to the impact on out-of-hours activity across GGC.

¡ Looking to standardise the Consultant led Emergency service across Glasgow. It is currently in operation in the North and Clyde but not QEUH. The lack of this cover in the QEUH is having a detrimental effect on the middle grade junior doctor rota i.e. increased intensity.

¡ As with Paediatric services the Chief Nurse is developing a long term plan to fill junior doctor gaps within gynaecology with ANPs.

¡ Early stage discussion regarding the expansion of the ACS service using appropriately trained nurses in place of medical staff.

¡ The General Manager is reviewing the 7-day Early Pregnancy & Advice Unit model to deliver the current service at a reduced cost. The impact of this on junior doctor rotas would be to reduce the overall workload and out-of-hours work intensity.

7.1.2 Diagnostics Directorate

Radiology ¡ Despite several rounds of recruitment there remain 10 x Consultant Radiology Vacancies.

This has led to an over reliance on Locums and Waiting List Initiative payments. This issue is particularly acute in the specialist areas of neuro-radiology, neuro-interventional, interventional and breast. There is evidence to support that neuro-interventional work is expanding and discussions are underway looking at regional options to support this specialism.


¡ With regards to mammograms the service is looking to increase the number of reporting radiographers. The service is also looking to train specialist nurses to undertake mammograms although this is unlikely to reduce the reliance on consultants as the service continues to expand. Two nurses have already been enrolled on a specialist course to undertake this role.

¡ One other area that requires to be addressed is around the ‘appropriateness’ of imaging referrals which leads to unnecessary pressure on reporting. This might be resolved with dedicated referral software.

¡ Interventional activity is growing annually, increased recruitment and decision making on the sites to deliver this service will be required.

Laboratories ¡ There is an overall trend to employ Clinical Scientists to fill consultant vacancies. ¡ Due to the expansion of neuro-pathology and difficulties in recruiting, a national solution

needs to be considered ¡ Within cytology the requirement for consultants is reducing due to the introduction of virus

testing AHPs but a Scotland-wide solution is required for the management of the remaining cytology.

7.1.3 Regional Services Directorate

OMFS ¡ Maintaining a compliant specialty training rota has been the subject of constant investment

by all WOS Boards over the last 10 years. There is a national training programme, and the WOS has 5-6 trainees at any time, but requires 10 junior-grade posts to maintain a complaint OOHs rota at 1B. The rota, which covers outreach to all WOS units, is maintained through use of four permanent clinical fellow posts and locum weekend shifts. There are currently two Consultants providing on call during the week and one on at weekends. The Service employs a Dental/FY2 to provide cover for the rota at weekends. If that resource was to be removed for any reason then the rota would go non-complaint which would incur a significant cost to the Service The current arrangement is not a viable way of providing this back cover and it should not be considered to be a long term solution to the problem. A more sustainable plan would be to increase Consultant cover and this would provide a long term solution to maintaining a compliant rota.

Oncology ¡ To ensure continuity of care across the West of Scotland Cancer Centre and QEUH sites,

there is a proposal to move away from single handed practices in favour of a team approach organised by tumour site and in addition to develop new acute Service delivery models. The first step has been to appoint three additional consultants who will have acute responsibilities at the QEUH and provide site specific responsibilities to the BOC.

¡ Out of Hours anaesthetic cover at the Gartnavel site is an expensive drain in resources and the short to medium term solutions are under discussion in providing a satisfactory Critical Care Model

¡ Review of the current middle grade rota is required to provide long term stability both from a service and educational perspective. Discussions are already underway to discuss solutions with Service, NES in developing robust stable rotas. One possible solution is to move rota to full shift, thus reduce the need to provide locum support out of hours required to maintain the band 1C On Call work pattern.

Haematology ¡ Haematology is currently employing locums to maintain single services particularly in Clyde.

There is currently a plan in place to resolve that situation by increasing Consultant numbers in this specialty. This is dependent on the ability to recruit to this hard to fill specialty.


Neurology/Neurosurgery ¡ Current rota provision at middle grade is untenable due to the nature of being resident

overnight. There are national issues in recruiting appropriately trained medical staff to fill funded Health Board middle grade posts. It is expected that natonal solutions will be required to assist in the review of Junior Dr provision. In addition further consideration on how neurosurgery is managed in the out of hours is required i.e increased Consultant numbers or SDAS support.

Disability services ¡ There are long-term recruitment issues at consultant level, with long-term highly expensive

locum cover sustaining the service for some years. There is a model looking at the reconfiguration of the PDRU service.

Hospital at Night ¡ Hospital at Night does not extend to the Institute of Neurosciences and the FY1/2 presence

for the service is provided predominantly by Dental SHOs. The Dental Deanery has indicated the long-term aim should be to withdraw all Dental Trainees from hospital OOHs cover, therefore the extension of Hospital at Night or some other form of FY1/2 cover for the Institute of Neurosciences will be required in the next 2-3 years.

7.1.4. South Sector

Older People Services ¡ The middle grade rota is fully staffed but remains fragile. If numbers reduce for any reason this

will impact directly on compliance and may push the rota into a higher banding threshold. ¡ There is a pressure on consultants due to the requirement to cover two rotas: Care of Elderly

Out-of-Hours plus the Stroke Medicine Rota. Plans are in place to review the current cover arrangements for Stroke.

¡ Rota management at consultant level is challenging as a number of consultants are Honorary which mean if they retire/leave they are not automatically replaced.

¡ The Stroke Thrombolysis middle grade rota which was only introduced in the South Sector is currently non-compliant (Band 3) due to breaches in rest requirements for on-call working patterns. The rest requirements are unachievable due to the level of Thrombolysis activity and direct admissions into the stroke unit. This is being urgently reviewed to ensure compliance.

General Surgery ¡ There is continuing pressure given the requirement to provide StR cover at the GGH site

from the QEUH. This is because the original planned rotas were based upon providing cover on one site only i.e. QEUH complex. Providing cover over two sites particularly with regards to out-of-hours has impacted on day time cover for the wards at QEUH. One option being looked at is whether the resource currently used to cover out-of-hours at the ACH could be better utilised covering the GGH rota instead i.e. ACH would be restricted to day cases only.

Urology ¡ QEUH has one trained consultant to provide specialist operative cancer care for the West

of Scotland (referrals from the WofS Beatson). The service has drafted a business case to secure funding from the territorial Boards to make a second appointment to run a national service.

General Medicine ¡ The level of unscheduled care requirements at QUEH is impacting on the junior doctor

workload. In addition, NES are reporting failings in respect of educational and supervision requirements. There are a number of areas to be addressed one of which is to provide more support through the introduction of a Chief Resident to provide mentorship and advice. The structure of the junior doctor rotas have also been revised to increase the level of cover in the wards. Moving forward the impact of this will be assessed.


7.1.5 North Sector

DME ¡ Significant overspend on high cost locums due to maternity leave Although the locum spend

has been removed there are plans for future recruitment using retiral sessions and dropped PAs to create an additional post which could be used to prospectively cover future maternity leave achieves the acute assessment bed numbers/consultant and on call frequency agreed as part of the On the Move group

Surgery ¡ Junior medical staff resource is insufficient to manage the increase in unscheduled care and

increased scheduled work within the wards. This is compounded by gaps in FY1 and Middle grade rotas. It was agreed that medical workforce planning was more difficult for junior doctors as the Board had no control over allocations as this was the responsibility of NES.

¡ Day time Cover is an ongoing issue given minimum numbers attached to the junior rotas which can be challenging depending how many gaps are in each rotation and can lead to high locum expenditure. Longer term plans around middle grade cover is to look at alternative models of different grades of cover including non medical grades within surgical specialties.

¡ In General Surgery, increased intensity following the closure of the Western on GRI has necessitated an increase in Consultant cover for weekends and out of hours. This has been absorbed by a direct reduction in elective activity. In correlation there has been no ability to increase junior numbers. As with the overall junior numbers issue, the introduction of alternative models of Service provision need to be considered.

Urology ¡ Currently there are 2 gaps in the CT rota as we have been unable to recruit to the Clinical

Fellow posts. This has led to problems with compliance of the ST rota, compounded by removal of the Specialty Doctor from this rota. There is also a knock on effect with junior daytime cover Remedial plans include applying for an IMRF Endourology fellowship using one of the Clinical fellow salaries. From Feb 2017 we will have a full complement of eight Consultants

General Medicine ¡ There is increased activity in unscheduled care. Appointment of one extra post either within

Acute Medicine or a speciality with a contribution to acute medicine would improve 7 day a week cover.

Diabetes. ¡ Issues with semi retirement from 01.04.17 and ongoing Maternity leave until November

2017. Timely replacement would support both the primary care action plan and secondary care in-patient diabetes

Orthopaedics ¡ Recruitment issues at FY2 / CT level resulting in problems with out-of-hours cover and rota

compliance ¡ Increase in trauma work post ASR and subsequent additional trauma theatres has had

knock on effect on elective activity. Appointment of 2 additional consultants would reduce theatre and outpatient cancellations resulting from trauma activity and reduce waiting lists and WLI.

Critical Care ¡ Ongoing issues with middle grade staffing / recruitment due to the gradual separation of

anaesthetic and critical care training ¡ Inability to provide consultant critical care cover for High Dependency Units at current

staffing levels


7.1.6 Clyde Sector

Medical Specialties ¡ Across the Clyde sector, but particularly within the medical specialties, there are significant

recruitment and retention issues. This may be due to geographical position or the perception that posts are more attractive elsewhere in the Board as they offer more educational and career opportunities (see Section 5)

¡ Due to a shortage of trainees within General Medicine there is an inequity in the ability to provide Acute Medical Receiving compared to the North Sector. The service are looking at alternative ways to cover e.g. Physician Assistants

¡ Within Gastroenterology there is a requirement to recruit additional consultant and nursing staff as there is an over reliance on high cost locum agency cover. As a consequence there has been an increase in patient waiting time (over 20 weeks) and difficulties arranging return appointments timeously.

DME ¡ There is a significant challenge within Older People Services due to long-term Consultant

vacancies combined with sickness absence and maternity leave. Discussion are taking place regarding the possibility of removing the Consultant Geriatricians from the Acute Medical Rota at IRH to free up capacity with the possibility of introducing an Older People Acute Assessment Unit (replicating units on other sites)

General Surgery ¡ Due to an insufficient allocation of senior trainees, the middle grade general surgery rota

at IRH is currently supported by SDAS grades. As well as a cost pressure the service finds it difficult to attract SDAS grades because of the large out-of-hours commitment. The service are looking at alternative ways to cover e.g. Physician Assistants

Trauma and Orthopaedics ¡ There is a difficulty in recruiting suitably experienced clinical fellow/locums to fill the current

middle grade rota slots in Orthopaedics, resulting in gaps. Again, looking for alternative means of cover.

¡ There is a perceived imbalance in the number of orthopaedic surgeons and orthopaedic geriatricians in comparison with the other sectors. This may be causing the higher spend on WLIs’ compared to other sites and contributing to an increased length of stay. Investing in additional consultant surgeon cover may be cost beneficial. In regards to ortho-geriatric cover there are plans to develop alternative means of cover.

Cardiology ¡ The current cardiology service is under significant pressure, particularly around providing

interventional cover. The board is looking at the possibility of extending the current interventional rota to include Clyde. The use of cardiology consultants to cover this rota would result in a lost of cover for general medicine acute receiving. The Service is looking to appoint an additional Acute Care Physician to backfill acute receiving.

Training Grades ¡ The Clyde service has requested a review of the senior trainee allocation as although the

activity is similar to the other sectors there appears to be significantly less trainees in Clyde. Consequently, the Consultants often have to cover the junior doctor duties to bridge the gap. Discussions are ongoing between the Board and NES to secure an increased allocation in 2016/17.

Emergency Medicine ¡ Providing ED cover at the IRH is a challenge, particularly during the out-of-hours period due

to lack of senior trainee cover. The service intends to do an options appraisal to look at the provision of cover by other staff groups and/or the implementation of a GP Service Model.


Cardiology ¡ Interventional cardiology is seen as an integral part of the cardiology consultant job plan

and newly appointed Consultant’s expect this to be accommodated within their job plan. As NHS GG&C have outsourced their intervention service to the Golden Jubilee, they expect to have input in the job planning discussion. In these negotiations the GJNH often takes more account of how many sessions the new Consultant would like, despite not having the additional funds required to pay for these sessions. If the Service does not offer interventional sessions then it would not attract candidates to work in this speciality. In terms of resolving this issue, in future NHS GG&C needed to negotiate with GJ in terms of what resource the Board required and what they would be willing to pay for.

¡ There is a need to consider expanding the medical and nurse specialist workforce in order to meet the increased demand due to patients surviving longer following heart failure etc, an increasing, ageing population and in turn an increase in cardio vascular demand issues associated with this section of the population and increased survival rates due to medical advances. A business case has not yet been put forward to increase the workforce because there is an acknowledgement that there is no money available, and that budgets are already over spent. The Service plan to manage the situation, by using the existing staff resource available and increasing efficiency, by discharging patients back to Primary care and increasing the number of nurse practitioners.

Stroke ¡ The stroke service as an entirety across NHS GG&C is under review centrally in particular the

issues that have arisen in covering stroke out of hours in Clyde and at the QEUH. ¡ The cover of out of hours for is a current pressure with one solution put forward to have pan

Glasgow stroke cover by one individual. This is at early discussion stage. ¡ The proposal would be to consolidate into one pan GG&C rota.


7.2 Appendix 2: Implementation Plan: Short, Medium and Longer Term Actions

Sect

ion

Shor

t/M

ediu

m/

Long

Ter

m

2016

/17

Actio

nO

wne

rshi

p

4Sh

ort T

erm

Und

erta

ke a

scop

ing

exer

cise

in p

artn

ersh

ip w

ith th

e M

edic

al S

taff

Foru

m

to o

btai

n a

bett

er u

nder

stan

ding

of p

roje

cted

retir

emen

ts fo

r med

ical

staff

ag

ed 5

5 pl

us

Jona

than

Pen

der,

Wor

kfor

ce

Plan

ning

and

Ana

lytic

s M

anag

er

4Sh

ort T

erm

To a

ssis

t with

futu

re w

orkf

orce

pla

nnin

g w

rite

to a

ll ca

reer

gra

de m

edic

al

staff

, who

are

with

in 1

0 ye

ars o

f wha

t has

pre

viou

sly

been

vie

wed

as a

‘n

orm

al’ r

etira

l age

, to

enqu

ire a

bout

any

pla

ns th

ey m

ay h

ave

rega

rdin

g th

eir w

orki

ng a

rran

gem

ents

.

Sara

h Le

slie

, Dep

uty

Dire

ctor

of

Hum

an R

esou

rces

5Sh

ort T

erm

With

the

assi

stan

ce o

f NH

S Ed

ucat

ion

for S

cotla

nd (N

ES) i

mpl

emen

t Exi

t in

terv

iew

s for

Spe

cial

ist R

egis

trar

s. T

his w

ill b

e us

ed to

cap

ture

pre

fere

nces

fo

r app

lyin

g fo

r con

sulta

nt p

osts

in N

HSG

GC.

This

dat

a co

uld

be a

naly

sed

to id

entif

ying

the

unde

rlyin

g re

ason

s for

pot

entia

l can

dida

tes n

ot c

hoos

ing

NH

SGGC

as t

heir

pref

erre

d em

ploy

er.

Kenn

y Tr

acey

, Med

ical

Sta

ffing

Le

ad

2.4

Shor

t Ter

mAs

par

t of t

he ‘O

nce

for S

cotla

nd’ s

hare

d se

rvic

es a

gend

a (fo

r tra

inee

do

ctor

s), d

evel

op S

cott

ish-

wid

e H

R po

licie

s, in

clud

ing

recr

uitm

ent

pack

ages

, to

ensu

re t

he B

oard

s are

abl

e to

att

ract

a w

ider

poo

l of m

edic

al

staff

acr

oss t

he U

K an

d fu

rthe

r afie

ld

The

‘Onc

e fo

r Sco

tland

’ Med

ical

W

orkf

orce

stee

ring

grou

p/

Kenn

y Tr

acey

, Med

ical

Sta

ffing

Le

ad4/

5Sh

ort T

erm

Revi

ew a

nd re

com

men

d al

tern

ativ

e ap

proa

ches

to h

ow N

HSG

GC m

arke

ts

vaca

nt co

nsul

tant

pos

ts, t

o pr

omot

e it’

s pos

ition

of ‘

flexi

bilit

y’ w

ith re

gard

s to

Sup

port

ing

Prof

essi

onal

Act

iviti

es (S

PA).

Iden

tify

a ra

nge

of m

easu

res

to co

mm

unic

ate

the

boar

d’s p

ositi

on th

at th

e ba

lanc

e of

the

diffe

rent

ca

tego

ries o

f pro

gram

me

activ

ities

(PAs

) can

be

nego

tiate

d on

app

oint

men

t w

ith th

e m

edic

al m

anag

er o

r as p

art o

f the

job

plan

ning

pro

cess

for c

urre

nt

med

ical

staff

. M

edic

al R

ecru

itmen

t to

supp

ort C

OM

s rec

omm

enda

tions

via

re

vise

d co

py fo

r rec

ruitm

ent a

dver

tisem

ents

and

job

pack

s for

Con

sulta

nt

post

s

CoM

s/M

edic

al S

taffi

ng U

nit/

Med

ical

Rec

ruitm

ent


Sect

ion

Shor

t/M

ediu

m/

Long

Ter

m

2016

/17

Actio

nO

wne

rshi

p

2Sh

ort T

erm

Incr

ease

recr

uitm

ent f

ill ra

te to

NH

SGGC

GPS

T tr

aini

ng sc

hem

es id

entif

ied

as p

art o

f the

wid

er S

cott

ish

Gove

rnm

ent i

nitia

tive

to in

crea

se th

e nu

mbe

r of

GP

rota

tiona

l tra

inin

g sc

hem

e n

umbe

rs

Paul

Kni

ght,

Dire

ctor

of M

edic

al

Educ

atio

n/Ke

nny

Trac

ey,

Lead

for M

edic

al S

taffi

ng/S

MT

Recr

uitm

ent

4Sh

ort T

erm

Ensu

re th

at si

ckne

ss a

bsen

ce a

nd m

ater

nity

leav

e is

bei

ng a

ccur

atel

y re

cord

ed o

n SS

TS fo

r med

ical

staff

Kenn

y Tr

acey

, Med

ical

Sta

ffing

Le

ad/H

eads

of P

eopl

e &

Chan

ge2

Shor

t Ter

mEn

sure

100

% co

mpl

ianc

e w

ith S

HD

regu

latio

n th

at n

o ju

nior

doc

tor s

houl

d be

rost

ered

to w

ork

mor

e th

an 7

cons

ecut

ive

shift

sKe

nny

Trac

ey, M

edic

al S

taffi

ng

Lead

/Cof

M C

lyde

6Sh

ort T

erm

Prom

ote

the

impo

rtan

ce o

f job

pla

nnin

g th

roug

h M

anag

ing

Cons

ulta

nt a

nd

SDAS

Gra

de J

ob P

lann

ing

even

ts fo

r med

ical

man

ager

s, e

mph

asis

ing

the

resp

onsi

bilit

y of

the

Cons

ulta

nts/

SDAS

gra

de to

pro

duce

evi

denc

e at

the

job

plan

ning

revi

ew m

eetin

g to

supp

ort m

aint

aini

ng st

atus

quo

or p

lann

ed

chan

ge to

the

num

ber o

f pro

gram

med

act

iviti

es (P

As) i

n th

e fo

rthc

omin

g ye

ar

Kenn

y Tr

acey

, Med

ical

Sta

ffing

Le

ad/L

&E

4Sh

ort T

erm

Enga

ge w

ith lo

cal t

rain

ees a

t an

early

stag

e to

enc

oura

ge th

em to

app

ly fo

r Co

nsul

tant

pos

ts w

ithin

NH

SGGC

CoM

s/CD

S/LC

s & D

ME

5M

ediu

m T

erm

(i) E

xpan

d fro

m c

urre

nt le

vels

the

num

ber o

f med

ical

locu

m sh

ifts c

over

ed

by tr

aini

ng g

rade

doc

tors

and

car

eer g

rade

staff

act

ivel

y re

gist

ered

on

the

NH

SGGC

Med

ical

Ban

k(ii

) Exp

and

from

cur

rent

leve

ls th

e nu

mbe

r of t

rain

ing

grad

e do

ctor

s and

ca

reer

gra

de st

aff re

gist

ered

on

the

NH

SGGC

Med

ical

Loc

um B

ank

by a

ctiv

e en

gage

men

t of e

xist

ing

bank

doc

tors

to p

rom

ote

locu

m sh

ifts

(iii)

Esta

blis

h a

recr

uitm

ent p

rogr

amm

e to

invi

te re

gist

ratio

ns v

ia e

xist

ing

and

new

NH

SGGC

med

ical

staff

to jo

in th

e N

HSG

GC M

edic

al L

ocum

Ban

k(iv

) Inc

reas

e ca

paci

ty a

nd e

xper

tise

of M

edic

al B

ank

serv

ice

to su

pply

m

edic

al b

ank

wor

kfor

ce in

line

with

requ

este

d de

man

d

CoM

s/CD

s/GM

s/M

edic

al S

taff

Bank

/Med

ical

Sta

ffing

Uni

t


Sect

ion

Shor

t/M

ediu

m/

Long

Ter

m

2016

/17

Actio

nO

wne

rshi

p

5M

ediu

m T

erm

i) Im

prov

e ap

plic

ant r

espo

nse

rate

s to

vaca

nt p

osts

from

cur

rent

leve

ls b

y im

plem

entin

g a

rang

e of

recr

uitm

ent a

dver

tisin

g an

d m

arke

ting

mea

sure

s to

pro

mot

e N

HSG

GC a

s an

attr

activ

e Bo

ard

to w

ork

by a

ctiv

ely

prom

otin

g fle

xibl

e w

ork

optio

ns a

s rou

te to

enc

oura

ge a

pplic

atio

ns fr

om a

wid

er

appl

ican

t poo

l.ii)

Impr

ove

rete

ntio

n by

pro

mot

ing

the

abili

ty to

wor

k fle

xibl

y, in

clud

ing

incr

easi

ng o

ppor

tuni

ties f

or p

art-t

ime

wor

king

for r

etire

d co

nsul

tant

s

Chie

fs o

f Med

icin

e/M

edic

al

Staff

ing

Uni

t/M

edic

al

Recr

uitm

ent

Appe

ndix

1

Med

ium

Ter

mW

ork

in p

artn

ersh

ip w

ith th

e Go

lden

Jub

ilee

Nat

iona

l Hos

pita

l to

deve

lop

post

s with

in N

HSG

GC, w

ith a

def

initi

ve n

umbe

r of s

essi

ons f

or

Inte

rven

tiona

l Car

diol

ogy

– th

is is

piv

otal

to a

ttra

ct C

onsu

ltant

Car

diol

ogis

ts

Geor

ge W

elch

, Chi

ef o

f M

edic

ine

(Sou

th),

Chris

De

igha

n, C

hief

of m

edic

ine

(Nor

th),

Chris

Jon

es, C

hief

of

Med

icin

e (C

lyde

)3

Med

ium

Ter

mO

ngoi

ng R

evie

w o

f ‘Te

mpo

rary

Med

ical

Wor

kfor

ce G

uida

nce’

issu

ed

Sept

embe

r 201

6, to

ens

ure

ther

e is

a co

nsis

tent

app

roac

h to

cove

ring

shor

t and

long

term

gap

s in

the

med

ical

wor

kfor

ce. T

his t

o in

clud

e th

e co

nsis

tenc

y in

pra

ctic

es o

f acc

essi

ng m

edic

al lo

cum

cove

r to

ensu

re

alte

rnat

ive

cost

effe

ctiv

e op

tions

are

prio

ritis

ed in

the

first

inst

ance

Med

ical

Sta

ff Ba

nk a

nd M

edic

al

Recr

uitm

ent/

med

ical

Sta

ffing

U

nit/

COM

s/CD

S/GM

s

5M

ediu

m T

erm

Agre

e in

par

tner

ship

to m

ake

e-jo

b pl

anni

ng m

anda

tory

to e

nsur

e a

sing

le,

tran

spar

ent,

auth

orita

tive

data

sour

ce. T

his w

ould

ena

ble

the

Boar

d to

ha

ve m

ore

robu

st co

ntro

l of j

ob p

lann

ing

info

rmat

ion,

lead

ing

to b

ette

r al

ignm

ent o

f act

ivity

with

bot

h or

gani

satio

nal a

nd d

epar

tmen

tal o

bjec

tives

.

Anne

Mac

Pher

son

HR

& O

D Di

rect

or/D

alla

s Bro

die,

Cha

ir of

LN

C

4M

ediu

m T

erm

Revi

ew a

ll ju

nior

doc

tor r

otas

to e

nsur

e th

at th

e lo

wes

t pos

sibl

e ba

ndin

g is

in

pla

ce, w

hils

t mee

ting

the

educ

atio

nal a

nd se

rvic

e re

quire

men

tsCh

iefs

of M

edic

ine/

Med

ical

St

affin

g U

nit

4M

ediu

m T

erm

Wor

k w

ith th

e se

rvic

e to

iden

tify

alte

rnat

ive

wor

king

pat

tern

s to

brin

g th

e cu

rren

t Ban

d 3

rota

s int

o co

mpl

ianc

eCh

iefs

of M

edic

ine/

Med

ical

St

affin

g U

nit


Sect

ion

Shor

t/M

ediu

m/

Long

Ter

m

2016

/17

Actio

nO

wne

rshi

p

5M

ediu

m T

erm

Mai

ntai

n a

capa

ble

wor

kfor

ce b

y en

surin

g th

at th

e m

edic

al st

aff h

ave

acce

ss

to tr

aini

ng, l

earn

ing

and

educ

atio

nal o

ppor

tuni

ties w

hich

will

hel

p th

em

furt

her d

evel

op a

nd e

nsur

e th

ey m

eet t

he p

rofe

ssio

nal s

tand

ards

set b

y th

e GM

C

Kenn

y Tr

acey

, Med

ical

Sta

ffing

Le

ad/L

&E

5M

ediu

m T

erm

Ensu

re th

at m

edic

al m

anag

ers a

re a

ppro

pria

tely

trai

ned

on C

linic

al

Lead

ersh

ipKe

nny

Trac

ey, M

edic

al S

taffi

ng

Lead

/L&E

5M

ediu

m T

erm

Deve

lopm

ent o

f a w

orki

ng g

roup

to re

view

com

mun

icat

ion

skill

s tra

inin

g fo

r m

edic

al st

affSa

rah

Lesl

ie, D

eput

y Di

rect

or o

f H

uman

Res

ourc

es/L

NC

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Appendix 3: Summary of retiral projections by specialty

NHS Greater Glasgow and Clyde Senior Medical Staff* (Acute Specialties) Projected Retiral Timeframes by Specialty Area

Specialty Area within 1 year

1 to 2 Years

2 to 3 Years

3 to 5 years

Anaesthetics 4 4 6 16Audiological Medicine 1Breast Surgery Cardiology 3 2 2Cardiothoracic Surgery 1 Chemical Pathology 1 1Clinical Genetics 2 1Clinical Oncology 2 1 2Clinical Pharmacology & Therapeutics

1

Clinical Radiology 5 4 5 5Community Paediatrics Dental & Maxillofacial Radiology Dermatology 1 2 1 2Emergency Medicine 2 2 1 3Endocrinology & Diabetes 2 1 2ENT Surgery 1 2 2 2Forensic Psychiatry 2 1 1 Gastroenterology 2General (Internal) Medicine 4 5 3 6General Surgery 7 5 3 3General Surgery & Vascular Genito-Urinary Medicine Geriatric Medicine 5 8 1 5Haematology 2 2 1 5Histopathology 3 1 2 1Homeopathy 2 Immunology Infectious Diseases 1 1 1Medical Microbiology & Virology 1 1Medical Oncology 1*Consultant and Specialty Grade Doctors


Specialty Area within 1 year

1 to 2 Years

2 to 3 Years

3 to 5 years

Microbiology 1 3Nephrology Neuroanaesthetics 1 Neurology 1 1Neurosurgery 1 1Nuclear Medicine Obstetrics and Gynaecology 6 5 2 6Oncology Ophthalmology 4 1 2 3Oral & Maxillofacial Surgery 1 2Paediatric Cardiology 1 Paediatric Haemato-oncology 1 Paediatric ICU Paediatric Neonatology Paediatric Neurology Paediatric Respiratory Medicine 1Paediatric Rheumatology Paediatric Surgery 1 1Paediatrics 3 3 5 6Palliative Medicine 1 Plastic Surgery 1 1 1Public Health Medicine 1 2 2Rehabilitation Medicine Renal Medicine 3 1Respiratory Medicine 1 1 1 2Rheumatology 1 2 1 Trauma & Orthopaedic Surgery 5 1 2 3Urology 2 1 2Virology Grand Total 79 60 46 97*Consultant and Specialty Grade Doctors


7.4 Appendix 4: Glossary of Terms

Term DefinitionAdvanced Nurse Practitioner

Experienced clinical practitioners with high level of skill and theoretical knowledge. Required to make high level clinical decisions and manage own workload.

Area Partnership Forum The Forum whereby NHS GG&C HB and the recognised Trade Unions and professional bodies work together to improve health services for the people living in Greater Glasgow and Clyde.

Associate Specialists A senior middle-grade doctor working in the UK, who has trained and gained experience in a medical or surgical specialty but has not gone on to become a consultant. These doctors usually work independently but are attached to a clinical team led by a consultant in their specialty.

Banding Banding is the assessment of Pay Supplements for Doctors in the training grades within the controls on hours worked applicable to their working arrangement.

BMA The British Medical Association is the Trade Union and Professional body for doctors in the UK.

CCT Certificates for Completion of Training confirms that a doctor has completed an approved training programme in the UK and is eligible for entry onto the GP/Specialist Register

Certificate of Eligibility for Specialist Registration (CESR)

CESR is for doctors who want to apply to have their name entered onto the Specialist Register or GP Register through the specialty equivalence route.

Clinical Fellow Formerly known as Locum Appointment for Service, this grade is appointed to fill short terms gaps on the rota. Time spent in these types of post does not count towards Core or Specialist training.

Community Health (and Care) Partnerships

Community Health Partnerships (CHPs) and Community Health and Care Partnerships (CHCPs) have been introduced across Scotland to manage a wide range of local health services delivered in health centre’s, clinics, schools and homes.

Consultant Grade A Consultant is a fully registered, medical Practitioner, on the GMC or GDC Specialist Register as appropriate, to be eligible for

DCC Programmed activity for career grades which relates to any work that directly relates to the prevention, diagnosis or treatment of illness.

Full Shift A full shift divides the total working week into definitive time blocks, not exceeding 14 hours.

Foundation Year (FY) Two year Foundation Programmes are the first stage of postgraduate medical training in the UK following graduation from medical school.

(GPST) StR trainees on the General Practice Specialty Training Scheme


Term DefinitionGP Register The GP Register was established on 31 March 2006. From

1 April 2006, all doctors working in general practice in the health service in the UK, other than doctors in training such as GP Registrars, have been required to be included on the GP Register.

GPST General Practice Specialty Trainee Junior Doctor Grade The term junior doctor incorporates the grades of Foundation

doctor and Specialty Registrars (StR).Locum Appointment for Training (LAT Core/StR)

An appointment to a LAT does not result in the allocation of a National Training Number (NTN) but it can be counted towards Training.

Less than Full Time Training (LTFT)

Junior doctors in training can train on a less than full-time (LTFT) basis in particular circumstances.

Management Steering Group (MSG)

The Management Steering Group (MSG) is a joint Scottish Government Health Directorate (SGHD) / NHS Employer body to discuss Strategic Service and consequential Workforce issues.

NHS GG&C Medical Bank Provides the Service with cover for short term rota gaps, if no internal cover within teams is available.

Medical Officer (MO) MO’s are doctors appointed on amended Terms & Conditions of the Old Consultant Contract

Modernising Medical Careers

A programme for postgraduate medical training introduced in the United Kingdom in 2005. The programme replaced the traditional grades of medical career before the level of Consultant..Replaced MMC in 2009

NHS Education (NES) NHS Education for Scotland (NES) is an education and training body and a special health board within NHS Scotland, with responsibility of developing and delivering education and training for the healthcare workforce in Scotland.

NHS Careers Framework The Career Framework was designed to improve career development and job satisfaction for NHS employees. It encourages individuals to learn new skills and take on extra responsibilities that enable them to progress within the organisation

On Call Cover or working pattern, overnight or weekend periods is covered by practitioners working “on call” i Practitioners are rostered for duty periods of more than 24 hours. The frequency of on-call depends on the number of practitioners providing cover and is normally expressed as 1 in 4, 1 in 5, etc. Practitioners working on on-call rotas shall have adequate rest during a period of duty.

Out of Hours Programmed activities worked in evenings, overnight and at weekends Defined within the Terms and Conditions.

Physician Assistant Physician assistants are health professionals with a postgraduate qualification who can work in a variety of healthcare settings under the supervision of a trained doctor.


Term DefinitionSalaried GPs A qualified GP in a secondary care setting providing a general

practitioner function.Scottish Medical Training (SMT)

All Foundation Training, Specialty Training, and GP Specialty Training posts across Scotland are advertised via the new Scottish Medical Training website. Replaced MMC in 2009

Seven Day Shifts The purpose of this type of shift is to ensure that patients receive the same standard of care at weekends as well as during the week

SPA Supporting Professional ActivityConsultants are allocated time withinTheir working week to carry out activities that supports their professional development.

Specialty Doctor (SAS) Specialty Doctors are senior, career grade doctors working in hospitals in the UK NHS. The previous grades of Staff Grade and Specialty Doctor were subsumed into this new grade when it was introduced in 2008.

SpR A Specialist Registrar or SpR is a doctor receiving advanced training in a specialist field of medicine. The SpR Grade closed in 2006 and was replaced by the Specialty Registrar Grade. (StR)

Staff Grade Is a middle grade Doctor. The grade was closed in 2008 and replaced by the Specialty Doctor Grade.

StR Is a Junior doctor or dentist who is working as part of a specialty training programme.

The Temple Report The Temple Report: Time for Training, published in 2010 was a review of the impact of the European Working Time Directive on the quality of training

Trained workforce Drs in the Consultant and Specialty Doctor GradeWaiting List Initiative Payments

WLI payments are paid in circumstances where, as a direct result of published national or local waiting times targets, the employer is required to increase ad hoc activity not previously identified within the job plan,

WTE Whole Time Equivalent


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