Primary Care Workforce

Transcription

1 Primary Care Wrkfrce Intrductin HENW s macr analysis f the 2014 secndary care prvider wrkfrce plans and lcally cllected wrkfrce data fr general practice frm acrss the Nrth West highlighted five key themed areas f pririty fr wrkfrce planning: nursing, medical, urgent and emergency care, primary care and radilgy. The purpse f this paper is t explre the issues arund the primary care wrkfrce in mre depth. It identifies in detail the key issues and areas f wrk that emerge frm a mre detailed regin-specific analysis, and sets ut ways frward and the implicatins fr HENW s wrk. Key Stry Messages The Primary Care Wrkfrce Transfrmatin Prgramme fcuses n fur areas: general practice, and ut f hspital pharmacy, ptmetry and dentistry. This chapter will highlight key successes in the 2014/15 wrk prgramme and identify next steps fr taking the prgramme frward. Significant prgress has been made in establishing cnnectins and netwrks with new stakehlders and rganisatins, creating intelligence, and develping HENW s primary care ffer. The General Practice Wrkfrce data cllectin was implemented with a 28% uptake t date acrss the Nrth West and is already highlighting significant issues cncerning the general practice wrkfrce that need t be addressed. Page 1 Based n the data received s far, additinal investment has been identified and allcated in 2014/15 t kick start the need t up-skill and develp the wrkfrce in general practice: Increasing the cash allcatin fr CPD as well as respnding t bespke CPD requirements, i.e. the Cre Fundatin Prgramme Ring-fencing f 30 Assistant and Advanced Practitiner cmmissins fr primary care in 2015/16 acrss the Nrth West, with an additinal 30 ringfenced fr cmmunity care and 30 fr urgent and emergency care Additinal cmmissins f 30 Cmmunity Specialist Practitiner prgrammes fr 2015/16 acrss the Nrth West Cmmissining 40 places fr new rles in the Nrth West, such as Physician Assciates GP trainee recruitment is underway with a target f 478 acrss the Nrth West.

2 A GP returner scheme is being funded with 13 GPs having returned t practice by January Cnnectins with Lcal Prfessinal Netwrks, particularly fr ptmetry and pharmacy, have been established and are being built n, with a view t defining their cntributin, establishing training gaps and meeting prvisin demands/requirements. Optmetry wrkfrce data cllectin pilt acrss Greater Manchester, led by ptmetry n behalf f NHS England Greater Manchester, yielded 65% return and indicated n immediate need fr cncern arund supply fr this wrkfrce. Strategic Cntext Over 90% f all patient cntact ccurs within primary care (Delitte 2012, p.4) with natinal plicy directing an emphasis n mving care clser t hme t imprve patient experiences and t reduce cst t the verall system. The NHS Five Year Frward View (2014) indicates that the fundatin f the NHS shuld remain list-based primary care, via a range f service mdels, with a strnger rle in preventin and cnditin management. This is demnstrated by Transfrming Primary Care which intrduced a named accuntable GP fr every patient aged 75 r ver and initiated the Practive Care Prgramme fr the mst vulnerable patients (Department f Health, 2014). As care shifts t the cmmunity and the demands n the wrkfrce acrss all sectrs f health and scial care changes, the develpment f the primary care wrkfrce is fundamental t supprt and enable new mdels f care. The HEE Strategic Framewrk s visin f the future wrkfrce suggests that new ways f wrking and new rles are required t create a wrkfrce which is respnsive t evlving change, fit t act flexibly acrss health ecnmies and nt bund by traditinal sectr lines. The HEE Mandate (DH, 2014) reflected the strng fcus required n the develpment f the primary care wrkfrce t supprt a whle system apprach t cmplex cnditin management and preventin. T supprt this, HEE is mandated t: ensure the wrkfrce will be trained and develped t enable them t wrk acrss different care settings and in multi-disciplinary teams ensure that 50% f medical trainees cmpleting fundatin level training enter GP training prgrammes by 2016 develp tariffs fr primary care medical educatin and training with stakehlders including the Department f Health develp the Care Certificate fr Health Care Assistants and Scial Care Supprt Wrkers. Page 2

3 The develpment f a wrkfrce planning framewrk fr primary care cntinues t be a key natinal pririty led thrugh the Wrkfrce Infrmatin Architecture prgramme 1, with a lcal prgramme being driven and aligned by HENW. Units f Analysis Intelligence has been gathered frm lcal wrkfrce data cllectins, natinal publicatins and research, and engagement with cmmissiners, prviders (including lcal cuncils) and educatin, as a system partner. Findings Analysis f the General Practice Wrkfrce data cllectin in 2014 cnfirmed anecdtal wrkfrce issues, such as an ageing wrkfrce and recruitment difficulties, and als indicated new intelligence, fr example the general practice wrkfrce prfile and clinical areas f risk. The natinal prfile f the general practice wrkfrce indicates that just ver 50% f the wrkfrce is admin and clerical staff (Figure 1), cmpared t 58% in the Nrth West. The percentage f the general practice wrkfrce that is defined as admin and clerical differs acrss the CCGs 2, hwever in all instances it was greater than the natinal prprtin. Anecdtally we knw that the admin and clerical wrkfrce, such as receptinists, prvide a supply int the clinical wrkfrce in general practice thrugh Phlebtmist and Healthcare Assistant rles. The greater prprtin f admin and clerical staff in the Nrth West prvides the ptential fr practices t grw yur wn clinical wrkfrce int these Direct Patient Care 3 rles thrugh Apprenticeship prgrammes, prviding a frmalised rute f develpment. The mix f clinical staff within general practices als varies cnsiderably acrss the Nrth West. While the natinal data indicates a 2:1 rati f GPs t Practice Nurses, the Nrth West data is clser t 1.6 GPs fr every 1 Practice Nurse. Acrss the CCGs, this rati varied between 0.7:1 and 2.7:1. Similarly, when cmparing the rati f GPs t Direct Patient Carers, while the natinal rati (3.5:1) is clse t the Nrth West rati (3.9:1), the variance at CCG level was large with the minimum rati 2:1 and the maximum rati 7:1. Figure Reprts were prduced fr CCGs with a set percentage return acrss the sub-regins. The fllwing CCGs received reprts: Knwsley, Liverpl, St Helens, Traffrd, Salfrd, Suth Manchester, Bury, Bltn, Heywd Middletn and Rchdale, Wigan, Eastern Cheshire, Blackpl, Fylde and Wyre, Lancashire Nrth, East Lancashire, West Lancashire, Greater Prestn and Chrley Suth Ribble. 3 Direct Patient Care rles include Phlebtmists, Healthcare Assistants and Assistant Practitiners Page 3

4 General Practice Team England: % FTE, GP* Practice Nurses Direct patient carers 51.4 Admin and clerical 12.5 Other 7.5 Data surce: Centre fr Wrkfrce Intelligence (2014) In-depth review f the general practitiner wrkfrce. P.29, Figure 7. * Des nt include retainers and registrars Figure 2 General Practice Team Nrth West: % FTE 1% 22% 58% 14% GP Nurse Direct Patient Care Admin & Clerical Other 6% Data surce: HENW General Practice Data Cllectin Data Extractin Date: 01/12/14 Page 4

5 The Health and Scial Care Infrmatin Centre (HSCIC) publish the GPs per 100,000 ppulatin in their annual General Practice Census data. This data was triangulated with Office fr Natinal Statistics (ONS) data and HENW lcal wrkfrce data cllectin. In the main the data crrelated, thugh there were sme differences caused by discrepancies between ONS ppulatin estimates and HSCIC ppulatin size. The HSCIC published data demnstrated that the Nrth West has a slightly higher prprtin f GPs per 100,000 ppulatin 4 than the natinal average (66.9 in the Nrth West cmpared t 66.5 acrss England), with the natinal utliers being the East Midlands with 62.5 GPs per 100,000 ppulatin and the Suth West with 76.1 GPs per 100,000 ppulatin. ONS data indicates a prjected 3.7% increase in ppulatin ver the next ten years in the Nrth West; hwever, there is a discrepancy between the ONS estimates and the HSCIC patient ppulatin data which indicates a larger ppulatin. The age and gender prfile f the general practice wrkfrce, as indicated by the HENW wrkfrce data cllectin, cnfirmed the natinal view that the wrkfrce is increasingly female and wrking part-time 5. Wrking patterns fr GPs acrss the CCGs differed: in sme areas the prprtin f GPs wrking part-time increased after the age f 50, whereas with thers it was under the age f 50. Hwever, the verall picture indicated a GP wrkfrce where female GPs tend t wrk part-time, with 56% f female GPs acrss the Nrth West wrking less than 0.8 fte, and male wrkfrce tend t wrk full-time, with 32% f male GPs acrss the Nrth West wrking less than 0.8 fte. With pending retirements and increased part-time wrking likely, with 21% f GPs in the Nrth West aged 55 r ver (HSCIC, 2013), this indicates a grwing pressure n the supply f GPs. Fr ther parts f the general practice wrkfrce (nursing, direct patient care and admin and clerical staff) the majrity f the wrkfrce were female (95%) and als a high prprtin f the wrkfrce were aged 50 r ver: 44% f nurses, 39% f Direct Patient Carers and 42% f admin and clerical staff were aged ver 50. There is n natinal data with which t triangulate this data, and with an average f 14% f null recrds fr year f birth fr these staff grups this data prvides an indicatin f ptential wrkfrce risks but des have sme caveats. Anther area that prvided valuable data that is nt currently cllected natinally was the cllectin f area f wrk fr nn-medical staff. Again, this was an area with data cmpletin issues, with nly 43.8% f secndary areas f wrk and 49% f tertiary areas f wrk cmpleted acrss the Nrth West. Hwever, it des prvide sme initial indicatins f ptential areas f clinical risk related t the nursing wrkfrce, particularly cncerning lngterm cnditin management where 37% f the nursing wrkfrce was recrded as having skills within this area, f which nearly 50% were aged 50 r ver. In additin, key areas that wuld indicate the invlvement f nurses wrking in expanded and leadership rles, such as management, minr illness and telephne triage, shwed lwer reprted invlvement (3.5%, 7.6% and 6.7% respectively). 4 Based n HSCIC data f GP headcunt (excluding registrars and retainers) and patient ppulatin f 7,460,272 as at 30 September Part-time is defined as wrking less than 0.8 full-time equivalent (fte). 1 fte is 37.5 hurs per week. Page 5

6 Data was cllected n leavers frm general practice acrss the 6 mnth perid prir t cllectin t prvide an indicatin f reasns fr leaving (Figure 3) and level f turnver in general practice. Over the perid 312 staff left their existing emplyment in general practice, with 17% f thse retiring. Figure 3 shws a significant number f staff leaving their emplyment fr better reward packages, prmtin, relcatin and wrk-life balance, indicating flux within the general practice wrkfrce. As data is cllected ver time, trend data will allw fr mre infrmative analysis. Similarly, the vacancy data will imprve ver time. 126 vacancies were recrded in the data cllectin during this perid f which 47% were fr admin and clerical staff. 46% f all vacancies did nt have an end date at time f reprting, indicating recruitment difficulties as vacancies remain pen. In Greater Manchester, the Optmetry Wrkfrce data cllectin key findings 6 demnstrated a wrkfrce with a bradly 50:50 gender split with 20% f the wrkfrce aged in the age grup. The balance between part-time and full-time wrking is evenly split, with 47% wrking full-time (0.8 fte r greater). In 2015, HENW are upgrading the general practice data cllectin t align with natinal requirements and investing in additinal functinality in WRaPT t develp wrkfrce cllectins fr Cmmunity Pharmacy and Optmetry. Figure 3 6 Based n data representing 65% f the ptmetry practices acrss Greater Manchester Page 6

7 General Practice Leavers Nrth West Whle Wrkfrce: 6 mnth perid, Headcunt Under 30 Null Data surce: HENW General Practice Data Cllectin Data Extractin Date: 01/12/14 * Redundancy: includes vluntary and cmpulsry * Vluntary early retirement: includes with and withut actuarial reductin Wrkfrce Develpment & Future Wrkfrce Slutins HENW are investing in the primary care wrkfrce t: ensure sufficient supply develp the existing wrkfrce supprt educatin in practice Sufficient Supply Health Educatin England HEE Wrkfrce Plan prpses an increase f 222 GP training places natinally, taking the ttal t 3,099. This is in additin t a range f initiatives prgressing the target f ensuring 50% f trainees cmpleting Fundatin level training chse t enter GP training prgrammes by Similarly fr nursing, HEE is cmmissining an additinal 500 pre-registratin places in 2014/15, taking the ttal natinally t 13,228 this being factred alngside the need t manage dwn attritin rates and deliver anticipated service transfrmatin plans. Page 7

8 In additin, a natinal 1m campaign t supprt Return t Nursing was launched in Octber 2014, prviding resurce t bth Returners as well as practices cmmitted t emplyment n cmpletin. Sufficient Supply Health Educatin Nrth West The Investment Plan identifies the supply figures being cmmissined each year and alngside an anticipated grwth f GP trainees by 28 in 2015/16, taking the ttal target recruitment figure t 478 acrss the Nrth West. There are currently c.1,200 GP trainees n prgramme acrss the Nrth West. Frm 2015/16, HENW will perate a single GP Schl and manage the allcatin f trainees acrss the Nrth West based n GP wrkfrce data in primary care, bringing increasing emphasis and imprtance t the accuracy and validity f data fr bth existing as well as leaving staff. Unlike GP psts, there is limited evidence f primary care recruiting nurses frm the newly qualified pl, but rather frm existing experienced staff in secndary care. The undergraduate prgramme is the same fr acute and primary care nurses, with the majrity f Practice Nurses registered n the Adult Nursing branch f the prfessinal register, but withut a specific Practice Nursing qualificatin. HENW intends t cmmissin 2,218 Adult Nursing places in 2015/16 and it is believed that initiatives t increase primary care expsure during training may prve helpful in increasing supply. The Cmmunity Specialist Practitiner prgramme fr practice nursing prvides further specialist training t develp field experts and leaders and despite the very lw uptake in recent years, HENW will be cmmissining (and marketing) an additinal 30 places fr the Nrth West in 2015/16. There is als lcal investment being made in return t practice fr bth GPs and nurses. The success f this year s lcally tailred GP Returner prject will result in 12 additinal GPs, facilitated by funding supprt t bth the returner and the training practice and this is likely t be repeated shuld demand be identified. Similarly fr nursing, funding t resurce c.160 returners has been included within the Investment Plan fr 2015/16, an increase f 25 n 2014/15 with scpe t increase shuld there be demand. This is in additin t thse subject t the natinal campaign. Wrkfrce Develpment Alngside additinal supply, there is a clear need frm the quantitative and qualitative analysis f the wrkfrce returns t recgnise the scpe t imprve the multidisciplinary functin f primary care thrugh a range f wrkfrce develpment and educatin supprt initiatives. These include: upskilling the existing wrkfrce imprving the skill mix reducing unnecessary administrative duties f clinical staff addressing the well-recgnised bstacles t recruitment and retentin f the primary care wrkfrce In view f this, and running cncurrently t the data capture exercise, the Wrkfrce Transfrmatin Team have been develping a range f immediate investment areas acrss the Nrth West, given the strength f anecdtal evidence. This includes: Page 8

9 The cmmissining f a Cre Fundatin Prgramme fr practice nursing, cmmencing September Acrss Lancashire, the prgramme is available lcally thrugh Cumbria and Central Lancashire Universities as well as there being ther HE prviders acrss the regin. The prgramme is accessible thrugh a variety f rutes e.g. afternn and evening tutrials, e- learning etc. t maximise flexibility f access and is available in bth accredited and nn-accredited frms. This new prgramme is aimed at reducing the variatin in skill set acrss the practice nursing wrkfrce and can als facilitate eligibility t enter the Cmmunity Specialist Practitiner fr practice nursing. The additinal cash allcatin f 800,000 acrss the Nrth West fr the cntinuing prfessinal develpment (CPD) f nn-medical clinical staff in 2014/15. CCGs have been encuraged t identify an accuntable lead fficer t ensure the apprpriate gvernance f funds, withut which the allcatin cannt be made. It can be used t resurce additinal existing CPD prvisin frm HE e.g. nn-medical prescribing, supprt access t new prgrammes such as the Cre Fundatin Prgramme fr Practice Nursing, r may be used t fund bespke educatin and training identified acrss the practice team e.g. behaviur change training, managing cnflict and supprting patients with special needs, etc. The cmmissining f Physician Assciate educatin prvisin in the Nrth West. Physician Assciates are relatively new rles natinally (althugh well develped in the US) and prvide an additinal slutin t bsting capacity and capability in primary care. Drawn frm existing science graduates (rather than health prfessinals), Physician Assciates are equipped t wrk alngside the GP, increasing patient access and thrughput f nn-cmplex cmplaints. The funding mdel supprting this new prgramme is yet t be determined and needs t be infrmed by primary care, in preparatin fr delivery in 2015/16. The cmmissining f 202 Assistant Practitiners and 136 Advanced Practitiners acrss the Nrth West, facilitating bth career develpment and imprved skill mix. Bth rles are well develped in acute care and are increasingly evidencing a central cntributin t service transfrmatin. Cmmissins fr 2015/16 are based n acute demand, but there are plans t facilitate a health ecnmy mdel shuld demand frm primary care and wider cmmunity based services be there. The develpment f a cnversin prgramme t equip thse currently wrking in acute services t wrk in primary and cmmunity based care. It is anticipated this will be available frm March 2015 thrugh a prtfli rute and will be a key enabler t enhancing the recruitment f experienced nnmedical clinical staff t primary care. The appintment f a dedicated pst t scpe the level f demand fr Apprenticeships in general practice and the mdel by which these wuld be supprted and delivered. HENW has achieved cnsiderable acclaim natinally fr its apprenticeship strategy, which has resulted in mre than 10,000 new apprentices acrss the Nrth West NHS in recent years. Page 9

10 Apprenticeships are available t bth new and existing staff acrss bth clinical and nn-clinical rles. The scping exercise is scheduled t reprt in March 2015, with an expectatin that primary care will be included in the delivery target f 3,400 in 2015/16. Opprtunities fr upskilling existing ptmetry and pharmacy wrkfrce t supprt the reductin f referrals int hspital and the shift f services int the cmmunity exist, partially due t the stability f the wrkfrce. Educatin Supprt Further investment is anticipated in a range f initiatives centred n supprting educatin in practice, infrmed by bth natinal and lcal develpments. Natinally, the pilt f the Care Certificate targeted at develping Healthcare Assistants is anticipated t prduce a tlkit fr system wide implementatin, the expectatin being that cmpletin f the standards will be a pre-requisite during an identified inductin perid in the future. Lcally, it is prpsed t spread the Cre Skills Framewrk 7 acrss primary care t help standardise and quality assure statutry and mandatry training bth reducing unnecessary duplicatin whilst als prviding assurance t practices in readiness fr CQC inspectin. A prject plan is in develpment fr implementatin acrss 2014/ /16. The Nrth West s unique Clinical Placement Develpment Netwrk is a multiprfessinal functin, tasked with ensuring sufficient, high quality clinical placements fr learners in clinical settings. Given bth the shrt and lnger term incentives t increase capacity in primary care, the Netwrk will be lking t wrk with practices n initiatives t enhance bth the number f students/trainees as well as the length f expsure t primary care in 2015/16. The qualitative narrative in sme returns suggests cnsideratin f cllabrative ventures with ther practices t enhance capacity and this may make an ideal mdel fr training the future wrkfrce. Prjects t develp and test bth simulated and peripatetic mdels f learning and assessment in primary care are als being explred and shw real prmise fr enhancing participatin f the wrkfrce in cmpetency based training, in a highly pressured wrking envirnment. This culd frm part f a slutin t the key challenges f insufficient time and resurce t train, mtivate and retain the wrkfrce. References Centre fr Wrkfrce Intelligence (2014) In-depth review f the general practitiner wrkfrce. Centre fr Wrkfrce Intelligence Delitte (2012). Primary care: Tday and tmrrw. Imprving general practice by wrking differently. Delitte LLP Department f Health (2014). A mandate frm the gvernment t Health Educatin England: April 2014 t March Department f Health 7 The Cre Skills Framewrk prvides a cnsistent and transferable apprach t standardise statutry and mandatry training acrss prviders in the Nrth West Page 10

11 Department f Health (2014) Transfrming Primary Care. Department f Health Health and Scial Care Infrmatin Centre (2013) ers%2fgeneral+practice+staff&srt=relevance&size=10&page=1#tp [Accessed ] Health Educatin England (2014) Strategic Framewrk 15. Health Educatin England NHS (2014) The NHS Five Year Frward View. NHS England Office fr Natinal Statistics [Accessed ] Page 11