Workforce PlanNHS Grampian2014
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Foreword
The 2020 vision for both NHS Grampian and NHS Scotland has the patient at its heart. It is about delivering safe, effective person-centred care in the most appropriate setting.
Delivering this vision requires us to have a well-trained, highly motivated workforce with the right skills. It requires the engagement and commitment of all of our staff, working in line with our core values of caring, listening and improving.
NHS Grampian’s 2014 Workforce Plan, developed in partnership with staff side representatives, is the means through which we can identify present and future staffing needs and develop our staff towards meeting our vision. We commend it to you.
Richard Carey Sharon Duncan
Chief ExecutiveEmployee Director
Contents
Foreword
Executive Summary
1. Grampian’s 2020 Vision
2. Delivering Workforce 2020
Workforce
Partnerships
Specialist Workforce
Development
What is your role in 2020?
3. Defining the Required Workforce
Direction of Travel
Workforce Recruitment Challenges
Nursing and Midwifery Workload and Workforce Tools
Changes in the Workforce
Technology
Workforce Plan 2013 – Update on Actions
4. Workforce Capacity and Capability
Data Quality
Current Workforce Highlights
5. Workforce Action Plan
Learning and Education Plan
Priority Areas for Development
Key Workforce Risks
Workforce Planning Action Plan
Priority Workforce Planning Actions
6. Implementation
Monitoring & Review
Executive Summary
Workforce planning is a statutory requirement as stated in CEL 32 (2011)[1] to support an evidence based approach to planning and developing the workforce. The aim is to ensure the highest quality of care by having the right workforce.This is further supported by the local delivery planning process which outlines the organisational priorities for the NHS in Scotland[2]. Underpinning this are the key values of NHS Grampian which are Caring, Listening and Improving[3] at all times.
The NHS Grampian2014 Workforce Plan captures the workforce planning evidence base across Grampian, describes the future workforce and updates on progress from last year’s Workforce Plan. The key theme running through this Plan is the direction of travel in terms of developing the skills and competencies required in the future.
The vision for the workforce in 2020 was outlined in depth in NHS Grampian’s 2013 Workforce Plan[4]. This would lead to a workforce which is more flexible, multi-skilled and empowered. One driver supporting this is the integration of Health and Social Care[5] which will support a more integrated workforce with partner organisations such as Councils and the Third Sector.
This2014 Workforce Plan includes an update on actions that have progressed since 2013. These include: the Advanced Clinical Practitioner workforce which has been supported by training opportunities and appointments to support patient care across the system; coaching, mentoring and talent management frameworks that have been established and progressed in partnership with other health boards and public sector organisations; and a General Practice 2013 Workforce Survey which has been completedand provides a comprehensive workforce profile for all those employed in General Practice across Grampian.
A number of workforce risks are identified in this Workforce Plan including recruitment to vacancies, the age profile of the workforce, career succession planning, and organisational development work to support the integration of Health and Social Care.
This NHS Grampian 2014 Workforce Plan concludes by highlighting further work required to progress the Workforce 2020 vision and how this will evolve as the flexible, multi-skilled and empowered workforce emerges.
1. Grampian’s 2020 Vision
The strategy for NHS Grampian is summarised by the Healthfit 2020 vision[6] and is outlined in Word Portrait Box 1. All other actions and activities are regarded as supporting plans which will move the Board and its services in that direction under the banner of Healthfit 2020.NHS Scotland has also adopted a 2020 vision for services across Scotland[7].
Word PortraitBox 1
What is the Grampian Healthfit 2020 Vision?
“The health of the people of Grampian and the health service in the area is radically different with how it was in 2011. People are healthier because they take responsibility for their own health…a reduction in premature death…people are less dependent on the health service… [But] when health services are needed, they are more effective and tailored to individual needs… possible because of release of staff, funding and buildings from traditional ways of working…The focus on the individual has been undertaken in partnership with local authorities and the third sector…”
In the NHS Grampian 2013 Workforce Plan, this Healthfit 2020 service vision was the basis for developing a 2020 vision for the future workforce.It was developed in partnership with staff, colleagues and stakeholders including the Third Sector and Councils last year. This Workforce 2020vision is summarised again below in Word Portrait Box 2 as it underpins the direction of travel incorporated within this 2014 Workforce Plan and reflects the themes that were included in the NHS Grampian 2013 Workforce Plan.
Word PortraitBox 2
By 2020:
NHS Grampian will employ a leaner, more flexible, multi-skilled workforce, who will enable and empower people to take responsibility for their own health,the workforce will be organised in an integrated way, focussing on the needs of the individual rather than the desires of the professional. Whilst managing growth and demand, healthcare professionals will be more accessible to the public and to each other. There will be a sense of responsibility across the organisation that will focus on:
•Results & value for patients;
•Enablement, anticipation & rehabilitation;
•Safety & Quality; and
•Those who need it most.
Sectors, Services and Community Health Partnerships (CHPs) have undertaken workforce planning in partnership with staff-side representatives during 2013/14. Progress from these sectors, services and CHP Workforce Plans in moving towards a Workforce 2020 vision is included in this NHS Grampian 2014 Workforce Plan.This detail was summarised in three key sections: the learning and education plan, a risk plan and an action plan.
An update is provided within this NHS Grampian 2014 Workforce Plan as well as an overview of the annual workforce planning cycle of 2013/14 across sectors, services and CHPs.
An example of the future workforce from Pharmacy Services Workforce Plan is shown in Word Portrait Box 3.
Word PortraitBox 3
By 2020:
In community pharmacy there will be a shift away from a historical supply function to a more clinically based service. Locally this will be driven by the Healthfit 2020 vision and the Workforce 2020 vision for pharmacy services.
Nationally, the driver will be through the maturation of the community pharmacy contract, further shaped by the recently published national strategy for pharmaceutical care in the community: Prescription for Excellence[8].
Where are we starting from?
Key facts on an organisation’s workforce are summarised in a workforce profile such as headcount, establishment, average age, gender spilt, full/part time working and turnover.The NHS Grampian 2013 Workforce Plan[9]included a comprehensive workforce profile.
This broad detail has been reiterated in this section to provide a clear starting point for 2014. Changes in the shape and size of the workforce over the past year(2013/14) are summarised below. These are:
- NHS Grampian employs 14,024 people (excluding bank) across all of the healthcare professions and support roles.This has increased by 1.2% compared to the same point last year.
- The whole time equivalent (WTE) has increased significantly from 11,405.4 WTE at the same point in 2013; to 11,541 WTE in 2014. These figures include training grade doctors.
- The average age of the workforce in 2014 was 43 years. This is unchanged from the previous year, although for the past 5 years, the average age of the workforce has increased in NHS Grampian.
- In 2014, 61% of the workforce is over 40 years of age and the percentage of the workforce over 55 years has increased by 4% from 2013.
- Gender split is 83% female and 17% male, which has shifted slightly from the previous year (82%/18% respectively). This has been relatively consistent over the past 7 years.
- The split between full-time and part-time working is 62% full-time and 38% part-time. This has shifted within the past 4 years, from 65% of staff working full-time and 35% working part-time.
- Nursing staff account for 43% of the workforce. 75% of nurses and midwives are registered with the Nursing and Midwifery Council and 25% are non-registered support staff.
- Turnover has remained at 11.1%.Within Job Families, Personal & Social Care had the highest turnover rate of 18.6%. Allied Health Professions have the lowest rate at 8.4%.
- Grampian also contracts with a number of independent contractors to provide primary healthcare services, including General Medical Practitioners, General Dental Practitioners and Optometrists and Community Pharmacists. These practitioners and the people who work for them are a significant part of the wider healthcare family in Grampian.
- This year, the workforce team has undertaken a workforce survey across General Practice. See Word Portrait Box 4.
Word Portrait Box 4
The General Practice Workforce survey 2013 was undertaken in the autumn/winter of 2013 to capture all staff currently employed by General Practice. As independent businesses, all General Practices are separate entities.
The completion rates were 100% across NHS Grampian and 71 out of 80 General Practices submitted a full data set. There are 503 General Medical Practitioners across Grampian including independent and salaried GPs.
Such a comprehensive workforce profile enables NHS Grampian to develop a thorough understanding of the opportunities and challenges facing the General Practice workforce.
There are challenges in terms of the NHS Grampian workforce profile; however there are also significant opportunities. Over the next five years, there is an opportunity to ensure the right staff will be employed in the right place with the right skills for patient care. Turnover in staffing provides an opportunity todevelop a multi-skilled workforce that supports the Workforce 2020 vision.
2. Delivering Workforce 2020
To support the Workforce 2020 vision, last year’s workforce plan included a theme of culture development and the implications of this on the public and empowering the patient. Such an evolving culture supported by organisational development will require staff acceptance of the change and for staff to embrace such change. Both teams and the population will have to be empowered for the culture to emerge that supports the NHS Grampian Workforce 2020 vision.
This culture change is supported by NHS Scotland Staff Governance Standards[10]which underpin and support the environment that employees work within. From a workforce perspective, staff are involved in workforce planning, thereby informing and supporting the decision making processes.
Integration between health and social care will be the most fundamental change for the three Community Health Partnerships in the next few years[11]. Patient care should become seamless between health and social care with integration of the different aspects of the patient journey.
Structural changes are starting to occur with the appointment of Chief Officers for these new partnerships. Further progress will be reported in future workforce plans.
Aberdeenshire CHP in its2013/14 workforce plan, highlights that the most fundamental change will be the development of the new Health and Social Care Partnership. The cultural challenges are significant but they are being addressed as seen in Word Portrait Box 5.
Word Portrait Box 5
Aberdeenshire Council and NHS Grampian are hosting Health and Social Care Integration road-shows across Aberdeenshire during spring 2014.
A series of road-shows will be taking place throughout May to engage with health and social care employees of Aberdeenshire Council, NHS Grampian as well as Third and Independent sectors about the forthcoming integration of Health and Social Care services. Withthe Chief Officer for the partnership in attendance, the road-shows will explain the new partnership, how it will work in practice and how staff can all be part of making a real difference to the population of Aberdeenshire.
Empowering the patient is a consequence of an evolving culture. Public health are supporting this by utilising the opportunity of patient and professional contact to promote preventive health messages as described in Word Portrait Box 6.
Word Portrait Box 6
Public Health, in collaboration with Aberdeen Royal Infirmary have developed and tested a prototype for a brief intervention, Making Every Opportunity Count, building on the evidence and materials from NHS East Midlands. This supports staff to capitalise on the 400,000 outpatient appointments by embedding preventive health messages and signposting, routinely, as part of quality care.
NHS Grampian is now rolling-out Making Every Opportunity Count, learning from the initial pilot in Maxillo-Facial and creating a resource to support staff to further enhance patient care.
For the NHS Grampian Workforce 2020 vision to be achieved, organisational development, empowerment and cultural change are all key aspects to developing flexible skills and competencies across the workforce.
Workforce
To deliver the Workforce 2020 vision, there is a requirement to have the right workforce in the right place with the right skills and competencies.
This includes the themes that the workforce will have to become more flexible and multi-skilled. The workforce will need to have more of a community based focus and be flexible in and between roles. The “professional” is more likely to deliver skills that are more technical with increasing reliance on engaged and empowered patients.The sectors, services and CHPs Workforce Plans of 2014 have confirmed this direction of travel.
Ultimately, how the workforce delivers patient care will need to change for the Workforce 2020 vision to be achieved. The workforce will have to work differently, in partnership with different stakeholders and in different teams with potentially different roles.
One driver that has supported developing the workforce skill and competencies is the move towards extended working as outlined in Word Portrait Box 7.
Word Portrait Box 7
NHS Grampian Allied Health Professionals (AHP) are progressing extended working to improve access to AHP assessment and intervention.
The focus is on supporting urgent and emergency services, AHP diagnostic services and AHP services that will reduce length of stay and re-admission rates.
Across NHS Grampian, there has been a pilot of exploring how a multi-skilled workforce can deliver a musculoskeletal hub. This is an example of a more flexible and multi-skilled workforce. This is described in Word Portrait Box 8.
Word Portrait Box 8
AHP Musculoskeletal services are undergoing significant redesign to implement the nationally agreed pathway.
From a workforce perspective, this will mean a number of changes in practice for administration and clinical staff involved in these services. The redesign will bring opportunities for role development within these teams and more joint working across clinical services to ensure a more efficient and effective journey for patients.
The General Practice 2013 Workforce Survey describes the profile of staff in General Practice. This provides an outline of the skills and competencies across professional groups in General Practice. An understanding of the workforce profile is also detailed in sector, service and CHP Workforce Plans.
As the Workforce 2020 vision was developed with partners such as Councils and stakeholders there is now a requirement to dovetail such skill and competencieswork with information from our Council and Third Sector partners as to their workforce profiles.
Partnerships
NHS Grampian has many partnerships with the local community, educational establishments and relevant stakeholders in the third sector, as well as Councils. These partnerships exist in terms of service delivery and in supporting patients or carers on their relevant journey. Some of these third sector partnerships are well-known in the local community and receive extensive support as evidenced through the local media. Often some of them are only known to the particular patient community that they support. All these partnerships are invaluable for supporting patient care and for the long term aspiration of the Workforce 2020 vision.
The workforce needs to be continually supported to see these partnerships as one way of empowering the patient and for this to be continually refined and developed as knowledge and expertise are shared. A key element of the NHS Scotland Healthcare Quality strategy[12] is for patient care to be person-centred. Such partnerships with the Third Sector and Councils are critical in enabling this to continue to evolve and develop.
Partnership Working
Partnership exists at many levels and working with staff side representatives underpins the organisational commitment to the Staff Governance Standards[13]. An example of this for NHS Grampian is outlined in Word Portrait Box 9.
Word Portrait Box 9
NHS Grampian Facilities and Estate sector management,by working in partnership with staff side representation, have developed a comprehensive learning and education plan that supports up-skilling and skills transfer which complements the development of a career succession planning framework.
The learning and education programme includes apprenticeships, workbooks, management development, relevant diplomas/degrees and in-house development programmes.