© Nuffield Trust 11 March 2016

Reshaping the healthcare

workforce

The Nuffield Summit

3rd March 2016

Candace Imison, Director of Policy

Twitter: @cimison

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The challenges we face – the need for

transformation

• Ageing population + rising burden

of chronic disease/co-morbidity

• Changing relationships with

patients & staff

• Impact of new medical and

information technologies

• Growing gaps in medical and

nursing workforce + 24/7 working

• Productivity challenge – £22bn by

2020

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New models of care rely on significant change in the

workforce

“We can design innovative new

care models, but they simply

won’t become a reality unless

we have a workforce with the

right numbers, skills, values and

behaviours to deliver it” (Five

Year Forward View, 2014)

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Most of the workforce in 10 years time – here today

Current

Staff Mix

Numbers

Roles,

Skills

Skill Development: Role enhancement Role enlargement

Skill Flexibility: Role substitution Role Delegation

New Roles

Future

Staff Mix

Numbers

Roles,

Skills

Current training pipeline

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Important opportunities at all levels in the non-medical

workforce

Expand number of

advanced roles

Extend skills – work to top of

license

Develop and expand support

workforce

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There is a lot happening: NHS Employer’s conference

feedback

• “Paramedics working in A&E

resus”

• “MRI assistant practitioners”

• “Advanced nurse

practitioners leading out of

hours”

• “Generic apprentice”

• “Holistic worker”

• “Assistant practitioner,

maternity”

• Physicians associate

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Band 4 Associate Practitioners, Bradford District Care

• Driven by vacancies in band 5 mental health

workforce (wards)

• Used Calderdale framework to develop

competencies for APs

• Work on ward and in community

• APs in community run physical health clinics

Enablers Barriers

LETB and CCG funding Professional resistance

Relationships with local GPs Concerns from GPs

Supportive leadership

Robust template for physical

checks

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Physician Associates, St George’s Hospital (with a focus on the

neurosciences care group)

• 10-15 PAs – driven by lack of jnr doctors

• Attend ward rounds, assess patients and organise aspects of the management plan

• PAs and senior clinicians positive about impact, particularly providing continuity of care and a flexible workforce

Enablers Barriers

Strong leadership Professional resistance

Post-grad training programme with

ongoing governance & supervision

Inability to prescribe or request

ionising radiation

Good consultant buy-in Lack of formal regulation

Career path flexibility

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The opportunities from reshaping the workforce

• More patient focused care

• Improved health outcomes

• More rewarding roles & happier staff

• Improved collaboration and support

• Improved recruitment and retention

• Addressing workforce gaps

• Better use of resource

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Lessons for implementation

• Build roles on a detailed understanding of patient needs and

necessary skills

• Strong communications and change management strategy

• Invest in the team not just the role

• Support task delegation - you may need to de-commission old roles if

commissioning new ones

• Build sustainability through clear career pathways and evolve to make

the best use of new skills

• Evaluate the impact of your workforce redesign

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Messages to National Bodies

• Needs dedicated and protected investment – HEE

• More consistent nomenclature and national competence frameworks

• Need for consistent messages from system regulators – new and extended roles

• Bridge the current regulatory gap – professional and system regulators

• Help resolve legal indemnity challenges in primary care

• National research and evaluation – with guidance for local evaluation

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Looking to the future

• New service models -- increasing no. of boundary spanners

• Professional focus => patient focus - professional boundaries breaking down

• Growing delegation of decision making rights

• New training models – “half-life” of knowledge falling

• Increasing importance of peer and carer support networks

• Increased focus on population health

• Information and medical technologies support change

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One vision of the future:

“The paradox of the future health system is that we will have

much more primary care, and primary care will be more important

than ever, but it will be supplied predominantly by patients and

non-physicians, with back up from specialized primary care

providers who are master diagnosticians and clinical decision

makers, powered by health information and organizational

supports”

David Blumenthal, Medical Professionalism in the New Information Age