Briefing The NHS is changing and the NHS workforce is changing with it. The NHS is no longer experiencing either the workforce shortages of the 1980s and 90s, or the rapid growth in workforce numbers initiated through the NHS Plan. Many initiatives for improving healthcare such as providing more treatment in the community and the introduction of new roles for staff and new providers of services are having an impact on how staff work, particularly in acute hospitals. In future we will also see an increasing shift of activity from hospital to community care and this will all need to be reflected in the workforce. As we move away from a situation where the NHS had staff and skills shortages and towards a more healthy position of supply, there will inevitably be more competition for jobs across the NHS. In the context of very real financial pressures this year, NHS employers will want to continue to invest in recruitment and retention strategies that protect the longer-term and sustain their hard-won gains in the last few years. Having invested in training more staff, it is these newlyqualified staff who are most vulnerable in the current climate. NHS employers will want to preserve their investment in the future. This Briefing illustrates how this can be achieved without threatening the financial bottom line. Employers and staff need to be supported through these changes and helped to develop new opportunities for working in the community, contracts that are more flexible and training programmes that prepare people to work in a range of settings. It will be for local employers to use their resources efficiently and productively in managing these changes. We are aiming for workforce stability but in a provider environment that is changing to better meet patient needs, so it will take some time to get it right. Newly qualified healthcare professionals The cohorts of newly qualified healthcare professionals in 2006 face a very different labour market from recent years. There are significant geographical issues and in many areas prospects for new staff are not yet confirmed, but it is clear that posts will not be immediately available for all those completing courses in 2006. There has been substantial growth in the number of newly qualified healthcare professionals in the last few years: a direct A part of the NHS Confederation working on behalf of the NHS Employers
result of increased commissions for healthcare training places by the NHS. For example, the number of nurses entering training in 2004/05 has increased by 75 per cent on the 1996/97 figure. This increase has enabled employers to deliver increased capacity and access for patients and users of services. Indications are that future commissions for nursing and physiotherapy will reduce by approximately 10 per cent in the coming year as workforce targets have been achieved and finances are increasingly tight. Trusts in some areas such as Leeds, Manchester and many parts of London are likely to take on the majority of newly qualified healthcare professionals while others, such as parts of the Midlands, are offering a limited number of posts. NHS organisations are endeavouring to find opportunities for newly qualified nurses by ring-fencing posts and where sufficient substantive posts are not available, for example, are taking them on as part of the bank or in a flexible pool. Vacancies for newly qualified healthcare professionals continue to be posted on NHS Jobs. However, these healthcare professionals are likely to need to be flexible and potentially move to other areas where jobs are available. This may not be easy for many, especially those with caring commitments or young children in schools. Should staff be required to relocate to secure employment there is assistance available to make buying or renting a home more affordable. The schemes vary from help with rental costs to offering interest-free loans for home purchase. The NHS is no longer the sole employer for the newly qualified healthcare professional and opportunities will be increasingly available outside the NHS as the independent sector treatment centre programme expands. Employers and higher education institutes are working across local health communities to ensure that healthcare professionals can access roles in the primary and social care settings as well as emerging independent and voluntary sector providers. Case study Barnet and Chase Farm Hospitals NHS Trust As a result of an innovative approach to planning their nursing workforce needs, Barnet and Chase Farm Hospitals NHS Trust will be recruiting all 80 of their student nurses this year. The trust is in a position to offer all their newly qualified nurses a post through a combination of a rigorous policy of full recruitment into all nursing posts and a flexible approach to vacancies. This flexibility enables them to hold posts back where necessary, which in turn ensures full recruitment of students who have trained at the trust. The trust has audited the nursing skills mix and staffing levels on the wards and has been able to reduce the use of agency staff by implementing a policy of fully recruiting to all posts, including those which are used for cover when staff are on leave, and using the trust s own bank nurses. This has provided a better continuity of care for patients. A policy of encouraging staff to take annualised hours also means that they have flexibility to place staff where they are needed. For further information, please contact Juliet Beal, Director of Nursing, on 020 8375 1154 or juliet.beal@bcf.nhs.uk 2
Case study Ashford and St Peter s Hospital NHS Trust The board of Ashford and St Peter s Hospital Trust has committed to ensuring jobs will be available for all of the 22 newly qualified healthcare professionals who conducted their clinical placements within the trust over the last three years. This is being achieved by: identifying roles where there is a natural high turnover and recruiting newly qualified healthcare professionals now for when those jobs become available; cutting back on temporary staff to create new positions instead; and focusing on potential service gaps which will need filling, aside from whether there is a position at present. Whilst it is unlikely it will be increasing service position in the near future, it would consider other students from further afield if this changed. For further information, please contact Cathy Dennis at Ashford and St Peter s, on 01932 723 707 or cathy.dennis@asph.nhs.uk Newly qualified healthcare professionals are the ultimate talent pool for the employer, bringing up-to-date skills and knowledge. In their workforce plans, trusts can ensure that the increased investment in training places can be utilised to the best advantage of patients by using new healthcare professionals effectively. The starting point is a greater focus on service delivery, particularly understanding how new healthcare professionals can work. This means enabling newly qualified healthcare professionals to develop their skills and not placing unnecessary conditions on employment such as specifying periods or types of post-qualification experience. Case study Essex SHA Effective workforce planning allowing Essex SHA to collect evidence of its required workforce for the next five years shows that 45 per cent of the nursing workforce is expected to retire. As a result of this analysis a guaranteed employment scheme has been implemented for nurses completing pre-registration, which ensures that student nurses are guaranteed employment within the county on registration. The scheme is undertaken in partnership with all NHS trusts in Essex and student numbers are agreed on a site-by-site basis for each intake, in partnership with directors of nursing and directors of human resources. This enables students to be offered at least one position in the NHS, on registration, within their home site area or within Essex. The scheme has been very successful with 800 newly qualified nurses being employed across Essex each year. For further information, please contact Michelle Gallifent, Director of Education and Development, Essex Workforce Development Confederation, on 01245 397 677 or michelle.gallifent@essexwdc.nhs.uk 3
Considering talent pools and the sharing of good practice Every effort is needed to retain the talent and skills of the newly qualified healthcare professionals who have been trained in modern and up-to-date practices to respond to the needs of patients. Consideration for the long-term supply of a skilled workforce is paramount in order to avoid the severe workforce shortages experienced in the NHS in the past. NHS employers will want to review their use of fixed-term and temporary contracts. As the opportunity arises, trusts may want to consider offering these posts to newly qualified health professionals, preferably on a permanent basis. This has the dual advantage of reducing recruitment and turnover costs and harnessing the knowledge and skills of the newly qualified healthcare professionals. Primary Care The NHS will see an increased demand for staff in primary care, particularly as the initiatives outlined in the Our health, our care, our say white paper come to fruition. All registered healthcare professionals are deemed to be competent to practise in their field of expertise by their regulatory body, so it is not necessary for employers to require a further period of experience in the acute sector before employing newly qualified healthcare professionals in primary care. Some primary care employers are designing innovative and personalised supervisory arrangements to enable newly qualified healthcare professionals to work in the community directly. Good-quality clinical supervision and mentoring are key tools to give both employers and employees the confidence that the demands of the job will be met. In addition to being beneficial to the individual, mentoring can also work as a retention tool within the organisation. In September 2006 NHS Employers will be publishing Case study Bradford Teaching Hospitals NHS Foundation Trust Bradford Teaching Hospitals NHS Foundation Trust s Charter Mark award-winning physiotherapy department is one of the busiest in the north of England, treating over 36,000 new patients per year. The physiotherapy department provides hospital services and is also commissioned by the Bradford PCTs and other organisations to provide a range of services in community settings across the city. Service organisation and flexibility enable newly qualified physiotherapists to work on a rotational basis within paediatric and adult teams in all settings, including community and primary care, and the service has developed appropriate support, supervision and continuing professional development systems to ensure that core skills are consolidated and extended. The approach has been beneficial in increasing interest in community posts at more senior levels because of the experience gained within junior rotations. Contact Jill Gregson at jill.gregson@bradfordhospitals.nhs.uk 4
the outcome of current research into the efficacy of a variety of mentoring schemes across the country. Temporary staffing Some trusts are undertaking a review of their temporary staffing policies. This includes making particular use of newly qualified healthcare professionals through flexible pools internally, and redeploying staff when vacancies or opportunities arise. Some trusts have stopped using all agency staff through this route, whilst others have dramatically reduced their reliance on temporary staff through their in-house bank or NHS Professionals as they have secured employment for newly qualified healthcare professionals. This will be particularly beneficial at a time when the management of temporary staffing remains a major challenge for employers in ensuring value for money. Please see NHS Employers Briefing 17, June 2006, Managing the costs of temporary staffing, www.nhsemployers.org/ publications International recruitment and managed migration International healthcare professionals have been a very welcome source of supply over the last few years whilst the NHS has improved its investment in training. There will always be a Case study Christie Hospital NHS Trust Christie Hospital NHS Trust will be taking on newly qualified staff as bank staff this year as part of a temporary initiative to give newly qualified nurses the opportunity to find work locally until the workforce situation improves. Newly qualified nurses who are taken onto the nursing bank will join a programme which will provide them with training and mentoring. The newly qualified healthcare professionals will work alongside more experienced bank nurses to enable them to develop their skills to become effective members of the nursing bank. For further information, please contact Alison Norman, Director of Nursing, on 0161 446 3760 or Alison.Norman@christie-tr.nwest.nhs.uk global market within which healthcare staff can move but the role for international recruitment will be far less now that the NHS is moving towards greater self-sufficiency. With the growth in the numbers of newly qualified healthcare professionals, trusts are now able to secure the majority of new staff from within the UK. There will be little if any need for future international recruitment when we have a good supply of UK-trained professionals. Investment in local skills is more cost effective than international recruitment. NHS employers will be investing in newly qualified staff now so that they can become the sustainable workforce of the future. NHS Employers supported the recent move to remove nurses at Bands 5 and 6 of Agenda for Change from the Home Office s work permit shortage occupation list. This means that employers will need to test the resident labour market first before undertaking international recruitment. Accelerated development programmes Introducing accelerated development programmes has the potential to up-skill the current workforce into specialist 5
roles which are often difficult to fill. This has the advantage of reducing skills gaps, improving retention and freeing-up posts for newly qualified health professionals. NHS employers will be reviewing their skills gaps and investigating where they have vacancies that are difficult to fill. Developing staff to accelerate their movement into more skilled roles can result in vacancies being made available for newly qualified healthcare professionals, reducing the need for agency staff and reducing costs overall. For example, encouraging the up-skilling of junior physiotherapists could mean increased vacancies for newly qualified individuals as well as filling currently hard-to-fill senior physiotherapist roles. NHS Jobs www.jobs.nhs.uk NHS Jobs is the electronic recruitment service for the NHS. Over 80 per cent of the 575 registered organisations use NHS Jobs as their primary source for candidate attraction. Its popularity in the NHS is continuing to increase as trusts realise the benefits derived from using the service. A third of NHS Jobs users reported half yearly savings of 6.8 million, Case study Kent, Medway, Surrey and Sussex NHS organisations in Kent, Medway, Surrey and Sussex will be employing healthcare professionals through NHS Jobs. By working in partnership with their local universities and professional education groups, they are encouraging all newly qualified healthcare professionals to find the their first job in the South East using the NHS Jobs website. They have distributed A3 and A4 posters to market the availability on NHS Jobs of jobs in the locality. enabling savings to go back to the NHS frontline. NHS Jobs is now one of the UK s top five internet recruitment sites, attracting over 50,000 visitors every day. In response to feedback from users, NHS Jobs has developed facilities to set both pre-application and filtering questions for each vacancy to improve candidate quality. Pre-application questions enable trusts to set essential criteria questions, which only allow candidates who meet requirements to apply. All students should have the opportunity to apply for posts at Band 5 level. A new guide to using NHS Jobs, to help newly qualified healthcare professionals and final year students get the best from the service, will be sent to all employers and will be available through higher education institutions and on the NHS Jobs website later this summer. Agenda for Change job profiles Trusts need to ensure that appropriate use is made of the Agenda for Change pay system in order to ensure consistency. Posts need to be identified as applicable to a pay band. The use of terms such as pay band 5 junior and pay band 6 junior are no longer applicable. NHS Employers provides access to a range of Band 5 job descriptions and profiles at www.nhsemployers.org/ pay-conditions/payconditions-262.cfm, as well as ten top tips for change management at www.nhsemployers.org/ workforce/workforce- 1125.cfm 6
NHS Employers NHS Employers is the employers organisation for the NHS in England. Our aim is to help employers improve the working lives of staff who work in the NHS and, through them, to provide better care for patients. NHS Employers is part of the NHS Confederation but we have our own director, policy board and assembly. In striving to make the NHS an employer of excellence, we have four key roles: negotiating on behalf of employers representing employers supporting employers promoting the NHS as an employer. Contact us www.nhsemployers.org Email enquiries@nhsemployers.org NHS Employers 29 Bressenden Place London SW1E 5DD 2 Brewery Wharf Kendell Street Leeds LS10 1JR This Briefing is available in pdf format at www.nhsemployers.org/publications The NHS Confederation (Employers) Company Ltd Registered in England. Company limited by guarantee: number 5252407 Ref: EBRI02001