Getting the right numbers of the right staff in the right care location
The NHS in Cambridgeshire and Peterborough has approximately 37,000 people working in the NHS, alongside approximately 19,000 in social care (excluding students, trainees, and volunteers), and we face a number of difficulties in getting the right numbers of the right staff in the right care location for the future.
Our difficulties include:
- recruitment of enough skilled, experienced and specialist clinicians (doctors, nurses, pharmacists, mental health workers, physiotherapists)
- the impact of staff leaving one post to take up another post within our local services
- training and keeping a strong support staff (e.g. Allied Health Professionals such as dietitians, medical technicians, occupational therapists, physical therapists, scientists, radiographers, respiratory therapists, pathologists)
- making it easier for our staff to work across different hospitals and community services
- retirements of GPs and general practice nurses over the next five years.
To address these challenges, we have developed a system-wide five-year workforce strategy.
Our system-wide five-year workforce strategy
Our integrated five-year workforce strategy identifies how our organisations will work together to tackle our issues. This was developed by system-wide representatives from HR, nursing and education, higher education, local authority, Clinical Commissioning Group and patient representatives. The strategy identifies how we will achieve our ambitions through:
- Improving staff supply
- Improving staff retention
- Development of new roles
- Setting up new ways of working and improving skills
- Leadership development
To support the strategy, a delivery plan has been written which includes:
- How to make it easier for staff to work across traditional organisation boundaries.
- Allow staff to transfer their training and checks from one organisation/trust to another e.g. Disclosure and Barring Service (DBS) check, fitness to practice.
- Working together to market the Cambridgeshire and Peterborough system as an ‘employer of choice’, rather than individual organisations.
Working across organisation boundaries
Members of our system-wide Joint Emergency Team
Our NHS and care organisations are working in more co-operative and combined way across hospitals, community services (e.g. district nurses) and GPs. We are placing greater importance on improving skills and availability of services for individuals with one or more long term condition.
There will be more sharing, of knowledge, information and resources (staff, offices) across organisational boundaries, which will improve services
and achieve a better understanding between our professionals.
To date, our work on providing new and improved services (sometimes called ‘new models of care’) has identified a need for significant increase in our workforce. These increases are due to:
- Providing more care in community settings (e.g. clinics in GP surgeries or other health or care buildings) so patients don’t have to
travel to hospital - Identifying and intervening if patients are showing signs of needing hospital care
- Providing patients and service users with the care that best meets their needs, in the more effective and efficient way, and in the
most appropriate setting - Making sure we have an adequate and sustainable levels of health and care staff so the system can meet demand.
Our key challenges
We have a number of key challenges:
- We need ‘Integrated Care Workers’ – a new role created to support our specialist staff (clinical experts in their area, such as cancer, diabetes) and to deliver basic care to patients – see our staffing model below.
- Also required for a number of our service improvement projects are the scarce Allied Health Professionals (dietitians, medical technicians, occupational therapists, physical therapists, scientists, radiographers, respiratory therapists, pathologists).
- We are also working with the pressures on our workforce through increasing patient demand for services, the management of patients with more complex, multiple conditions, staff vacancies, overseas recruitment for nursing, and retaining older staff.
Our data
What we know about our current workforce:
- We have a younger workforce across the system in comparison with the rest of our region (Midlands and East), with the highest percentage of staff aged 21 to 30, and the fewest aged 46-55.
- The number of doctors rapidly reduces past the age of 46, with a decline in nursing post the age of 54.
- Locally we have high cost of living areas making it difficult to attract staff.
Our staffing model
In order to provide the required staff to support the new and enhanced services (new models of care) that will deliver the changes we need, the following factors have been considered as critical for success:
- Development of Integrated Care Workers across the whole health and care system – to create a large workforce which is responsive, flexible, and competent in a range of areas to support our specialist staff and deliver basic care to our patients.
- Development of two new roles to ‘close the supply gap’:
- Medical Assistant – designed to work with GPs in general practice surgeries and provide high level administrative support.
- Physician Associate – designed to provide high level support to hospital consultants.
- Taking steps to increase the number of the newly-qualified nurses, therapists and district nurses.
- Education and training programmes to encourage staff to move into specialist roles, other career enhancement opportunities, and to increase the skills of our staff.
Overseeing the system-wide five-year workforce strategy
The Sustainability and Transformation Partnership has set up a Local Workforce Advisory Board (LWAB). This board has system-wide representatives from HR, nursing and education, higher education, local authority, Clinical Commissioning Group and patient representatives.
The board group is overseeing the delivery of our system-wide five-year workforce strategy. Jo Bennis, LWAB clinical lead, said: “Our challenge is to deliver and balance the workforce requirements across our provider organisations, general practice, and social care. Our group members are providing greater working together and understanding of the issues and solutions improving a range of patient services.”
(Published January 2018)