workforce assessment: dhb psychologist workforce · workforce assessment: dhb psychologist...

Prepared by Kamini Pather

For Strategic Workforce Services

Strategic Workforce Services

Workforce Assessment: DHB Psychologist Workforce

April 2016

Strategic Workforce Services – DHB Psychologists Workforce 1

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Contents

Executive Summary ............................................................................................................................ 3

Key findings include: .......................................................................................................................... 3

1. Purpose ........................................................................................................................................... 5

2. Workforce Information ................................................................................................................... 5

3. Current Status of the DHB Psychologists Workforce ...................................................................... 7

3.1 Overall Assessment of the Psychologists Workforce ......................................................... 7

3.2 Rationale ............................................................................................................................. 9

3.3 Summary of the Current Status of the DHB Psychologists Workforce ............................. 10

3.4 Workforce Assessment ..................................................................................................... 11

a) Service Demand ..................................................................................................... 11

b) Supply ..................................................................................................................... 13

c) Operational Flexibility ............................................................................................ 15

d) Operational Capacity .............................................................................................. 16


Executive Summary

Current analysis of the DHB Psychologists workforce has resulted in it being classified as a

‘Transitional Occupation’. This classification highlights that service demand is progressively

increasing with some supply issues around the number of Maori and Pacific psychologists

and with particular areas of specialisation. There are emerging sector requirements to

begin looking at alternative models of care and roles for this workforce, as greater flexibility

is required. Some recruitment and retention issues are occurring in areas of specialisation,

minority ethnic groups and particular geographic areas, with longer timeframes for gaining

this workforce. Overall, the Psychologists Workforce within the DHBs remains stable with a

few long standing issues continuing to gain momentum. No significant priorities have been

identified for the DHBs to address through the bargaining strategy.

Key findings include:

Service demand has been increasing and is predicted to continue increasing as primary intervention and integration is prioritised.

Population growth and variegation, the outcome of the Christchurch earthquake and increasing recognition of the value of psychology in health are also impacting on service demand.

There have been significant changes to Mental Health Services, models of care and service delivery. As a result, psychologists are increasingly being required to take on new key roles with significant increases in responsibility.

The DHB Psychologist Workforce has no major distribution or supply issues. However, there are some wider issues with supply, i.e. with Maori and Pacific psychologists, particular areas of specialisation, some geographic areas and the funding of intern placements; rather than the entire workforce. This is resulting in slightly longer timeframes for gaining this workforce.

The demand for specialist practitioners is increasing, particularly in emerging areas such as transgender surgery, transplants, cardiac, renal, neuro injury (stroke), and cancer support services. There is a need for the consideration of options to support long term capability development in the areas of specialisation which are experiencing or are likely to experience supply issues.

It can be challenging recruiting qualified and experienced psychologists for rural areas and a lot of proactive work needs to be done, usually involving longer timeframes. There can also be high turnover where there are solo practitioners, who don’t get a lot of support.

The quality of interns coming through are generally good, however there are concerns around the funding of interns and placement numbers. Some interns are within current FTE budget, while others are partially funded through HWNZ. There


have been funding changes which are also having an impact. Clarity needs to be sought from HWNZ.

Supervision requirements mean that trained psychologists are sometimes recruited over interns. While interns are registered as psychologists, they still need to complete their internship and 1500 hours of supervision. It can be difficult to provide supervision, and there is a tension with service delivery. This can make it difficult for interns to get appropriate placements.

Access to training can become a retention issue as funding of Continuing Professional Development (CPD) is negotiated. Training is needed to develop specialist skills, however funding is an issue.

While the DHBs are doing the best they can to support a Maori perspective and effective delivery of service to this group, under representation of Maori in this workforce does create difficulties. Increasing the number of Maori psychologists and support is a significant concern. There are small numbers of Maori going into training. While there have been a few Maori interns coming through, the numbers are very low. There are a range of barriers inhibiting minority groups from entering the profession, including the limited availability of colleagues within the group to support / supervise appropriately. The long training pathway and different perceptions of mental health can also be deterrents and barriers to entry. Changes to Postgraduate funding of student loans has also reduced access. The Kia Ora Hauora Programme may change this over the long term.

There are well qualified overseas trained psychologists being recruited by DHBs, however there is low reliance on this source as there are sufficient numbers of psychologists available locally. There is an identified gap in terms of overseas trained psychologists requiring New Zealand specific cultural training, which the New Zealand Psychologists Board is currently looking to addressing.

Longer term challenges remain around the public/private interface, particularly in relation to loss of experienced staff to private practice and/or a reduction in hours worked for DHBs.

There are also increased pressures in terms of the aging workforce, reducing hours of work and time out for parental leave. These issues also impact on capacity for supervision of interns.

Psychologists need to be responsive to consumer needs. There is a move away from the usual Monday to Friday, 9am to 5pm hours. There is also an increasing need for flexibility around locations.

New technologies are providing some flexibility in the way work is structured and organised, and services are delivered. There is increased use of technology such as online tools for consultations, monitoring and communicating with clients using secure transmission. This seems to work particularly well with the younger age groups.


1. Purpose Employment Relations is a key accountability for DHBs and has a significant impact on DHB

outcomes. The Employment Relations Strategy Group (ERSG) has an operational governance role

over Strategic Workforce Services (SWS) ER activity and has mandated a range of advice to ensure

that development of bargaining strategy is well supported.

Operational advice on the DHB employed workforce is developed by the Strategic Workforce

Services team and is complementary to the strategic advice and direction provided by Health

Workforce New Zealand (HWNZ). The intent of the operational advice is to ensure that Bargaining

Strategy Groups have access to accurate information on the current status of the DHB employed

workforce.

This paper provides summary advice to the ERSG and the Bargaining Strategy Group on the current

status of the DHB employed Psychologists Workforce. It is based on the feedback received from

DHBs through the workforce assessment process and workforce information data. This information

is provided for the purpose of informing the development of a bargaining strategy for the

Psychologists MECA – expiry date 31 May 2016.

2. Workforce Information The DHB psychologist workforce comprises 570 FTE (723 people in total) as at 30 September 2015.

Canterbury DHB has the highest FTE of psychologists at 79.1 followed by Auckland DHB with 77.2

FTE.

HWIP trend analysis from 2007 to 2015 demonstrates a steadily increasing number of clinical

psychologists, with an overall FTE increase of 36% over this period. Conversely, over the same period

the Mean FTE has reduced from 0.83 to 0.79 indicating an increasing proportion of part time staff.

The DHB psychologist workforce has an average age of 44.7 years and an average length of service of

6.4 years. The proportion of females to males increased from 74% in 2007 to 79% in 2015. The

turnover rate which is currently 17% has fluctuated between 15-20% for the period 2007 to 2015.

The number of psychologists leaving is extremely small and therefore susceptible to significant

variation. This combined with an increasing length of service and an increase in mean age for both

sexes, suggests a stable and aging workforce.

The majority of psychologists are classified as ‘Other’ ethnicity (87.9%) followed by Asian, Māori and

Pacific groups with ratios of 6.5%, 4.5% and 1.1% respectively. This represents a change from 2007,

when the ethnic composition of the DHB psychologist workforce comprised 94.6% ‘Other’, 2.1%

Asian, 3.3% Māori and 0% Pacific. The difference between workforce ethnicity and population


ethnicity proportions indicates negative values, i.e. significant under-representation, of Asian, Māori

and Pacific ethnic groups.

In general employees are 9 to 5 workers with very little overtime and penal payments paid. It is

unknown what percentage are union members.

The key statistics suggest a stable workforce, increasing in size, proportionately more dominant

female representation, with a fluctuating turnover, an increasing proportion of part time staff and

under-representation of minority ethnic groups. A detailed Workforce Information Report is

included at Appendix 1.


3. Current Status of the DHB Psychologists Workforce

3.1 Overall Assessment of the Psychologists Workforce The current status of the DHB employed Psychologists workforce was assessed by DHB sector

experts using a structured screening tool. (Appendix 2)

The screening tool assigns a score to the workforce being considered according to:

Service Need The operational stability/instability of the service

Supply Demographic factors impacting on the overall availability of this workforce

Operational Flexibility Operational flexibility around this workforce for service delivery and innovation

Operational Capacity Recruitment and retention

The purpose of the screening tool is to provide an overall assessment of the workforce to highlight

any pressures impacting on the workforce operationally and/or in the context of employment

negotiations. Results of the screening, place the workforce in one of 4 categories as shown in the

figure below. Results should be considered indicative only.

Health Workforce Classification Table

Overall Classification Intervention Overall Score

Stable Occupation WATCHING BRIEF 4 < 6

Transitional Occupation SOME INTERVENTION RECOMMENDED ≥ 6 < 10

At Risk Occupation INTERVENTION REQUIRED ≥ 10 < 15

Occupation Under Pressure INTERVENTION IMPERATIVE ≥ 15

Preliminary assessment of the current status of the DHB Psychologists workforce by sector experts

has identified the DHB Psychologists workforce as a Transitional Occupation.

National DHB Psychologist Workforce Classification

Transitional Occupation - SOME INTERVENTION RECOMMENDED

Domain Assessment Score

Service Demand

Service demand is progressively increasing. 3

Supply There are some emerging distribution issues and wider issues with supply; but these are localised issues rather than the entire workforce, i.e. with particular areas of specialisation, Maori and Pacific psychologists, the number of intern placements and certain geographic areas.

2

Operational Flexibility

There are some sector requirements to begin looking at alternative models of care and roles for this workforce, as greater flexibility is required.

2.5

Operational Capacity

Some recruitment and retention issues are occurring, with slightly longer timeframes for gaining this workforce.

2

Total Score 9.5


DHB Service

Demand Supply



Total

Auckland 2 2 3 2 9

Counties Manukau 3 2 3 2.5 10.5

Northland 1.5 2 1 2 6.5

Waitemata 3 2.5 3 3 11.5

Bay of Plenty 3 2 2.5 1 8.5

Lakes District 3 1.5 2.5 1 8

Waikato 3 2.5 2.5 2 10

Capital & Coast, Hutt Valley & Wairarapa

3 3 3 3 12

Hawkes Bay 4 3.5 3 3 13.5

Mid Central 1.5 2.5 1.5 3 8.5

Whanganui 2 2 2 2 8

Canterbury 3 2 2 2 9

Nelson / Marlborough 3 1 2 1 7

National Score (Rounded off )

3 2 2.5 2 9.5

Regional DHB Psychologist Workforce Classification

DHB Service

Demand Supply



Total Regional

Classification Intervention

Northern Region

2.4 2.1 2.5 2.4 9.4 Transitional Occupation

SOME INTERVENTION

RECOMMENDED

Mid-Central Region

3 2 2.5 1.3 8.8 Transitional Occupation

SOME INTERVENTION

RECOMMENDED

Central Region

2.6 2.9 2.4 2.8 10.7 At Risk

Occupation INTERVENTION

REQUIRED

Southern Region

3 1.5 2 1.5 8 Transitional Occupation

SOME INTERVENTION

RECOMMENDED

National Score (Rounded off)

3 2 2.5 2 9.5 Transitional Occupation

SOME INTERVENTION

RECOMMENDED


3.2 Rationale The analysis of the Psychologists Workforce within the DHBs has resulted in the classification of a

Transitional Occupation. This classification highlights that service demand is progressively increasing

with some supply issues around the number of Maori and Pacific psychologists and with particular

areas of specialisation. There are emerging sector requirements to begin looking at alternative

models of care and roles for this workforce, as greater flexibility is required. Some recruitment and

retention issues are occurring in areas of specialisation, minority ethnic groups and particular

geographic areas, with longer timeframes for gaining this workforce.

Key findings include:

Service demand has been increasing and is predicted to continue increasing as primary

intervention and integration is prioritised.

Population growth and variegation, the outcome of the Christchurch earthquake and

increasing recognition of the value of psychology in health are also impacting on service

demand.

There have been significant changes to Mental Health Services, models of care and service

delivery. As a result, psychologists are increasingly being required to take on new key roles

with significant increases in responsibility.

The demand for specialist practitioners is also increasing, particularly in emerging areas such

as transgender surgery, transplants, cardiac, renal, neuro injury (stroke), and cancer support

services.

There are also increased pressures in terms of the aging workforce, reducing hours of work

and time out for parental leave. These issues also impact on capacity for supervision of

interns.

The DHB Psychologist Workforce has no major distribution or supply issues. However, there

are some wider issues with supply, i.e. with Maori and Pacific psychologists, particular areas

of specialisation, some geographic areas and the funding of intern placements; rather than

the entire workforce.

Longer term challenges remain around the public/private interface, particularly in relation to

loss of experienced staff to private practice and/or a reduction in hours worked for DHBs.

Some recruitment and retention issues are occurring in areas of specialisation, minority

ethnic groups and some geographic areas, with slightly longer timeframes for gaining this

workforce.

Overall, the Psychologists Workforce within the DHBs remains stable with a few long standing

issues continuing to gain momentum. No significant priorities have been identified for the DHBs to

address through the bargaining strategy.


3.3 Summary of the Current Status of the DHB Psychologists Workforce

Summary of Key Service, Operational Workforce and Employment Drivers

1. Operational Service Needs

Current Service demand has been increasing and is predicted to continue increasing

12 month outlook Service demand is likely to continue increasing

1 - 3 years outlook Watching brief in regards to volume increases

2. Employed Workforce Structure (Demography)

Average age Ageing workforce with an average age of 44.7 years.

Gender balance Predominantly female part time workforce with the risk of losing workforce numbers due to parental leave

3. Recruitment Current vacancies There are issues with particular specialisations and rural regions

Average time to fill Issues with particular specialisations and geographic regions

Distribution There are issues with particular geographic regions

Pressures on related workforces

No reported issues

4. Retention Factors Turnover Has fluctuated and is currently 17%. Although actual numbers leaving are small.

Sick Leave No reported issues

Part-time /Fulltime A part time workforce with a 0.79 mean FTE

Skill Mix No reported issues

Access to Clinical leadership

No reported issues

Clear career path No reported issues.

Development There are some issues regarding funding for CPD

Workload management Some issues due to increasing service demand

Roster management Some issues due to reducing hours of work and time out for parental leave

5. Ongoing Training and Development

Entry/ Transition competency

No reported issues

Match to service requirements

No reported issues

Access to ongoing training (progression)

There are some issues regarding funding for CPD

Access to training to maintain practising cert

No reported issues

Key

Working Well - no current problems, no immediate action required

Moderate Alert - action required in short / medium term

High Alert - immediate action required, extreme risk to occupation group


3.4 Workforce Assessment

a) Service Demand

Service Demand is about the demands on a particular service and associated workforce, and it

relates to the need for service provision within the environment or context being examined.

Service demand relating to the DHB Psychologist Workforce is progressively increasing.

The following considerations are influencing this:

Population growth and variegation, the outcome of the Christchurch earthquake and

increasing recognition of the value of psychology in health are some of the factors driving

increases in service demand.

There is increasing recognition of the role and value of psychological interventions in

primary care, therefore increasing demand for service. Overall service demand has been

increasing and is predicted to continue increasing as primary intervention and integration is

prioritised. Psychologists are increasingly taking a lead role or multi-disciplinary integrated

approach. While there is an expectation of integrated primary and secondary interventions,

no guidance has been provided on how to achieve this.

Reduced societal stigma about mental health issues in addition to increased publicity and

communication has increased the uptake of psychological services. There seems to be

decreased community resilience.

There have been significant changes to Mental Health Services, models of care and service

delivery. The increasing rate of access for mental health services is leading to a re-

examination of models of care to utilise resources, including psychology resources, in

different ways. As a result, psychologists are being required to take on new key roles, with

significant increases in responsibility.

The value of psychological assessments is also being recognised more, therefore also

contributing to an increase in demand. The scope of the role is broadening and changing.

Psychologists are required to complete more comprehensive assessments of individuals,

contextual and background factors. This is also a workforce development issue in that there

are changing requirements and skills that are needed.

Specialty demand is increasing in terms of the need for specialist practitioners. Areas such

transgender and transplants need pre-surgery psychology assessments. There may be a

need for a centralised resource. Cardiac and renal are also emerging areas. An area where

Psychologists can also have a positive impact is Neuro injury (stroke), i.e. the areas of brain

damage injury and chronic pain. Cancer support services is another new and increasing area

of service demand.


Forensics is a growth area which is experiencing an increase in requests for court reports.

This is a significant part of the work that Forensic Psychologists do and requires high levels of

technical competence. Legislative compliance requirements mean that only Forensic

Psychologists and Psychiatrists can write court reports. Youth Forensic is a national service

and which starts on 21 April 2016.

There has been an increase in referrals for both short & long term psychological

interventions, e.g. DBT - currently most community teams run waiting lists. In adult CMHS

there are long waiting lists for psychology input. Some DHBs are using FTE for outsourcing to

move through the short term referrals. This is freeing up the more experienced

psychologists to focus on the prioritised referrals. This involves them working on a

consultancy basis and allocating work appropriately.

There has also been an increase in the acuity and complexity of referrals, requiring specialist

services. As a result of the ‘Stepped care’ approach, psychologists are increasingly working

with clients with complex issues over an extended period of time.

Clients with chronic conditions are living longer and have changed care needs over a longer

extended period. Talking therapies are in common use for long term conditions. There will

be difficulties meeting the needs of this area in the future and if the underlying issues are

not addressed then this will place demand on other areas, e.g. longer term stays. Other

workforces could be used to deliver the therapies with psychologist supervision or on a

consultant basis.

General referrals in the areas of children and adolescents are also growing, with anticipated

increases of 10-14%. Hamilton has experienced more than 100% increase in children and

adolescents referrals in recent years. There are also new regional in-patient services with a

focus on younger clients, i.e. Children and Adolescents. There will be a need to find

increased number of specialists in this area.

The establishment of Children’s Teams under the Vulnerable Children Act 2014, involves

practitioners and professionals in government agencies, iwi and non-government

organisations bringing together existing services for vulnerable children into one

personalised plan for each child and their family/whānau with existing resources. A key aim

is to fast track children into government services such as health. There is also a focus on

targeting resources on priority areas such as the ‘Million dollar babies’. Additionally, FTE is

being assigned to the Children’s Teams which puts pressure on the rest of the team.

As a result of the Ministry of Health targeting access rates for service, within the context of

DHBs being required to do more with less, services are being reorganised. This includes

meeting waitlist targets across all age groups.

There is high demand for rural work due to factors such as high suicide rates in farming

communities, increasing pressures with falling dairy prices, isolation, etc. Rural roles are

often recruited from overseas, mainly South Africa. These recruits generally work out well.


However, it was noted that in Tairawhiti which has a strong Maori presence, there have

been some tensions.

ACC related ‘Sensitive Claims’ is a growth area. ACC Special Services Contract with Capital &

Coast and Canterbury DHBs is a one year pilot which utilises the services of Psychologists,

psychiatrists and social workers.

There are also increased pressures in terms of the aging workforce, reducing hours and time

out for parental leave. These issues also impact on capacity for supervision.

Service provision hours are almost exclusively Monday to Friday currently. However, this is

changing in terms of the drive to be more responsive, and is likely to expand to include early

evening and Saturdays, to ensure families are able to attend and participate in family

therapy. Acute care teams are available to provide after hours service.

b) Supply

Supply is about the actual quantity and distribution of a workforce; including current demographics

and the quantity and quality of students / graduates.

There are some emerging distribution issues and wider issues with supply; but these are localised

issues rather than the entire workforce, i.e. with particular areas of specialisation, Maori and

Pacific psychologists, the number of intern placements and certain geographic areas.

The following considerations are influencing this:

There is increasing diversity in the general population. Ideally, the psychologist workforce

should be representative of the general population. However, there are supply issues with

regard to gender and ethnic demographics such that the workforce is not representative of

the wider population, with significant under representation of minority groups. The small

numbers are not meeting demographic needs, since there are insufficient Maori and Pacific

psychologists available.

While the DHBs are doing the best they can to support a Maori perspective and effective

delivery of service to this group, under representation of Maori in this workforce does create

difficulties.

Increasing the number of Maori psychologists and support is a significant concern. There are

small numbers of Maori going into training. While there have been a few Maori interns

coming through, the numbers are very low. There are a range of barriers inhibiting minority

groups from entering the profession, including the limited availability of colleagues within

the group to support / supervise appropriately. The long training pathway and different

perceptions of mental health can also be deterrents and barriers to entry. At a local level


there are identifiable barriers such as family pressures, social issues, costs, distance from

training institutes, etc. which are deterring Maori from training as psychologists. Changes to

Postgraduate funding of student loans has also reduced access. The Kia Ora Hauora

Programme may change this over the long term.

While there is sufficient supply available in general psychology, there are increasing

shortages of psychologists in specialised areas and sub-specialties. These are long standing

issues which have escalated in recent years, as referrals for specialty services are increasing

significantly. Some specialist therapeutic models are requiring a special suite of skills and

qualifications, e.g. DBT. There is a tension between specialist vs generalist capability

development. The drive towards specialisation could create a shortage of generalists over

the long term.

There are well qualified overseas trained psychologists being recruited by DHBs, however

there is low reliance on this source as there are sufficient numbers of psychologists available

locally. There is an identified gap in terms of overseas trained psychologists requiring New

Zealand specific cultural training, which the New Zealand Psychologists Board is currently

looking to addressing.

There are fewer male psychologists, which can put pressure on service delivery.

There is an emerging trend of an increased number of fulltime staff reducing their hours in

order to also work in private practice. It is difficult to recruit to cover small FTE gaps. This

increase in part-time hours puts pressure on service delivery.

The quality of interns coming through are generally good, however there are concerns

around the funding of interns and placement numbers. Some interns are within current FTE

budget, while others are partially funded through HWNZ. Clarity needs to be sought from

HWNZ. There have been funding changes which are also having an impact. Some DHBs have

to recruit interns within current FTE. This is resulting in an adhoc reactive approach.

Supervision requirements mean that trained psychologists are recruited over interns. Interns

are usually used to fill vacancies which DHBs may be having difficulty filling. Counties

Manukau has a short term planned approach but this is funding dependent. While interns

are registered as psychologists, they still need to complete their internship and 1500 hours

of supervision. It can be difficult to provide supervision, and there is a tension with service

delivery / demand. It can be difficult for interns to get appropriate placements. Sometimes

Clinical Psychologists need to settle for less than desirable placements.

Intern placements are controlling what comes through the universities. There is a need for

more intern placements otherwise the universities cannot take more students. There are

only 8 partially funded annual placements for DHBs nationally, which is considered

inadequate.

Interns are considered to be very hard workers and a highly skilled/valuable resource. Intern

remuneration is quite high. Some DHBs are debating whether if the salary was lower, more


interns could be funded. However, some DHBs consider the remuneration reasonable for

the value interns provide.

c) Operational Flexibility

Operational Flexibility is primarily about substitution of a workforce and the ability for other

workforces to potentially take on the roles involved. It includes specificity of skills and how

specialised particular roles / scopes of practice are in regards to delivery of required care. It is also

about how enabling or limiting a current scope of practice is on workforce utilisation.

There are some sector requirements to begin looking at alternative models of care and roles for

the DHB Psychologist Workforce, as greater flexibility is required.

Considerations include:

This is a relatively small workforce with a long training/education pathway. The training is

prescribed and there is no other entry pathway.

Psychologists are increasingly required to be responsive, consumer focused / centred with

flexibility of approach. While the psychologist workforce comprises specialised roles with

specific qualifications and scope of practice, there are aspects of the role that can be moved

to other roles with appropriate training and support. There are only a few aspects that only

a psychologist can do. Some aspects of treatment can be done by others with appropriate

training and support, e.g. co-facilitation of therapy groups. Ideally, there should be a

stepped model of care to enable more flexibility.

There are requirements in mental health to look at different models of care to meet

increasing need, and this will have an impact on the role of psychology in teams / services.

Changing models of service delivery are looking at taking a multi-disciplinary approach and

breaking down silos. There is an increased focus on looking to increase integration with

primary care, provide shared care, etc.

Some DHBs are using FTE for outsourcing to move through the short term referrals. This is

freeing up the more experienced psychologists to focus on the prioritised referrals. This

involves them working on a consultancy basis and allocating work appropriately. At the

moment the focus is on psychologists managing a workload of mainly acute, but ideally their

workload should comprise a balance of acute and medium care.

The possibility of developing ‘Psychologist Hubs’ is being looked at as a way of getting

people to work smarter. This workforce can be resistant to changes to their way of working.


There are increasing requirements for psychologists in areas where they may not have

previously been involved. Increasingly complex issues are coming through, so trying to take

an integrated approach.

There is flexibility in working with other health professions within multi-disciplinary models

of care. There is some tension here due to how the value of the different roles may be

perceived and how the priorities are assessed.

Dialectical Behaviour Therapy (DBT) is a specialist cognitive behavioural treatment

developed for clients with severe emotional problems, who meet criteria for Borderline

Personality Disorder (BPD) or Complex Post-Traumatic Stress Disorder (CPTSD). The goal of

DBT is about building a life worth living. Community DBT can be demanding and often results

in psychologists being the ones responsible for the ‘risky’ interventions.

Some psychologists such CAF Psychologists can only work with people up to the age of 18

years, so while they tend to be flexible, they are restricted by their scope of practice.

Specialisations can reduce service flexibility. Neuropsychology and cognitive assessments are

at the complex end and can only be done by clinical psychologists.

Similarly, Forensic court reports can only be done by Forensic Psychologists. No substitution

is possible. Legislative compliance requirements can restrict operational flexibility and

require a structured approach.

New technologies are providing some flexibility in the way work is structured and organised,

and services are delivered. There is increased use of technology such as online tools for

consultations, monitoring and communicating with clients using secure transmission. This

seems to work particularly well with the younger age groups. The adult sector tends to be

the most challenging.

Psychologists need to be responsive to consumer needs. There is a move away from usual

Monday to Friday, 9am to 5pm hours. There is also an increasing need for flexibility around

locations. The role allows flexibility, however it depends on the individual. There is also

flexibility in the range of therapies and deployment of psychologists.

There is high potential for psychologists to move into psychiatric areas. Substituting

psychologists to pick up some of the work, so less treatment with drugs and more

psychological therapies.

d) Operational Capacity

Operational Capacity is about recruitment and retention of a workforce. It includes availability and

the ability to buy / bring in more of a particular workforce as required.


Some recruitment and retention issues are occurring in areas of specialisation, minority ethnic

groups and some geographic areas, with slightly longer timeframes for gaining this workforce.

Considerations include:

It can be challenging recruiting qualified and experienced psychologists and a lot of

proactive work needs to be done. There are longer timeframes involved in sourcing the

limited supply of qualified and experienced staff, particularly for rural areas. There are small

numbers of applicants for advertised roles. Very few applications (maybe 1 or 2) are

received for vacant positions, and mainly from overseas applicants. It does seem however

that recruits with overseas qualifications manage to achieve registration in New Zealand

with relative ease.

Recruiting to rural areas can be difficult, as it involves getting people to move to small towns

without university linkages.

There can be high turnover where there are solo practitioners, who don’t get a lot of

support.

While not highly reliant on overseas qualified psychologists, some DHBs do use them as a

source. Some overseas recruitment is done with the UK, Australia and South Africa being

primary source countries. There has been a decrease in overseas applicants recently.

There is competition between DHBs during recruitment.

Differences in credentialing overseas graduates and placement on salary scales can lead to

movement between DHBs.

There is some difficulty involved in recruiting minority ethnic groups and for cultural

services. There are some but it can take a long time to source people.

There are some retention and recruitment issues relating to specialised areas and roles. It is

harder to recruit for specialised areas or services, especially new and developing specialist

services such as Youth Forensics Services.

Sometimes, due to budgeting issues psychologists have been de-prioritised in terms of

vacancies, leading to time lags in recruitment. The diverse nature of the service and small

FTE numbers in some locations impacts on recruitment timelines.

There are issues with increased movement to private practice, i.e. increasing the hours

worked in private practice and decreasing availability for DHB work. This trend results in

reducing FTE and it is difficult to recruit to fill the gaps created, which challenges service

delivery. There is a potential issue of retaining psychology staff fulltime in DHB settings, as

compared with other non-medical staff, there are many and increasing opportunities for

private practice. There are significant and increasing, numbers of psychologists who have

work split between DHB and private practice. There is a lack of willingness to work fulltime

in the DHB environment, due to the nature of the work. The differences between the private


and DHB contexts are hard to overcome, i.e. more exciting opportunities, greater

satisfaction, higher remuneration, greater control over the hours worked, etc.

The high numbers of females means that there are high levels of parental leave and people

not returning from parental leave, which impacts on retention.

The DHBs lose highly skilled psychologists to the Department of Corrections (DoC) due to

higher remunerations on offer. The DoC has no merit progression steps to achieve and this

can be seen as a positive above the merit step remuneration in a DHB context. They are

competing for a limited pool of highly skilled psychologists.

The high cost of living in Auckland impacts on recruitment and retention. The DoC gives a

$2.4K extra allowance to psychologists working in Auckland.

Interns are utilised to cover FTE gaps. Some DHBs are reducing the number of interns,

resulting in people moving into other areas.

Access to training and lead in time can become a retention issue. Funding of Continuing

Professional Development (CPD) is negotiated. Training is needed to develop specialist skills,

however funding is an issue.

workforce assessment: dhb psychologist workforce · workforce assessment: dhb psychologist...

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