Workforce in the NHS: addressing complex challenges
Workforce is finally in the spotlight – but for all the wrong reasons. As the complexity of England’s health and care needs continues to increase so do the workforce challenges facing our health and care system.
In a climate of growing financial constraints and pressure to meet nationally set targets, it is harder than ever for providers to ensure their workforce plans are realistically achievable within the financial parameters of commissioners. This means not only meeting the challenge of retaining existing staff but recruiting additional, substantive highly skilled staff – who may or may not exist – and providing training and development to keep up with advances and changes in ways of working, supporting community settings and using new technology.
A key principle that is finally becoming recognised more widely is that workforce planning and development are complex and integral components of service planning, requiring a unique expertise in workforce analytics, service design and leadership and organisational development that extends beyond the remit of traditional human resources teams working in isolation to plug a gap.
Cracks in the foundations of health systems
Primary care is often where cracks in services – linked to difficulties accessing clinical staff – first appear. In recent weeks we have seen communities in Horsham and Mid Sussex run out of patience with the longstanding difficulties in getting access to GPs. It is reported that there are 2,997 patients per GP – more than double the best area in the country – Rushcliffe in Nottinghamshire. This is not an isolated incident however, with Pulse reporting that, nationally, family doctors are seeing up to 60 patients a day – double the number they consider safe – as services struggle with staff shortages and a rising demand for care. As in other areas, issues with planning and funding processes over many years have brought us to tipping point.
What can be done in primary care?
Initiatives to tackle these issues include Communities of Practice which can bring together NHS and social care staff into integrated multidisciplinary teams who work closely with GPs, local hospital staff and others in the community to ensure patients with complex or long-term health conditions get the support they need and can proactively look after themselves. For example, the Paramedic Practitioners home visiting service works across a number of GP practices to provide urgent home visits to patients with frailty and has seen a positive impact on patient experience and clinical outcomes. These initiatives have recently been announced in West Sussex to reduced the traditional reliance on overstretched GP-led care where more workable alternatives exist.
Attain has supported Sustainability and Transformation Partnerships across the South, Midlands and North of England, including all five London STPs, to model and plan for how multidisciplinary teams and appropriate technology can help relieve these pressures in primary care.
How is it different in the acute sector?
In hospital services, recruitment and retention are often cited as the key challenge. These are in many cases linked to perceptions of how attractive the area is to work. While this can be a key factor, the root cause of the difficulties are often due to much wider regional and national staff shortages of key roles.
The issues facing Morecombe Bay NHS Trust (Furness General Hospital in Barrow, Lancaster Royal Infirmary and Westmorland General Hospital in Kendal) have long been publicised. In the last month, further recruitment challenges have come to light as has out of date training breaching safe staffing levels and delivery of high quality, safe patient care.
Trust chief executive Aaron Cummings said the most “relentless” problem was recruitment: “Nationally we’re just not in a position where we are selling the NHS well enough as a great place to work, to encourage people to train and develop and want to come into our services.”
There are also examples of staff shortages in individual specialties preventing not only that service but also other interdependent services, from functioning at all.
Challenges to recruiting and retaining radiographers in Gloucestershire’s community hospitals has recently resulted in a reduction of available appointment hours (cut by 75 hours per week last November across the nine smaller non-emergency hospitals) to cope with an “unsustainable” level of staff shortages. To address this in the short term, additional agency staff have been secured, and bank shifts have been offered to existing staff. However, it is evident that as the reported 1,100+ national shortage of consultant radiologists grows greater still, a wider collaborative approach with neighbouring providers in the region may be required.
Attain has recently supported the workforce planning for a £165m new specialist oncology hospital in Merseyside as well as extensive pathway and service reconfiguration across the South and Midlands regions.
How can we begin to address these complex and long-standing challenges?
Through the examples we outline above, two clear trade offs emerge in terms of where workforce interventions are required.
Timeframe and responsiveness
The first of these concerns the timeframe and responsiveness of the intervention. In some cases, short-term operational fixes are required and in other cases a longer-term strategic shift may be the only solution. In many cases, an approach combining each of these may be the best way to both address today’s operational pressures and also plan for a better future by looking at transformational improvements to groups of services.
Scale and geography
The second trade off concerns the scale and geographical footprint of the intervention. As we have seen in the examples above, some of the solutions will involve rapid single provider responses whereas others will require groups of providers to take collective action – perhaps even larger collaborative reponses across providers, commissioners, ‘Arms Length Bodies’ and regulators at a regional or national level.
The Attain workforce support packages have been developed with this is mind. They can be applied in a modular way to enable exactly the right balance of fire-fighting today’s pressures and setting long-term direction. Similarly, they have been designed to provide answers for single providers where this is needed and, in other cases, a series of system-wide responses to work across the entire healthcare landscape.
Clinical leadership and workforce modelling underpins each of the workforce solution offers. including:
- Rapid Service Recovery Programme
- Primary Care Capacity Building Programme
- Non-Clinical Functions Optimisation Programme
- Acute and System Service Reviews
Across England, Sustainability and Tranformation Partnerships’ (STPs) five year plans will be refreshed in the Autumn and for many this will of course present additional administrative pressures. There is, however, a significant opportunity here for all parts of the NHS to pull together cohesive plans across the system that address the short and long terms workforce challenges we all face.
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