Phase 3 Planning: Developing Realistic Workforce Plan

This month every STP/ICS needs to submit a series of planning returns as part of the Phase 3 Planning Submission.  

Attain are helping systems across England to model different scenarios at scale to see the impact of a range of recovery strategies on the availability and productivity of workforce. This will support the Phase 3 Submissions but, critically, also provide key insight for operational planning more locally by joining up the required increase in activity and the demands on the workforce.

What are the key questions we need to solve?

Systems essentially need to develop credible workforce plans to enable a ramping up of activity, in areas such as planned care, with broadly the same size of workforce we had in May.

Another key question is how to make sure the workforce growth we use in these plans, for September 2020 to March 2021, aligns with the Long Term Plan responses from earlier in the year. For instance, if our staffing levels are lower than they should be now, then how can we bring them back in sync by March 2021?

Added to this challenge is the need to deliver this Operating Plan with the ongoing effects of Covid plus other factors such as social distancing, test and trace and infection prevention control (IPC) measures.

What kind of COVID-linked workforce impacts are we seeing?

  1. Productivity linked with IPC and PPE: We have seen in many areas that new IPC and PPE-requirements have led to productivity reductions ranging from 15% to 30% for procedures.
  2. Green Pathways: Having to set up “green” pathways (non-covid) for planned care patients and to provide assurance to patients about the safety of coming to hospital for procedures appears to present a significant additional challenge to hitting activity targets. An inextricable element of this is driven by public perception rather than actual safe, operating capacity.
  3. Activity: Most providers are preparing to more than double planned activity levels (admissions) from July to September, whilst planning for winter pressures plus the possibility of a second wave of covid impacting on bed and workforce capacity
  4. Staff Availability during peaks: Sickness and self isolation in nursing and clinical support workforce in many areas reached almost a quarter of the total workforce. Including shielding, approximately one third of the workforce was unavailable at a given time.
  5. Staff sickness now: Most providers’ sickness/self isolation rates in nursing and clinical support has returned to just above normal levels averaging around 6% which is split evenly between COVID and non-COVID causes.
  6. Staff availability now: Staff unavailability, including shielding, has fallen back below 20%.
  7. COVID risks to the workforce: Most providers have between 10% and 30% of their medical workforce classified as ‘high risk’ or ‘at very high risk’.

So what is the main pitfall to avoid?

One of the key pitfalls will be associated with workforce plans that are not reflective of realistic staff supply over the coming 6 months and rely on new recruits who, quite frankly, do not exist.

Despite the need to align new workforce plans with the Operating Plans, by March 2021 – which inevitably involves ambitious staff growth rates in most cases – we should be wary of setting unrealistically steep staff growth trajectories or we will run the risk of falling behind on day 2 and never being able to recover.

Where can we look for Opportunities?

  1. Increasing Outpatient Ambition: Some providers have already ramped-up Outpatient activity by switching to virtual clinics as the default position, rather than the exception. The number of ‘Did Not Attends’ (DNAs) have halved in some areas.
  2. Promoting new flexible ways of working: an emerging benefit of the pandemic on the workforce, is the step-change in accepting flexible working arrangements. During the peak, it was clear that productivity of the workforce remained high and in some cases increased, through the enforced remote working and increase in flexibility in working hours. By promoting this as the new normal, it should be possible to attract more substantive staff who would previously only work via agency or bank routes, potentially enabling them to increase their working hours.
  3. Alternative roles: including Nursing Associates and Physicians’ Associates can support overstretched and understaffed medical and nursing teams – particularly in certain settings and specialties.
  4. Model and test alternative service models: to see the full system impact before ruling it out or implementing it with full confidence
  5. Digital opportunities: O/P digital consultations may not save significant time traditionally but may now eliminate social distancing productivity losses and DNAs.
  6. Load-levelling: Improved productivity through sharing waiting lists
  7. Planned care recovery groups: Risks stratification, reordering priorities and recommending alternative treatment including innovative practices etc. These are particularly effective when they involve Board level representation and can provide a leading example of effective, mature system-working at scale.

These are just a sample of the initiatives we can look to test and include in our workforce returns to help us to develop plans that we are confident we can keep pace with over the coming months.

If you would like to find out more about the work Attain is doing to support systems with their Phase 3 returns, or with workforce planning more generally, please contact Tom.Houston@Attain.co.uk

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