Annex 5

SUMMARY OF MAIN WORKFORCE ISSUES FACING BOARDS

Provide a BRIEF summary of the main workforce issues facing your Board to set the broader context within which the workforce implications of the HEAT targets would sit. This should be based around the following 3 headlines:

information on significant changes in skill mix and the plans to take this forward,

 existing and planned new service areas with particular workforce pressures and possible solutions; and

other significant workforce issues that the Scottish Government should be aware of that may require a national focus.

Skill Mix Changes

  • There are a number of plans within the service to change skill mix by introducing more Band 3 and 4sto support clinical staff and release specialist skills. This is occurring in all areas across the service, including the community where there is a focus onolder patients with complex needs.NHS Grampian has developed an agreed framework for Band 3 / 4 support workers, to help achieve a safe and affordable workforce.
  • NHS Grampian isusing a multi-professional and multi-agency approach to develop a workforce plan for the new Emergency Care Centre (ECC). Given the complexity, we are working across systems to ensure we develop a flexible, affordable and sustainable workforce for the future. The plan is to introduce new ways of working andworkforce redesign prior to the opening of the facility(e.g.the project team is currently developing a workforce model for the Medical High Dependency Unit which will be piloted prior to the ECC opening). The agreed methodology for planning is the Six Step Approach.
  • In an effort to reduce the level of Did Not Attends (DNAs) we are piloting the use of band 2 administrative staff to communicate with the patients and to encourage attendance for appointments.
  • There are plans to develop existing staff e.g. Band 4 and Band 5 (commensurate with Smoking Cessation Advisor level 4) with specialist training support to delivery of target on smoking cessation
  • In relation to the 26 weeks referral to treatment target for for Child and Adolescent Mental Health Services (CAMHS) NHS Grampian has commenced preparatory work for redesign in 2011/12. This redesign will fully engage the relevant stakeholders in multidisciplinary working within CAMHS with the aim of developing the current workforce and building the most appropriate skill mix for sustainable services.
  • Plans have been developed to identify appropriate Band 5 nursing staff, from the current nursing and community establishment, to support delivery in the community of thechild healthy weightintervention target. Specifically this will include the enhancement of current skill and knowledge levels.
  • NHS Grampian is reviewing the roles, grades and competencies of community nursing teams to ensurethat the skill mix is fit for purpose and development needs are met.
  • There is an exigency from the national reshaping the medical workforce project to further develop training/educational opportunities for specialty doctors locally. National work is required on marketing the specialty doctor role and developing a framework that allows over a number of years for a specialty doctor to Certificate of Competency Training.
  • Physician assistants are a workforce solution suggested by the reshaping the medical work-force project. This requires agreement in principle across the North of Scotland and development of a common core competency set regardless of clinical background, with a possible three year time lag before there is any output from a local University course.

Workforce Pressures & Solutions

  • For a number of targets including A12, T11 and H5 there is a significant development requirement for the workforce which creates pressure in balancing operational needs with the need to release staff for appropriate learning and development. The effective use of the Knowledge and Skills Framework (KSF) will help to determine both the appropriate workforce groups and the required level of learning. The issues associated with releasing individuals from service provision is being tackled by using creative ways of providing learning including on-line modules and self directed learning. The implementation and use of AT learning will support the effective management of training administration. We have recently reviewed the requirements for all mandatory and statutory training. This is to be agreed by the Grampian Area Partnership Forum (GAPF) at its next meeting however this will probably increase the pressure on operational areas to release staff for training.
  • NHS Grampian has completed a second workforce survey of all general practice staff within the Grampian area (the previous year’s survey only covered Practices within AberdeenCity). From this information we have been able to develop a greater understanding of the workforce issues associated within General Practice. One specific issue is the replacement of the workforce due to the changes associated with retirement and turnover. For some, as vacanciesarise, General Practices will need to consider if there are alternative ways to provide the service utilising different skill mixes and methods of delivery
  • Services are working closely with the Infection Control Team for support, advice and training to develop improved skills and practice in Infection Control.
  • NHSGrampian willutiliseContinuous Service Improvement and lean methodology to create opportunities for staff to work more efficiently and thus releasing their time to focus on the provision of quality services. These processes put the patient at the centre and look at the redesign from the patients’ perspective. An example of this would be the Releasing Time to Care project within nursing which has already identifiedefficiencies.
  • NHS Grampian continues to develop relationships with all our partners, including working more closely with local authorities, voluntary services and education to improve service delivery and provide more effective joined up services. For example:
  • Child Protection and working with families with multiple needs will be supported by multi agency working e.g. close working with Social Care Services
  • Addressing health inequality in relation to smoking cessation by working closely with voluntary sector and local authority.
  • NHS Grampian has promoted closer multi-professional working with primary care and community teams to ensure effective service and efficient use of the workforce. The Long Term Conditions Collaborative (LTC) is assessing various models, including the Productive Community model, to augment this.
  • NHS Grampian ran an event at the end of January 2010 with GPs and practice nurses aimed at promoting further close working with Alcohol Drug Partnerships locally to resolve issues for primary care, including the readiness of workforce. Work is continuing with community nursing teams and in particular,school nursing and dietetics, to identify competence and establish workforce readiness to deliver the H3 target. NHS Grampian is assessing the need to recruit a research nurse for alcohol brief intervention within the Sexual Health Service
  • The review of dementia inpatient and outpatient provision has resulted in a reduction in the need for dementia inpatient beds. This has already reduced staffing requirements and will continue to do so.
  • There is a continued review of the usage of GP acute beds in Community Hospitals including the development of anticipatory care and the long stay services. NHS Grampian isreviewing the redesign of the clinical support required for the future provision of services to meet the demographic challenges.
  • NHS Grampian is experiencing ongoing pressure concerningmedical locums and the unavailability/affordability issue of locums across the North of Scotland. There is an urgency to develop pro-active, creative solutions locally, to address this issue (including further work on national/international medical recruitment in addition to the national medical locum bank work-stream).
  • The number of applicants for GPSpecialist Training programmes has reduced considerably in recent years and this appears to be repeated for this coming Scottish Medical Training application round in 2010. There is work required locally, regionally and nationally to explore this issue.

Other Significant Workforce Issues

  • Within NHS Grampian there is an overall issue of achieving financial balance whilst ensuring there is a competent workforce available to provide a sustainable service. NHS Grampian’s current financial position does not allow for additional workforce resources, therefore we need to ensure that we are working effectively and efficiently whilst ensuring we have a safe and affordable workforce. A project to address the issue of a safe, affordable and effective workforce has been implemented across the nursing workforce (SANE project).For all other workforce groups a similar project is about to be launched across NHS Grampian with the aim of developing a safe, effective and sustainable workforce. This is being initiated with the management workforce in the first instance.
  • NHS Grampian continues to monitor European Working Time Directive (EWTC) compliance through a variety of data sources including, but not limited to, New Deal monitoring. Intelligence suggests that EWTD compliance for NHS Grampian is 100%. Although junior doctor vacancies are ongoing in the background there are local operational plans in place to cover these. The current vacancy rate is approximately 5% (dependent of definition). No services have been reduced or cut as a consequence of the EWTD in NHS Grampian. There have been no requirements so far for NHS Grampian contingency plans as services were redesigned in 2008/9 ahead of EWTD being enacted. This included additional medical staffing and role development i.e. advanced nurse practitioners, health care support workers and allied health professionals
  • NHS Grampian continues to work with our medical services to introduce multi-professional solutions (i.e. a “mixed economy” acute medical workforce) to meet current and future medical workforce challenges, including the impact of CEL28 i.e. reduced reliance on trainee doctors for the provision of service and the move to a trained doctor service. This will require the development of the role of specialty doctorOut of Hours who will work resident shift patterns, undertaking solely night work at 30 hours a week. New models of care will be required for each speciality to comply with the reduction in trainee doctor numbers. We are currently reviewing this in light of service needs and delivering a cost effective patient safe service for each specialty. NHS Grampian needs to ensure that they take a multi-disciplinary approach for medical workforce planning and development.
  • In light of the current financial climate the ability to fill existing vacancies and recruit to new posts will remain difficult. (For example there are a number of consultant vacancies in key diagnostic specialties across NHS Grampian). There is a vacancy control procedure in place to ensure that service redesign has been undertaken as soon as any vacancy or potential new post arises. This process is to ensure a balance between sustainable operational service delivery and affordability.
  • Recent progress has been achieved in our plans to work more closely with regional colleagues in the North of Scotland to ensure a sustainable workforce for the future. A number of actions have been agreed which will be taken forward regionally over the next 12 months.
  • Due to the geographic location and the level of skills required there may be issues associated with the recruitment of some specialist practitioners e.g. With available funding for Children’s’servicesthe recruitment of staff may be difficult due to competition across Scotland

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