Northamptonshire GP Forward View Programme

Primary Care Workforce Strategy

Northamptonshire GP Forward View Programme

Primary Care Workforce

Strategy

GPFV Workforce Working Group

10th November 2017

Version: 12

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Table of Contents Executive Summary ........................................................................................................................................................... 3

Forward - Clinical Executive Directors for Primary Care ................................................................................................... 5

Forward - LMC ................................................................................................................................................................... 6

1. Introduction .............................................................................................................................................................. 7

2. Primary Care Workforce Context and Drivers ............................................................................................................ 10

2.1 National Context ............................................................................................................................................. 10

2.2 Local context ................................................................................................................................................... 12

2.2.1 LMC Workforce Activities ............................................................................................................................... 12

2.2.2 HEE Activities.................................................................................................................................................. 13

2.2.3 Federation/CPEN Activities ............................................................................................................................ 14

2.2.4 CCG Activities ................................................................................................................................................. 15

2.2.5 Clinical Pharmacists in General Practice ........................................................................................................ 17

3. Vision for the Primary Care Workforce ...................................................................................................................... 17

3.2 Primary Care as a Learning Organisation ........................................................................................................ 18

3.2.1 Enabling workforce transformation ....................................................................................................... 18

3.2.2 Developing future supply ....................................................................................................................... 19

3.2.3 Upskilling the current workforce ........................................................................................................... 19

3.2.4 Developing new roles ............................................................................................................................. 20

3.2.5 Promoting New Ways of Working .......................................................................................................... 20

3.2.5.1 Primary Care Homes ............................................................................................................................... 20

3.2.5.2 Active Signposting ................................................................................................................................... 20

4. General Practice Workforce Data and Modelling ....................................................................................................... 20

4.1 Primary Care Workforce Demand and Supply ................................................................................................ 20

4.1.1 Midlands and East Workforce Baseline and Modelling ................................................................................. 22

4.1.2 Health Education England Simulation ............................................................................................................ 23

4.1.3 Whole Systems Partnership Strategic Workforce Planning Tool ................................................................... 24

4.1.3.1 Scenario 1 (Run 1) “Do Nothing Scenario” .............................................................................................. 25

4.1.3.2 Scenario 2 (Run 2) “International Recruitment, Better Retention” ........................................................ 25

5. Local Workforce Priorities and Initiatives ................................................................................................................... 26

5.1 Strategic Workforce Analysis and Planning .................................................................................................... 26

5.2 Attraction, Recruitment & Retention.............................................................................................................. 30

5.2.1 GPs ................................................................................................................................................................. 30

5.2.2 Practice Nursing ............................................................................................................................................. 31

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5.2.3 Clinical Pharmacists ........................................................................................................................................ 32

5.2.4 Mental Health Workers .................................................................................................................................. 33

5.2.5 Other .............................................................................................................................................................. 33

5.3 New Ways of Working ........................................................................................................................................... 34

5.3.1 The Primary Care Home (PCH) Model .................................................................................................... 34

5.3.2 Pathway Redesign .......................................................................................................................................... 37

5.4 Organisational Development ................................................................................................................................ 37

5.4.1 Practice Reception and Administration Staff ................................................................................................. 38

5.4.1.1 Care Navigation ....................................................................................................................................... 38

5.4.1.2 Clinical Administration Support .............................................................................................................. 38

5.4.2 Healthcare Assistants ..................................................................................................................................... 39

5.4.3 Nursing ........................................................................................................................................................... 39

5.4.4 Medical Assistants .......................................................................................................................................... 40

5.4.5 Physicians Assistants ...................................................................................................................................... 40

5. Primary Care Workforce Programme Governance ..................................................................................................... 40

6. Finance ........................................................................................................................................................................ 41

6.1 Implementation Costs ........................................................................................................................................... 41

6.2 Costs of additional staff needed in primary care .................................................................................................. 41

6.3 Organisational Development Costs ....................................................................................................................... 42

6. Workplan 17/18 and 18/19 ......................................................................................................................................... 43

Appendix 1 – Steering Group Terms of Reference ......................................................................................................... 44

Appendix 2 – Workforce Risk Register ............................................................................................................................ 49

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Executive Summary

The Northamptonshire GP Forward View Primary Care Workforce Strategy document describes current general

practice in the county, looks at the challenges ahead and provides a vision for the future. It recognises that status

quo is no longer an option. In the face of rising demand and finite budgets, the model of general practice must

change if the challenges of preventing ill health, easier access to healthcare and the rising demand of complex

technological healthcare are to be met.

The document is structured to describe national and local context for primary care workforce and the drivers and

challenges within which this strategy is set in sections 1 and 2 together with activities we have already undertaken

locally to address some of these.

Section 3 describes our local vision for the primary care workforce and in Section 4 we provide Primary Care

workforce supply and demand data in the context of both the local vision for primary care and a whole system view

of primary care workforce data in work done as an early part of the Northamptonshire STP. This section compares

specific workforce figures from both the Midlands and East modelling tool and the HEE tool. Discussion is also

provided from local simulation initiatives about how the GP recruitment gap might be filled through implementing

future strategy activities and examples are given.

Overarching workforce priorities across health and social care in Northamptonshire have been agreed through the

Local Workforce Action Board (LWAB) of the Sustainability and Transformation Partnership (STP). The strategy for

General Practice has been developed in partnership with stakeholders from the Primary Care Workforce

Development Group, a sub group of the LWAB, and aligns to the STP wide plan. This is reflected through the

common focus on four core pillars, which will address the challenges currently faced, whilst planning for those on

the horizon.

Section 5 describes the 4 key pillars of our local workforce strategy

Strategic workforce analysis and planning

Retention

New roles and new ways of working

Organisational Development

It describes current and future initiatives under each of these pillars and gives a description of how the future

workforce model for primary care will be better understood in the primary care home model of care by March 2018

with our local workforce explorer sites. Local approaches to improve retention and support staff training and

development are also described here. The governance for this programme of work is described in section 6 and the

financial implications together with investment we have already obtained as a direct result of creating this strategy

are described in section 7.

Finally in section 8 the workplan for the remainder of this year and the next 2 years in as far as it is currently

understood is provided. This is a working document and will be updated as the workforce explorer site findings

become clearer and the primary care workforce steering group matures.

Northamptonshire’s Primary Care Workforce Strategy recognises the need to support and develop primary care to

deliver a service that addresses its population needs and to ensure a primary care that is sustainable and fit for the

future. The strategy highlights that workforce development is a key enabler for primary care transformation, and

sets out how Northamptonshire’s CCGs and others will support and enable primary care providers to develop a

multi-disciplinary workforce, in the right numbers with the appropriate knowledge, skills and values, to provide high

quality primary care for the residents of the county.

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The strategy will underpin the national strategy of the delivery of primary care at scale through the development of

a seven day access model via primary care ‘hubs’ which may be physical or virtual depending on local needs. The

model sees nurse practitioners, clinical pharmacists and community paramedics working more closely with GP

practices, releasing more GP time to deliver care for complex patients.

The strategy is integral to local GP Forward View (GPFV) implementation highlighting the need to consolidate work

already underway around skills development for practice reception and administrative staff together with

developing local skills around quality improvement in implementation of the 10 high impact changes.

Joined up communication between different healthcare providers and the wider social care system is of critical

importance to an integrated healthcare model. Significant work is being undertaken locally alongside the

development of workforce strategy to develop a truly integrated clinical IT system which facilitates the use of

essential clinical information between organisations, reduces inefficiencies and duplication and maximises the time

spent by clinicians with their patients. Systems development will need to be coupled with business process redesign

and associated skills development and training needs for staff.

The GP Forward View strategy seeks to understand local primary care estates both in terms of their fitness for

purpose and current utilisation. The aim is to develop and deliver a physical environment that matches the service

aspirations of the future and this in turn will support recruitment and retention of staff in primary care. It will build

on the work previously commissioned regarding primary care estates over many years.

General practice in Northamptonshire and nationally is at a cross-roads. There are significant challenges but also

opportunities associated with additional funding and support available through the GP Forward View programme.

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Forward - Clinical Executive Directors for Primary Care As local GPs and clinical commissioners we are privileged to see first-hand the dedication and excellent patient care

provided by our primary care workforce in the face of increasing demand and complexity. With changes in patient

demographics, complexity of medical care and an ageing population that requires more intensive health care to keep

them well, unfortunately it appears that traditional model of general practice is nearing a stage when it will no

longer be able to provide the gold standard of care that it is renowned for worldwide.

In Northants we appreciate the strain on workforce and the need to change the model by which primary care

operates. The need to move to a more sustainable multidisciplinary team approach is essential to not only allow

delivery of reactive care but also preventative medicine to ensure patient wellbeing is maintained. The strain on the

workforce is also added to by the reduction nationally in healthcare professionals taking up the traditional primary

care careers of general practitioners and practice nurses. In addition to this due to the intensity of workload more of

the workforce is retiring early.

All of the above mean that we feel it is essential to not only protect and develop our workforce, but also to continue

providing the best care to our patients we need to look at innovative ways to recruit, retain, train and support a

changing primary care workforce for Northants. Part of the challenge is ensuring that as a healthcare system we

look at the issues in primary care from the smallest GP practice to primary care at scale and utilise lessons from all.

In addition our workforce challenge requires not only appreciating new models of primary care delivery but also

changing career pathways, technology and training.

At present the picture of the primary care work force is comparable to a new jigsaw and as commissioners we need

to ensure we help to find and mould the right pieces to complete the perfect picture, which is a sustainable primary

care system.

Dr Sanjay Gadhia Dr Naomi Caldwell GP Governing Body Member and Primary Care Lead Clinical Executive Director Localities & Primary Care

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Forward - LMC The LMC believes that the best shaped GP Forward View which will improve patient care and access, and invest in

new ways of proving primary care must be led, driven and implemented by the very workforce delivering the service,

the general practice team together with the patient participation forums and the wider multi-skilled workforce in

primary care. No other service works so long, closely and personally with patients as primary care day-to-day from

the cradle to the grave.

The LMC role is to advise and assist GPs and their practices. We represent the GP workforce at both a local and

national level in all aspects of their career from trainee to locum. We are passionate about strengthening the role of

general practice plans in the future of the National Health Service.

Dr Jonathan Ireland Sharon Firmin Chair Northants LMC Chief Executive Northants LMC

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1. Introduction General practice is the foundation of the NHS, over 90% of patient consultations within the NHS happen in general

practice.

National and local strategies are driving more care out of hospital. This means that primary care will need to

collaborate with partners to develop new models of care as part of an integrated health and social care system.

However, the demands on general practice are increasing, particularly for people with multiple, complex problems.

Workload projections suggest that older people with long term conditions, including people with frailty, will be the

major source of increasing work for primary care in coming years. In addition to this, patients and the public have

rising expectations in relation to access and treatment. The situation is amplified by chronic shortfalls in the general

practice workforce, specifically in terms of numbers of general practitioners (GPs) and nurses working in primary

care (Advanced nurse practitioners, practice nurses and health care assistants).

The GP Forward View describes how primary care roles will need to change in order to meet this demand. It states that GPs must feel confident in the vision and how it will feel to be a GP in the future. A significant proportion of demand will need to be managed through helping patients to stay well by taking care of themselves better, and be navigated to other team members, or alternate services. The GPs’ core role will be as first contact care for people with undifferentiated problems who will benefit from continuity of care and to act as leaders within larger multi-disciplinary teams linking to hospital, community and social care specialists. The GPFV also describes how primary care professionals will increasingly work at different organisational levels and at scale (their own practice, a neighbourhood of practices and across the local health economy) opening up opportunities in pathway design, service leadership, education, training and research, or developing areas of specialist clinical interest supported by colleagues from secondary care. These changes should develop a more unified team approach, creating portfolio opportunities to offer more satisfying and rewarding career choices in primary care. The GP Forward View cannot be delivered without recruitment and workforce expansion. Therefore this document outlines the local approach to achieving the national targets to expand the workforce and implement national staff development programmes.

Small changes in general practice capacity have a big impact on demand for hospital care, so the need to support

general practice in underpinning the whole NHS has never been greater.

Health inequalities associated with deprivation and problems such as isolation and loneliness, with mental health

feature in one in every four consultations. Prevention and self-care are therefore key to the CCGs operational plan in

relation to major areas of health impact. Life expectancy is 8.8 years lower for men and 7.0 years lower for women

in the most deprived areas of Northamptonshire than in the least deprived areas.

NHS Corby CCG and NHS Nene CCG are a part of the leadership model for the Northamptonshire STP. NHS Corby

CCG has had fully delegated responsibility for general practice contracts since April 2016. NHS Nene CCG have

chosen to remain in joint commissioning arrangements with NHSE for the time being.

The Northamptonshire STP outlines a number of challenges for the local health and care system. Across

Northamptonshire there are ranging levels of deprivation, socio-economic, geographical and political drivers that

exist in our localities:

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Fig 1: Northamptonshire STP baseline population challenges

The STP recognises that workforce is a key enabler to supporting implementation and through the Local Workforce

Action Board (LWAB) over £220,000 is being invested locally in 17/18 to drive transformation. This investment has

been aligned to four key areas:

Fig 2: Northamptonshire Local Workforce Action Board 17/18 Investment Priorities

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Local data has established that Nene practices last year provided an average of approximately 130 clinical contacts

per 1000 population per month (range 93-254; practice self-reported all clinical contacts as part of the local Quality

Contract, excludes HCA appointments).

For Corby practices it is estimated that 115 GP appointments are needed per month, per 1,000 populations.

Nene and Corby practices experience wide variations in practice population, associated deprivation and other

demographics. This, in part, drives variation in outcomes for patients. Information on quality indicators at practice

level is collated within a quality dashboard that illustrates variation and highlights priority practices who then receive

targeted support to deliver high quality care.

Since 1981 the total population of Northamptonshire has increased by almost 33% (in excess of double the increase

for England), growing from around 530,000 residents to just over 750,000 today. Whilst this has seen growth in all

segments of the population, it has also witnessed a shift toward a more ‘top heavy’ population (residents aged 65+)

with relatively slow growth amongst those aged 0 to 15 years since 1992 and a plateauing of 16 to 64 year olds after

2008.

Local modelling suggests that population growth and an increase in complexity of care will lead to a large increase in

demand by 2021. Nationally A 2.8% annual growth in GP contacts is anticipated which could mean 578,830 new GP

Contacts needing 150 new GP’s by 2021 (according to RCGP) if the system does not change now.

Nene and Corby CCGs have 71 practices and there are 4 emerging “at scale” primary care providers, 3 GP federations

and 1 superpractice.

The benefits of federation (either formally or informally) with other practices is increasingly acknowledged locally

and nationally. Federation enables practices to share resources and to focus more on the delivery of a high quality

service, extend opening hours and to co-operate in developing a local general practice workforce through shared

investment and shared use of existing training capacity. This document describes how this is starting to happen in

Northamptonshire and what’s needed in terms of workforce development to underpin it.

Fig 3: Northamptonshire Geography

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Federation / Superpractice Population No of practices

GPA 253147 26

Lakeside Superpractice 69781 3

PML DoCMed 165490 15

3Sixty 265275 27

Total 753693 71

Table 1: Federation and super practice list sizes

2. Primary Care Workforce Context and Drivers

2.1 National Context

Building on the Five Year Forward View, the General Practice Forward View, published by NHS England in 2016, sets

out a plan to stabilise and transform general practice through additional investment and support in relation to

workload, workforce, infrastructure and care redesign.

The Five Year Forward View emphasises that primary care will remain the foundation for the NHS, but recognises

that a ‘new deal’ is needed to expand and strengthen general practice. The strategy also sets out the need to reduce

the divide between primary care, community services and hospitals in order to integrate services around the person

and highlights how primary care is a key element within new models of care. The Forward View acknowledges the

need for a suitably skilled workforce to deliver these new models of care. It highlights that whilst there has been a

growth in the overall healthcare workforce since 2000, this growth hasn’t been equitable across all parts of the

system. The ‘new deal’ for general practice includes a commitment to expand as fast as possible the number of GPs

in training while training more practice nurses and other primary care staff.

The document sets out how NHS England, in partnership with Health Education England (HEE), Royal Colleges and

other stakeholders, will grow the GP workforce whilst accelerating use of the wider, multi-disciplinary workforce. It

sets out a bold ambition to create an extra 5,000 doctors in general practice and a further 5,000 non-medical staff

over the next 5 years.

In relation to the GP workforce, the Forward View describes plans to increase recruitment and retention of GPs by:

Increasing training capacity

Promoting general practice as a career choice

Offering flexibility of career paths

Supporting post CCT (Certificates of Completion of Training) fellowships

Developing a new portfolio route for GPs with previous UK experience

Addressing workload concerns to support GPs to stay in practice

Investing in leadership development, coaching and mentoring skills

Offering targeted financial incentives to GPs to work in areas of greatest need

The plan recognises that the success of general practice in the future will also rely on the expansion of the wider

non-medical workforce, including investment in nurses, pharmacists, practice managers and administrative staff and

the introduction of new roles, such as physician associates and medical assistants. The plan describes how NHS

England and HEE will:

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Invest in general practice nurse development, including support for return to work schemes, improving

training capacity in general practice and increasing the number of pre-registration nurse placements

Extend the clinical pharmacist programme to enable every practice to access a clinical pharmacist

Invest in additional mental health therapists to work in primary care

Provide funding to support reception and clerical staff to play a greater role in care navigation

Invest in practice manager development.

The role of Health Education England (HEE) is to provide system wide leadership and oversight of workforce

planning, education, and training. The overarching aim of HEE is to support the delivery of excellent healthcare and

health improvement to the patients and public of England by ensuring that the workforce of today and tomorrow

has the right numbers, skills, values and behaviours, at the right time and in the right place.

Each year, HEE publishes a workforce plan to set out its investment in education and training across the system. The

2016/17 plan ‘Investing in People’ sets out three key challenges for the healthcare workforce in England:

Future workforce supply

Service and workforce transformation - designing sustainable services and the teams that deliver them to

deliver on the aims set out in the Five Year Forward view

Current workforce capacity and supply - establishing the mix and numbers of funded workforce posts

capable of delivering the volume of services to standards required

The Workforce Plan for 16/17 recognises that investment into the primary care workforce is essential to ensure that

primary care remains as the foundation for the NHS. It sets out a vision to ‘ensure that we will provide challenging

and fulfilling careers as part of a modern, innovative primary care system’. HEE’s workforce plan defines the

additional investment into GP training to support the GP ten point action plan, published by NHS England in 2015,

which aims to:

Increase recruitment into general practice

Retain more doctors within general practice, and

Support more doctors to return to general practice

In addition to investment into GP training, HEE acknowledges that a wider, multi-professional workforce is required

in primary care. The Workforce Plan highlights that new clinical roles such as Physicians Associates, Clinical

Pharmacists and Paramedics and the creation of the new administrative support roles will ensure an integrated,

diverse workforce for the emerging service models.

HEE (East Midlands) has developed a number of initiatives and funded activities to support primary care providers to

transform their workforce to support service transformation. This includes, but is not limited to:

Leadership and guidance for the training of GPs.

Recruitment, programme planning, educational planning/monitoring and provision, and assessments

including panel decision and appeals.

Recommending trainer appointments to the GMC

Re-approval and problems in placements in primary and secondary care.

GP locality programmes

Advice on primary care issues for all teams

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Support for development of educational strategy.

GPNorthants Recruitment Website

Learning beyond registration

Northamptonshire CCGs have supported the implementation of a number of these initiatives across

Northamptonshire practices and are described in later sections of this strategy.

2.2 Local context

The STP details the strategic approach to improving the health outcomes of the residents of the county, while also

moving towards financial and clinical sustainability of health and social care services. It is the blueprint for the

health and social care system in Northamptonshire for the next 5 years.

One of the limiting factors for achieving the key objectives within the plan is the availability of a suitably skilled

workforce. The development of seven day services, transforming primary care at scale and pace and the integration

of health and social care are likely to need new roles as well as a regular supply of existing roles.

All health and social care partners across Northamptonshire, along with wider public sector organisations have been

engaged in the development of this primary care workforce strategy to support STP delivery. This document

represents progress to date for the strategy and whilst it is a working document that will develop over time the key

strands of the plan will remain:

Strategic workforce analysis and planning

Retention

New roles and new ways of working

Organisational development

Early thinking around the workforce transformation priorities to enable delivery of the locality plan focuses on:

An expansion of the workforce delivering primary medical services

Increased numbers of staff delivering care in a community setting

Staff with a broader range of skills that span health and social care

Exploring opportunities for integrated training and education

Exploring opportunities for staff to gain skills in working across all areas of care delivery (hospital,

community and primary care)

Exploring opportunities for the creation of new roles that will reduce duplication and improve the

experience of people using health and social care services

To oversee ongoing development of the primary care workforce plan and to drive delivery of its ambition, a primary

care workforce transformation group has been established (see section 5).

There are a range of different local stakeholder bodies that already actively support workforce development and

transformation and the sections below describe these bodies and summarise their work to date.

2.2.1 LMC Workforce Activities

The Northamptonshire LMC are fully engaged members of the Primary Care Workforce Steering Group and actively

support practices with recruitment of GPs and other practice staff, advertising vacancies and working with practices

to improve recruitment procedure.

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Health Education England (HEE) provided local funding for the LMC to develop the GPNorthants website and

supporting material to promote Northamptonshire as a place to live and work. This links to and works alongside a

national promotional campaign for Northamptonshire the ‘Best of Both Worlds’ which is hosted by the NHS Trusts in

the County.

The LMC website was developed to cover all aspects of recruitment in Northamptonshire general practice from year

9 students to medical students in universities. It also has a large section for practice vacancies in the county. To date

we have received 118 email enquiries direct to the LMC office. Unfortunately we do not know how many have gone

direct to practices advertising on the site. Locally practices are making us aware when they have successfully

recruited through the site.

The LMC also have local GP and Practice Nurse Ambassadors who visit local schools and other careers events to

promote healthcare careers in the county and in particular in general practice. We have developed a number of

videos for year 9 and A levels to help students to choose the right course. There is also a video to for medical

students applying to university explaining what the requirements are and preparation for their interviews.

The LMC worked closely with the CPENs to develop a work experience form for students to complete on the website

www.northantsgp.co.uk. This has already generated over 34 work experience requests and has been able to place

10 students. This form enables parents and teachers to support students wanting work experience in general

practice. The CPENs and LMC will then try to place these students in suitable positions, whether they wish to

become doctors, nurses or administrative staff.

General practice through the LMC has worked closely with Northampton General Hospital, Kettering General

Hospital and Northamptonshire Healthcare Trust to develop material for schools to promote the apprenticeship

route into nursing, Healthcare assistants and administrative roles. We have been fortunate to place a number of

apprentices in general practice and the LMC office. We strongly believe in growing our own.

The LMC has set up a mentoring scheme for GP, nurses and practice managers. 6 doctors, 2 nurses and 2 practices

managers have been trained as mentors. The LMC developed a leaflet to launch the programme to all practices in

the county and so far two doctors have gone through mentorship. Colleagues can apply for the scheme through the

LMC office who will put them in touch with an assessor. The assessor will decide the best route for the mentee to

take and arrange for them to undergo the mentorship scheme if they feel it is appropriate. 4 sessions are free to the

mentee and the LMC reimburses the mentor.

The LMC encourages all GPs thinking of retiring to go through the mentorship scheme or to remain on the

Performers List for at least one year after retirement. If they wish to undertake locum work then the LMC will try

and arrange this for them thus avoiding costly agency fees.

The LMC has purchased leadership training from East Midlands Leadership Academy which is available for all

practices.

The LMC has funded a number of Healthcare Assistant certificate training for practices across the county and

continues to do so. This has been a very successful scheme for workforce in general practice. We have expanded

this to cover a few pilots for mental health navigators and CBT Therapists and await the evaluation of these projects.

2.2.2 HEE Activities

HEE are also fully engaged in the Northants Primary Care Workforce Steering Group supporting funding proposals

that have arisen as a direct result of this evolving strategy documentation.

The HEE Training Hub (CEPN) Initiative is designed to increase placements for a range of roles in general practice,

from year 10 work experience pupils through to medical students, to assist with developing innovative workforce

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solutions to the challenges faced by primary care. The programme has been devised to showcase general practice as

a career choice and improve attraction, recruitment and retention of the wider general practice team. Within the

County we also have two Training Hubs which are working in partnership with HEE on this programme.

Newly qualified GPs are more cautious about taking on a full equity partnership practice role. The HEE-EM fellowship

programme has allowed some of them to start in practice as a part time salaried doctor while pursuing a “project”

which supports the local health economy. These fellowships provide the opportunity for developing a portfolio

career, but also the time and space required to develop the primary care workforce to manage the transfer of

services from secondary to primary care.

HEE provide a Learning Beyond Registration programme to support the development of nursing professionals post

registration. Fig 10 demonstrates usage for primary care and PVI sector between 2016-present. Advanced practice

programmes were the most commonly undertaken overall ranging from diagnostics, minor illness and examinations,

a trend that was true for 2016-17. However in 2017/18 there has been an increase in requests for non-medical

prescribing (NMP) locally with 41% of all LBR allocated this year in Northamptonshire on NMP programmes.

Fig 3 Learning Beyond Registration – Use by Primary Care

2.2.3 Federation/CPEN Activities

Northamptonshire has 3 federations and a superpractice. All are invited to take part in the primary care workforce

steering group. These “at scale” primary care organisations are currently reviewing how they collectively engage

with the STP and it’s associated activities to ensure maximum primary care input across the whole.

The 3Sixty Care Partnership covering the north of the county and hosting one of the CPEN training hubs, currently

works with Northamptonshire Healthcare Foundation Trust (NHFT) to provide nursing placements within primary

care for a set period within the twelve week placement duration. In 2016/17 the training hub hosted 25 nursing

placements across a cluster of 12 practices, with plans to expand on this and offer more placements in 2017/18 and

beyond. The approach adopted was employed to introduce the nursing students to the GP settings initially on

shorter placements as part of a rotation within community, however the longer term plan will be to develop

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mentorship capacity and confidence across the practices and increase the duration and number of placements being

hosted.

The 3Sixty training hub will also be hosting medical placements in partnership with Leicester Medical School starting

with nine medical students joining practices across the federation from January 2018.

The 3Sixty Care Partnership has also successfully secured 3 places on the General Practice Improvement Leaders

Programme Cohort 7 which commenced in September 2017. The programme is for those working in and with

general practice including, GPs, practice managers, nurses, project managers and facilitators, working directly with

general practice to support the GP Forward View.

The modular programme consists of six days in total, completed over three to four months. Each module builds

personal learning and the ability to help others use quality improvement techniques.

The PML DoCMeD federation covering the South of the county hosts the other CPEN training hub. As a training hub

they have adopted an alternative approach to placing student nurses. Ten of the 16 practices within the federation

have nurse mentors and take placements, occasionally of up two or three students at one time. The placements are

hosted within General Practice for the full duration of the 11 week placement, giving the student nurses a longer

duration within the general practice setting to develop their skills.

Both approaches have successfully increased student nurse exposure to general practice within the county, and the

training hubs will work closely together over the coming months to establish how nursing confidence and capacity

can be further developed in general practice in line with the NMC education reforms, to ensure they are equipped to

support more student nurses going forward.

GPA are the federation covering the Northampton town and surrounding area. They take pre-registration

Occupational Therapist students on placement within their collaborative care team model, broadening the exposure

the students have of working within multi-disciplinary teams in General Practice.

As a medical training academy, GPA will be increasing the number of medical placements offered in 2018, and

currently offer end of placement teaching sessions on the business management element of general practice to

promote the unique opportunities provided through a career in general practice.

2.2.4 CCG Activities

Nene and Corby CCGs have led on drafting this workforce plan and will continue to inform the development of this

through engagement with CCG membership and all the local STP delivery partners. The CCGs recognise that the

development of primary care workforce must be considered in the context of the wider workforce plan to enable

integrated working across organisations and sectors to ensure a sustainable workforce, fit for the future.

The CCGs have been working with member practices, through the New Care Models Development Group, to develop

a ‘blueprint’ of how general practice might work more collaboratively to deliver primary care at scale and pace

within the integrated care system. A federated, collaborative general practice model would enable many

opportunities for education, training and workforce development. These include:

Countywide coverage through at scale education hubs

Learning and development programmes for all general practice staff

Stronger links with education partners, including HEE and universities

Improved recruitment and retention of the workforce, specifically for GPs and practice nurses

Broadening the skill mix within primary care through workforce innovation and the establishment of new

roles

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The CCGs both work with local universities to create opportunities for completion of training certificate (CCT)

fellowships in parts of the county where GP recruitment is hardest.

In March 2015 the return to practice scheme was re-launched, providing an opportunity for GPs who have previously

been on the GMC Register and on the NHS England National Performers List (NPL), to safely return to General

Practice after a career break, raising a family or time spent working abroad - The CCGs have embraced this scheme,

however our county still faces challenges when recruiting GPs.

Since July 2017 reception and clerical staff have been given training and access to information about local services, in

order to help them direct patients to the most appropriate source of help or advice. This includes services in the

community such as Improving Access to Psychological Therapies (IAPT) and First for Wellbeing as well as teams

embedded within the practice. As of the 1 November 2017 517 members of staff from 59 practices (83%) had

received both online and face to face training. The remaining 12 practices will have completed their training by 31

Nov 2017, all will be actively care navigating by December 2017.

Eight practices from the county have applied for and been successful in being awarded financial support as part of

the GP Resilience Scheme. Some of these schemes have involved recruiting to and testing out new ways of working

in practices (in particular thorough the practice nursing workforce) and this learning has been considered as part of

development of this strategy.

There is no single solution or project around primary care workforce. Some practices in areas where recruitment is

relatively easy and retirement rates are lower may choose to configure their workforce to historical norms. Our

modelling suggests that most practices who find themselves under increased workload stress will need to evolve

their workforce skill mix through necessity. There are a small number of practices who are closer to an extreme

situation demanding more radical workforce transformation, redesign of primary care pathways and more urgent

wrap around support from community services. Our strategy focuses on how we support practices in both

circumstances to move to a more sustainable workforce model underpinning the move through access to national

and local schemes

One of the key recommendations of the General Practice Forward View was the development of a framework to

help and support practices to identify and implement quality improvements. The Productive General Practice (PGP)

programme, developed by the NHS Institute for Innovation and Improvement, provides a systematic approach to

support practices in their drive to improve productivity, by creating improvement capability. The programme enables

the whole practice team to review their current working practices, identify where improvements could be made and

agree a plan for improvement. The CCGs worked with NHSE to obtain places for local practices to complete the PGP,

8 practices completed the course in 16/17 and a further 16 are currently engaged in the programme. The

programme will provide practices with information relating to how they are currently utilising their workforce and

will support these practices to consider how new ways of working may lead to improvement and increased

productivity. We aim to align the PGP programme locally with the approach being developed to identify future

staffing models, as described in an earlier section and early links have been established across the two programmes

of work.

Nene and Corby CCGs have successfully developed protected learning time for general practice over the last 15 years

that is led by a dedicated GP with an educational and development focus. The programme provides eleven

afternoons a year when practices can close for training. The schedule is currently organised into:

3 county-wide, centrally-organised events for doctors and practice nursing staff. Each of these comprises two

programmes which run side by side – one aimed primarily at doctors, the other at practice nursing staff.

17

National speakers who are leaders in their field are booked and 350-400 doctors and nurses from Nene and

Corby CCGs attend each event

3 locality based, centrally-organised events for doctors, i.e. three localities and Corby, three times a year. These

are events for all clinical personnel in Corby to come together to have learning on up to date best practice,

national guidance, local services and changes and also discuss common issues and learning from each other.

5 afternoons a year for in-house PLTs to allow practice managers to organise mandatory and other training for

their staff

NHS Nene and Corby CCGs have continued their predecessor organisations investment into supporting and

facilitating PLT. Venue and catering costs of PLT events are largely funded by sponsorship from the pharmaceutical

industry within our conflicts of interest and ABPI guidelines. The programme format has evolved continually to

respond to the CCGs changing clinical priorities and the healthcare needs of the local population.

Anecdotal evidence from schemes implemented through the GPFV programme indicates that GPs on the point of

retirement are being retained in the workforce.

2.2.5 Clinical Pharmacists in General Practice

In 2016 seven clinical pharmacists undertook an accelerated development programme with 3Sixty Care Partnership

to prove the clinical pharmacists in general practice concept locally and pump prime the national agenda in

Northamptonshire. During the second wave of NHS England Clinical Pharmacy funding, all GP Federations were

supported by the CCG and have now successfully secured funding from the national scheme. Recruitment has

commenced. Our wave 1 scheme has been evaluated and the lessons from wave 1 have enabled us to plan for the

wave 2 pharmacists coming into post and obtain additional funding from HEE to support embedding them into

practices.

A unique pilot project supported by HEE is currently underway in the north of the county with Kettering General

Hospital and practices within both the Lakeside superpractice and 3Sixty Care Partnership. This pilot will explore the

viability of a shared role for clinical pharmacists across acute and primary care, enhancing their patient facing

experience and also the relationships between the hospital medicines team and practices. This is due to be launched

within 2017; again evaluation will be fed back into the Primary Care Workforce Group.

3. Vision for the Primary Care Workforce

Our STP describes an approach to care that means providing the right care for people without going to hospital if

that isn’t necessary – and also ensuring that our hospitals can provide consistently high-quality specialist services

when they are needed.

Critically this kind of out of hospital care will be dependent on integrating GP practices with community services and

other providers (in particular the voluntary sector through social prescribing). This vision can only be delivered once

a core primary care offer that is robust, sustainable and provides consistent high quality general practice services is

secured.

The vision will be achieved by both working with federations and individual practices and encouraging practices to

work at scale and in partnership with others to provide comprehensive, population based out of hospital care. The

plan recognises that the workforce required to work within the transformed system will need to be supported to

develop new skills and new ways of working and that this will impact on education programmes and workforce

development activities.

18

In Northamptonshire we recognise there are a number of challenges facing primary care and the primary care

workforce not just the recruitment and retention of GPs.

In 2015, Health Education England (HEE) commissioned an independent review of the primary care workforce. The

Primary Care Workforce Commission was asked to identify workforce solutions that would meet present and future

needs of the NHS primary care workforce. Through the submission of evidence, site visits and conversations with

local and national organisations, the commission found that many areas had created new and innovative ways of

working and recommended that these examples of good practice be rolled out more widely. The report ‘The future

of primary care – creating teams for tomorrow’ includes three key recommendations:

1. A multi-disciplinary workforce. The report sets out how new clinical and support roles can enhance the skill mix

in primary care. It specifically highlights the contribution that clinical pharmacists, physician associates,

physiotherapists, paramedics and medical assistants can make to patient care within general practice.

2. Better use of technology. With advances in technology, the report emphasises that education and training will

need to reflect the different skillsets required for alternative forms of consultation.

3. Organisational changes to the NHS primary care system. The commission recommended that networks or

federations of practices will enable primary care to offer a wider range of services, as well as better

opportunities for staff development and training and the creation of new roles. It also highlighted that the

primary care workforce has historically been relatively unengaged in NHS opportunities for leadership

development and that this must be redressed. This review and recommendations therefore set the context for a

review of Nene and Corby CCG baseline workforce data.

3.2 Primary Care as a Learning Organisation

With some exceptions, for example medical student teaching and GP training, little priority has been given to

training and professional development for staff working in primary care beyond their continuous professional

development requirements. In addition to this, pressures of both capacity and capability in general practice have

historically hindered systematic engagement with healthcare training, resulting in limited exposure of healthcare

students to primary care.

The Primary Care Workforce Commission recommended that structured training opportunities should be available

for all primary care staff to develop extended clinical, academic or leadership roles and that there should be more

opportunities for joint training of health and social care staff. The report also highlights that there should be

increased primary care exposure at pre and post-registration level through additional placements in primary care.

Northamptonshire’s CCGs believe that developing primary care as a learning organisation will lead to improved

recruitment and retention of the primary care workforce. The CCGs endorse the development of Enhanced Training

Practices which are accredited to provide undergraduate and postgraduate training placements through a hub and

spoke model, whilst creating a multi-professional learning organisation ethos. In addition to this, the CCGs are

committed to developing a primary care learning and development programme for the whole primary care

workforce to support delivery of a consistent Standard. The CCGs will identify priorities for training and utilise its

CPD allocation in the most effective way to deliver these.

3.2.1 Enabling workforce transformation

Workforce transformation is about developing a workforce responsive to changes in care, now and in the future,

taking account of national, regional and local drivers. The Five Year Forward View, The GP Forward View, the

Northamptonshire Health and Wellbeing Strategy and Northamptonshire CCGs Primary Care Strategy all highlight

that primary care workforce transformation is required to enable reform and change to happen at scale and pace, in

a sustainable way.

19

There are four key ways to transform the workforce:

Developing future supply

Upskilling the workforce

Developing new roles

Promoting new ways of working

3.2.2 Developing future supply

The CCGs have an ambition to develop primary care as a career of choice and to work with partners to ensure that

Northamptonshire is as an attractive place to train and work. It is essential that a wide range of professionals are

exposed to primary care as part of their pre- and post-registration training and that primary care is seen as a

desirable option for a post-registration career.

3.2.3 Upskilling the current workforce

National and local strategies are driving more community based care. Alongside this there is a local

Northamptonshire vision to improve the quality of care offered by primary care. The CCGs recognise that the whole

general practice team needs to be highly skilled to deliver high quality care in an effective way. This includes up

skilling both clinical and non-clinical staff, to ensure the most effective skill mix is available to meet patients’ needs.

HEE has recently published Talent for Care, a strategy produced to recognise, support and further develop the

healthcare support workforce. Talent for Care was created following wide consultation with national bodies,

education institutions, health and social care employers and healthcare staff and represents a significant

development, as it is the first ever national strategy for the development of healthcare support staff. One of the key

pledges included in the Talent for Care strategy is the implementation of the Care Certificate. The aim of the Care

Certificate is to ensure that all new support staff are taught and can demonstrate the right skills, knowledge, values

and behaviours to provide high quality and compassionate care. From April 2015 all new NHS and social care staff

providing direct support to patients and clients need to complete the Care Certificate. We will consider as part of the

implementation of this strategy how the implementation of the Care Certificate within primary care can be

integrated into the support workforce to enable practices to utilise it in a way that is meaningful to staff and

patients.

Practice managers provide a crucial senior administrative function within general practice and, although the role can

vary from practice to practice, they are usually responsible for a number of key activities including business planning,

handling financial systems including payroll, selecting, training and supervising non-clinical staff and the effective use

of data and information. Practice managers can gain relevant qualifications through external accredited providers,

such as AMSPAR (Association of Medical Secretaries, Practice Managers, Administrators and Receptionists ) which

offers a Certificate/Diploma in Primary Care and Health Management or the ILM (Institute of Healthcare

Management) which provides the Vocational Training Scheme for General Practice Managers. The recent General

Practice Forward View committed new investment to support practice manager development, although the detail of

this is not yet known.

Historically, the development of this part of the workforce has been overlooked and practice managers have found it

difficult to identify appropriate education and training programmes to develop their teams. Northamptonshire CCGs

vision for the primary care workforce is inclusive of non-clinical roles and therefore the CCGs are committed to

supporting the development of this part of the workforce.

20

3.2.4 Developing new roles

The success of general practice in the future will rely on the development of the wider, non-clinical workforce.

Northamptonshire CCGs recognise the contribution that practice managers, receptionists and other non-clinical roles

make to the practice team. The administrative burden on primary care clinicians is well documented and it is

estimated that GPs spend 11% of their time on administration. The HEE report ‘The future of primary care – creating

teams for tomorrow’ suggested that new support roles have the potential to reduce the administrative workload of

GPs and other clinicians.

Administrative roles within general practice are often used as an entry point into the primary care workforce and can

be used as a foundation for career development into other roles. Practices cite that they are keen to develop their

administration and reception staff into healthcare assistants or into more senior administration roles.

3.2.5 Promoting New Ways of Working

Two examples of local new ways of working are illustrated below and their subsequent impact on workforce is

described later in the strategy document:-

3.2.5.1 Primary Care Homes

Two federations in Northamptonshire are actively engaged in the The National Association of Primary Care (NAPC)

Primary Care Home Programme. The model is based on four defining characteristics:

Provision of care to a defined, registered population of between 30,000 and 50,000;

An integrated workforce, with a strong focus on partnerships spanning primary, secondary and social care

inclusive of patients and the voluntary sector;

A combined focus on personalisation of care with improvements in population health outcomes; and

Aligned clinical and financial drivers through a unified, whole population budget with appropriate shared risks

and rewards.

The PCH shares some of the features of the new multi-speciality community provider model whilst also being flexible

enough to be considered as a standalone unit or as a foundation or delivery unit for other at scale models of care.

The primary care homes programme locally is bringing together practices to work at scale to provide general practice

services. This scale also enables community services and others to configure their services as the “extended” primary

care team in a way that was previously impossible working with individual practices.

3.2.5.2 Active Signposting

Active signposting (or Care Navigation) is one of the 10 high impact changes of the GP Forward View and it aims to

provide patients with a first point of contact which directs them to the most appropriate source of help. Web and

app-based portals can provide self-help and self-management resources as well as signposting to the most

appropriate professional. Receptionists acting as care navigators can ensure the patient is booked with the right

person first time.

4. General Practice Workforce Data and Modelling

4.1 Primary Care Workforce Demand and Supply

The Health and Social Care Act 2012 places a duty on all organisations that deliver care funded by the NHS, to

provide data on their current workforce and anticipated future workforce needs. NHS England has developed a

workforce census module within the Primary Care Web Tool (PCWT) which practices can use to fulfil the

requirements of the workforce minimum data set and provide details of their current workforce.

21

Benchmarking figures from HEE indicate that both Nene and Corby have a higher ratio of registered patients to

doctors than the East Midlands benchmark of 1:1980 (Nene = 1:2039 and Corby 1:2112). Partners and salaried GPs

make up around 90% of the GP workforce, the remaining part of the workforce are mostly GPs in training and

locums. Around 1 in 5 of the local GP workforce are aged over 55 and have the option to retire, and about 14% of

these GPs are male.

Fig 4: General Practice Staff Group and Skills Group Age Profiles

The nationally determined Northamptonshire share of the GPFV GP trajectory can be found in Table 2 below. The

county share is an increase of 54 WTE GPs. What follows is a description of the factors that are impacting on current

numbers of GPs and other staff in the county and what implications this has for the target of 54 new GPs by 2020.

Table 2: Midlands and East Shares of GP Forward View GP Trajectories

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4.1.1 Midlands and East Workforce Baseline and Modelling

NHS Midlands and East have used national workforce data to provide baseline workforce numbers for the

Northamptonshire STP in Table 3 below (note that it is likely this national data underestimates the number of locums

working locally):

Sep-15 Mar-16 Sep-16 Dec-16 Mar-17 Jun-17

All Practitioners 397 397 381 379 374 380

All Practitioners (excluding Registrars) 367 368 357 355 354 356

GP Provider 300 298 293 291 284 285

Salaried 65 63 60 60 63 66

Retainers 0 1 0 0 0 0

Registrars 30 29 24 24 20 24

Locum 2 7 4 3 6 5

Not Stated - - - - - n/a

All Nurses 221 232 246 n/a 238 n/a

All Direct Patient Care 133 129 135 n/a 154 n/a

Health Care Assistants 70 68 70 n/a 83 n/a

Dispensers 55 53 58 n/a 60 n/a

Phlebotomists 4 4 4 n/a 6 n/a

Pharmacists 1 2 1 n/a 2 n/a

Podiatrists - - - n/a - n/a

Physiotherapists - - - n/a - n/a

Therapists 0 0 - n/a - n/a

Physician Associates - - - n/a - n/a

Paramedics n/a n/a - n/a - n/a

Nursing Associates n/a n/a 1 n/a 1 n/a

Apprentices n/a n/a - n/a 1 n/a

Others 1 1 1 n/a 1 n/a

All Other Workforce - Clinical 354 361 381 n/a 392 n/a

All Admin/Non-clinical 812 844 843 n/a 832 n/a

Table 3: Northamptonshire baseline primary care workforce data (source Midlands and East GPFV Workforce Tool)

The Midlands and East tool also illustrates the number of GP WTE (excluding registrars) reported by NHS Digital and

compares this to the shared allocation of the GPFV target (Table 2) by 2020. Variance from the expected FTE in 2020

is expressed in whole terms as well as a proportion of the shared allocation in Table 4.

23

Sep-15 Mar-16 Sep-16 Dec-16 Mar-17 Jun-17

All Practitioners (excluding Registrars) 367 368 357 355 354 356

Trajectory

Expected 2020 421 421 421 421 421 421

Variance from Expected 2020 -54 -53 -64 -66 -67 -65

Variance from Expected 2020 % -13% -13% -15% -16% -16% -16%

Table 4: Northamptonshire primary care workforce data (source Midlands and East GPFV Workforce Tool)

Fig 4: Northamptonshire primary care workforce data (source Midlands and East GPFV Workforce Tool)

Baseline Previous Period

Current Period

Current vs Baseline

Trend

Latest Period Trend

Shared Allocation

Expected 2020

Variance from

Expected

Variance from

Expected %

CCG Sep-15 Mar-17 Jun-17

Corby CCG 38 36 38 6 44 -6 -14%

Nene CCG 329 318 318 48 377 -59 -16%

Table 5: Northamptonshire primary care workforce data baseline position (source Midlands and East GPFV Workforce Tool)

The Midlands and East tool indicates a recruitment gap for Northamptonshire of 65 GPs by 2020 if nothing is done to

meet the NHSE target allocation of 54.

Local modelling has been commissioned in order to create a trajectory to close this gap based on the

implementation of this primary care workforce strategy. There are 2 modelling approaches that have been used.

4.1.2 Health Education England Simulation

Health Education England have created a model against the GPFV shares that takes into account the likely attrition

rates for GPs. The model works from baseline assumptions of

354 GP FTE

92 Clinical Support Staff

24

2 Pharmacists (Northamptonshire has 8.6 clinical pharmacists in 2017)

238 Registered Nurses

120 Managers/Senior Managers

712 Admin

And assumes the following

100% of staff over 55 will retire next 5 years

30% new CCT holders leaving programmes do not join the workforce

3% annual net GP leavers/joiners

12% GP vacancy rate and 10% for all other staff

There will be no gain in staff from additional recruitment schemes

Taking these into account the model projects a recruitment gap of 57 wte GPs by 2020. This is broadly consistent

with the Midlands and East projected gap of 65 but assumes a small proportion of the gap can be closed by role

substitution.

Table 6: Impact of potential role substitution in Northamptonshire

Using role substitution may be part of the workforce solution. The scale of the values required however, will be too

significant to meet the total gap. This means a comprehensive approach that supports both recruitment and

retention of GPs as well as developing the multidisciplinary team and adapting practice business processes is likely to

be required to fill the gap.

4.1.3 Whole Systems Partnership Strategic Workforce Planning Tool

To test the assumptions around GP retirement and retention we have also commissioned a local piece of workforce

modelling through the Whole Systems Partnership. The tool and methodology is called SWiPe and uses workforce

baseline data but also sets this alongside population demographics. This is being used to test different scenarios and

options for how we fill the gaps in workforce presented by the GP Forward View.

The model outputs are illustrated in Figs 5 and 6 and these show 2 scenarios.

Baseline

inc.

Locums

Year 0

Baseline

Demand

year 0

Demand

Year 5

5 year

Impact of

Role

Substituti

on

Total

Demand

Year 5

5 year Change

in demand

before role

substitution

5 year

Change in

demand

after role

substitution

Clinical support 92 102 112 0 112 9% 9%

General Medical Practitioner 354 383 421 -57 364 10% -5%

NHS Infrastructure support - Admin & Estates 712 791 865 0 865 9% 9%

NHS Infrastructure support - Managers & senior managers 120 133 145 0 145 9% 9%

Pharmacists 2 3 3 28 31 9% 1138%

Physician Associates 0 0 0 57 57 10% 254771%

Registered Nurses 238 264 289 0 289 9% 9%

Therapists 0 0 0 0 0 10% 10%

Mental Health Therapists 0 0 0 28 28 10% 141544%

Total 1518 1676 1835 57 1891 9% 13%

Back to Scenarios

Print Report

Next Report

25

4.1.3.1 Scenario 1 (Run 1) “Do Nothing Scenario”

This scenario is based on current intelligence and baseline data and assumptions about GP retirement ages,

retention of GP Registrars and no local recruitment initiatives.

4.1.3.2 Scenario 2 (Run 2) “International Recruitment, Better Retention”

Scenario 2 is based on adjusted assumptions about retention of GPs, gaps between training and starting work, and

current rates of retention of trainees all made at a meeting of our joint Primary Care Co-Commissioning Committees

and informed by current experience of GPs, LMC and others in practice locally. Scenario 2 also includes conservative

assumptions about international recruitment (17 GPs recruited from outside the UK with 50% leaving after the end

of their contract). Finally scenario 2 involves an element of role substitution.

Scenario 2 illustrates that the schemes included in our workplan for 17/18 and beyond such as international

recruitment and improving local GP retention rates will effectively close the gap for Northamptonshire by 2020 with

a remaining deficit against the GPFV target of 54 of 0.5 WTE.

Fig 5: SWiPe Simulation Outputs

Fig 6: GP Recruitment Trajectories Scenarios 1 and 2 SWiPe Simulation

The remainder of this strategy document illustrates how we intend to deliver this proposed approach for

Northamptonshire.

26

5. Local Workforce Priorities and Initiatives

In order to try to close the gaps in primary care workforce locally we have aligned this primary care workforce

strategy to the Northamptonshire LWAB priorities and workplan. There are 4 key pillars to the local strategy

illustrated below:

Fig 7 Northamptonshire Primary Care Workforce Strategy 4 Key Pillars

5.1 Strategic Workforce Analysis and Planning

Firstly there are no clear ways to measure demand for general practice services and there is a distinct absence of any

measures of activity. As a consequence policy-makers have been unable to have a clear view of the pressures that

practices are working under.

A clearer view of local workload and workforce is essential for better planning and more creative use of skill-mix in

order to deliver primary care on a more sustainable footing. Local roll out of the national GP workload tool will be a

key priority both for delivery of GPFV access and for understanding and providing more context to this strategy

document.

National modelling by the RCGP has stated that the number of GPs being trained will not be sufficient in order to

meet future demands. Indeed the Centre for Workforce Intelligence has said that there will be a significant

undersupply of GPs by 2020 unless steps are taken to address this imbalance between supply and demand. The

predicted numbers of practice nurses due to retire in the near future is also a major concern.

Across the Northamptonshire STP baseline workforce data has been collated for staff working in the NHS trusts,

EMAS and Primary Care. Using the Whole Systems Partnership (WSP) SWiPe modelling techniques this workforce has

been segmented into four workforce groups. This segmentation methodology supports a move away from referring

to roles by banding or professional group and towards a common terminology across both health and social care.

The segments can be described as follows:

Foundation - Awareness of work procedures after induction and on the job training. (Indicative comparison: bands

1-4, HCAs, Dispensers, Phlebotomists)

Organisational Development

Change management, information and process sharing to make it happen (Section 5.4)

New Roles, New Ways of Working &

Upskilling

Expanding the MDT, working collaboratively on HCA and ACP development frameworks, building training placement capacity (Section 5.3)

Attraction, Recruitment and

Retention

Making Northants an attractive place to work, utilising skill mix and maximising staff development opportunities that contribute to staff retention in primary care (Section 5.2)

Strategic Workforce Analysis

and Planning

Analysing current workforce challenges, population demand and planning for future new models of care (Section 5.1)

27

Core - An understanding and knowledge of work procedures requiring theoretical knowledge normally acquired

through formal training or equivalent experience. (Indicative comparison: Band 5s, Practice nurses, Therapists, Social

Workers, OT’s)

Enhanced - Understanding of a range of work procedures and practices requiring a higher level of theoretical

knowledge and practical experience through formal training or equivalent and applied in a specific area of need such

as a single health condition. (Indicative comparison: Bands 6/7, Non consultant medical staff, Nurse specialist,

Registrars)

Advanced (Autonomous) - Knowledge across a range of work procedures underpinned by advanced theoretical

knowledge through formal education, training and practical experience. (Indicative comparison: Medical

consultants, Advanced practitioners or social care specialists)

Baseline workforce data was allocated to segment and STP workstream and this is illustrated below (Fig 8):

Fig 8 Northamptonshire Current Skill Mix Across STP Workstreams

The overarching strategy for workforce in Northamptonshire indicates that by doing nothing and working in line with

forecasted pressure, all skills groups within the workforce to need to grow by up to 15% to keep pace with demand.

However, taking into account how this demand can be met through service transformation, the SWiPE methodology

anticipates overall workforce growth across the STP footprint could be managed. It predicts that across the system

there will be a limited change in workforce numbers, but with a shift and a further 238 wte in patient facing roles by

2021. Fig 7 demonstrates the expected change in skill mix by STP workstream by 2021 in line with this analysis:

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Women &Children's

Primary Care Complex Care Urgent Care ScheduledCare

LD MH/ CAMHS Diagnostics

Current Skill Mix of Workforce Across STP Workstreams

Foundation Core Enhanced Advanced

28

Fig 9 Northamptonshire Future Skill Mix of Workforce Across STP Workstreams

This would be a significant shift in how the Primary Care workforce could be constructed, with greater proportions of

staff within the Foundation, Core and Enhanced skill sets. As outlined in the overarching workforce strategy for

Northamptonshire, this must be considered in the context of current workforce challenges faced within general

practice which include;

Retirement and turnover for GPs and Practice Nurses,

Attraction, recruitment and retention,

Lower participation rates, GPs coming into the workforce, and those nearing retirement choosing to work fewer

sessions, or having a portfolio career,

Over reliance on locum and temporary staffing solutions,

Skills, time and capacity within general practice to develop the workforce of the future.

All of which pose key risks to the ability to maintain the necessary proportion of workforce at the Enhanced and

Advanced levels, and the ability to stabilise the current general practice workforce ahead of transitioning to new

models of care. It is because of this, the overarching LWAB priorities for workforce in Northamptonshire are focused

on solutions to the challenges currently faced including:

Collaborative agreement across the system for commissioning training numbers for key workforce shortage

groups through an education strategy,

Collaborative approaches to retention and upskilling for key areas of the workforce: e.g. Apprentices, Health

Care Assistants, Advanced Practitioners, Medical staff,

Collaborative approach to attraction and marketing Northamptonshire as a place to live and work,

Investment in new role development,

Implementing approaches to fully assess the impact of the STP and manage change.

Practices need to make informed decisions about their desired staffing model based on current activity, and longer

term planning assumptions to enable them to move towards the vision of a multi-professional workforce. There is

not one ‘ideal’ staffing model (for example, based on ratios of GPs or nurses per head of population) and practices

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Women &Children's

Primary Care Complex Care Urgent Care ScheduledCare

LD MH/ CAMHS Diagnostics

Future Skill Mix of Workforce Across STP Workstreams

Foundation Core Enhanced Advanced

29

will need support to consider how their workforce should be configured both to align with workforce transformation

across the STP and to reflect the needs of their local population.

To achieve the vision of a multi-professional workforce, based around the needs of a local population, and to enable

workforce transformation to take place, a number of foundations need to be in place as a basis for further workforce

development. These foundations will enable practices working together in partnership, to consider where they are

now and where they would like to be in terms of their workforce. In summary, it will be important to:

Understand the current workforce – roles and numbers

Identify skills and skills gaps within the current workforce

Consider the desired staffing model for a defined population

Nene and Corby CCGs have commissioned a piece of work to develop, test and embed a model which can be used at

practice cluster or Primary Care Home level to determine future “shared” staffing requirements.

The approach is based on analysis described above and already completed as part of the Northamptonshire STP. It is

an approach that connects workforce supply, population health needs and service transformation in a meaningful

way to enable the development of a workforce plan.

The workforce analysis model has been tested in general practice, using the same methodology, with the Lakeside

superpractice, to create a general practice focussed picture of potential workforce changes over time.

Fig 10: Lakeside workforce skill mix changes over time

The output from the Lakeside work reinforces the STP wide analysis, in that the future construct of the workforce in

general practice will need to be more equally weighted across the skill groups.

For 2017/18, the LWAB has invested in the roll out of the SWiPe modelling methodology to three primary care

homes or practice cluster Workforce Explorer sites within the county (the emerging primary care home model is

described in section 6). The work will explore and provide options for team structures across more than 1 practice

and based on the skill groupings of Autonomous, Enhanced, Core and Foundation outlined above. This will then be

taken alongside the evaluation of roles such as clinical pharmacists and medical assistants, and the opportunity to

form part of the HCA development framework and ACP Academy

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The aim is to complete modelling with local Workforce Explorer sites by the end of March 2018 so that these outputs

can be brought together and triangulated against all other baseline and modelling data and local revised STP

programme plans. This will determine a target workforce model for a primary care home that can be adapted to

local needs and will enable the development of detailed Primary Care Home level operational plans to feed into the

strategy document and support future workplans.

The plans will be incorporated as part of the countywide workforce strategies overseen by the LWAB. They will

include targeted campaigns for recruitment, retention and attraction, as well commissioning the required workforce

training and development needed to deliver the new models of care.

5.2 Attraction, Recruitment & Retention

5.2.1 GPs

GPs are the bedrock of general practice. Locally we recognise the GP role is core to the practice team and must be

valued as the lead provider of holistic, patient-centred care for undifferentiated illness, across time within a

continuous relationship. For this reason the strategy promotes GP training, recruitment and retention. We recognise

however that it will not be possible to recruit the number of GPs needed to provide a traditional model of general

practice and are therefore supporting the primary care home model as a way to secure the appropriate skill mix of

staff to provide services at scale across the county.

We have adopted the ‘HEE Training Hub (CEPN) Initiative’ in the county which is designed to increase placements for

a range of roles in general practice, from year 10 work experience pupils through to medical students, to assist with

developing innovative workforce solutions to the challenges faced by primary care. The programme was devised to

showcase general practice as a career choice and improve attraction, recruitment and retention of the wider general

practice team.

The General Practice Forward View (GPFV) included a commitment to deliver a major international recruitment drive

to attract up to 500 appropriately trained and qualified GPs from overseas by 2020. On 22 August 2017, NHS England

announced a major expansion of the International GP Recruitment (IGPR) Programme. The expanded programme

will now accelerate the original plans, and aim to recruit 2000 GPs from overseas by 2020.

The Nene and Corby International Recruitment Scheme is proposing to recruit 27 GPs and is requesting a total of

£972k (+ the International Recruitment Costs) from NHS England GP transformation fund to deliver the scheme. In

addition we anticipate that we would require a further £2500 per GP to support integration and retention, along

with funding for dedicated project management support which will need to be agreed with the local and national

recruitment team office.

Local practices are currently being asked for expressions of interest to host international recruits when they arrive.

To date 15 practices have expressed an interest.

We have placed a business case with HEE for some local additional funding to put systems in place to support newly

recruited GPs and their families, helping them integrate in to the communities, enabling them to deliver robust care.

We will do this working closely with the LMC and using the experience of others (eg Lincoln) to inform planning.

International GP Recruitment Scheme will work to complement our local ‘GP retainer programme’ to fill local gaps

around GP workforce.

The LMC is currently working with the CCGs to look technology tool to support both locums and practices to reduce

operational costs in employing locums thus increasing the GP and hopefully the nursing capacity in

Northamptonshire. These tools will streamline the booking and invoicing systems thus reducing the administrative

burden required of locums. It will also help locums to be able to work quickly and efficiently in any practice in the

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county by enabling practices to develop personalised information and protocols unique for that individual practice.

It will help Federations to collaboratively and seamlessly manage Extended Hours Hubs rotas with compliance and

billing provided from one platform. At the moment the www.northantsgp.co.uk website generates emails

requesting work from about 10 locums a month.

5.2.2 Practice Nursing

Practice nursing is equally core to primary care service delivery and increasingly important in the delivery of services

to people with long term conditions. In July 2017 England’s Chief Nursing Officer launched a ten point action plan to

recognise and develop the roles that general practice nurses have which transform care and can help deliver the

Forward View plans. The plan brings together key actions including attracting new recruits, supporting existing GPNs

and encouraging return to practice. It is backed by a £15 million national investment to help target and prioritise

where improvements are needed most.

Actions include measures to:

Increase uptake and promote nursing in general practice – by raising the profile of nursing in General

Practice through the ‘Image of Nursing’ programme, offering clinical placements for undergraduates and

supporting additional routes into general practice nursing.

Support for existing GPNs – all nurses new to general practice will have access to an induction programme,

training and mentoring and an expansion in leadership and career opportunities.

Encouraging GPNs to return to practice – The national return to practice programme will now include GPNs.

Regional GPN Boards will provide a platform to share best practice.

Fig 11 General Practice – Developing confidence, capability and capacity – 10 Point Plan

The HEE ‘General Practice Nursing Workforce Development Plan’ outlines retention as one of the key problems for

GPNs. The plan suggests that similarly to GPs, to boost retention a range of measures could assist including offering;

portfolio careers, education, networking and management roles alongside undertaking clinical duties. The Queen’s

Nursing Institute (2016) indicated that 19.3% of GPNs surveyed were considering leaving the profession to avoid

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revalidation, this is likely to contribute to a further issue in the anticipated spike in retirements for this workforce

over the coming years.

Recommendation 8 of the HEE plan states ‘All GPNs should have access to accredited training to equip them for each

level of their role’, recommendation 9 states ‘ All HCAs and GPNs should have access to quality assured CPD to

support career development and inform revalidation’, and recommendation 10 ‘Implement measures to encourage

nurses at all levels to remain in practice’. These recommendations are supported by the RCGPs and will be led and

jointly implemented by HEE, NHS England and CCGs (with the exception of recommendation 10 which is also to be led

by federations and practices).

Locally HEE have not set targets specifically for Return to Practice (RtP) for GPNs. Nationally, nine HEI’s have been

selected to run a bespoke GPN Return to Practice programme. The targets for the bespoke courses include running

one cohort per year, with an expectation that there will be ten returnees per cohort. The closest HEI to

Northamptonshire running this programme is the University of Bedfordshire, however the University of

Northampton have supported a number of GPNs through their generic RtP programme, and placements have been

available through the training hubs in the county. As outlined in the HEE ‘General Practice Nursing Workforce

Development Plan’, a key obstacle for placements of GPNs back into practice is current mentorship capacity within

primary care, particularly the availability of sign off mentors. Therefore working with the CCG and University, the

training hubs in the county will work in partnership to baseline data on mentor availability and develop future plans

to address capacity and capability.

5.2.3 Clinical Pharmacists

As part of the GP Forward View delivery NHSE are also supporting funding and recruitment of clinical pharmacists

and mental health therapists. During the second wave of Clinical Pharmacy funding, all GP Federations were

supported by the CCG and have now successfully secured funding from the national scheme. General Practice

Alliance (GPA) will employ nine pharmacists on this programme (one senior and eight clinical pharmacists),

recruitment to these roles is imminent and therefore it is expected the pharmacists will be in post before the end of

the year. PML obtained funding for 1.6 WTE pharmacists and are also recruiting to these posts now.

Our wave 1 clinical pharmacist scheme which involved 7 pharmacists has been evaluated and the lessons from wave

1 have enabled us to plan for the wave 2 pharmacists coming into post. A business case has been presented to HEE

for additional funding to support a range of support activities both with the pharmacists and the practices to

successfully embed pharmacists into the multidisciplinary team.

Future plans to expand clinical pharmacist roles within general practice include;

working alongside local Higher Education Institutes (HEIs) and the Pharmacists currently employed within the

federation to develop a plan to host pre-registration pharmacist students.

working alongside the project lead for the healthcare apprenticeship and work experience expansion project,

funded through the LWAB, to initiate this work across practices

working with local HEIs to ensure the next intake of Physicians Associates can be placed within general practices

in 3Sixty

working in partnership with Kettering General Hospital, piloting a joint role for pharmacists across acute and

primary care to address the recommendations of both the Carter Review and GPFV.

A unique pilot project supported by HEE is currently underway in the north of the county with Kettering General

Hospital and practices within both the Lakeside superpractice and 3Sixty Care Partnership. This pilot will explore the

viability of a shared role for clinical pharmacists across acute and primary care, enhancing their patient facing

experience and also the relationships between the hospital medicines team and practices. The pilot is due to be

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launched within 2017 and again evaluation will be fed back into the Primary Care Workforce Group to inform future

strategy and planning.

5.2.4 Mental Health Workers

Mental health problems are widespread and mental health and physical health are often linked. Many people

presenting to general practice have primary mental health needs or secondary mental health problems associated

with their physical conditions. As well as impacting on physical health outcomes, individuals with mental health

problems are less likely to engage in school or employment, leading to an impact on wider public health services and

resources. Nine out of ten adults with mental health problems are treated in primary care, although the primary care

workforce may not always feel it has the appropriate level of knowledge and skills to care for these people

effectively. Resources for primary care practitioners have increased through the development of IAPT (Improving

Access to Psychological Therapies) services, and in some areas nationally, the attachment of primary care mental

health workers to practices.

The General Practice Forward View has set an ambitious target to ensure there are an extra 3,000 mental health

workers in primary care by 2020, providing an average of a full-time therapist for every 2-3 typical sized practices. In

Northamptonshire this translates as 10 by March 2018 and 17 by March 2019. One practice cluster in the south of

the county are piloting direct access to a mental health worker, working collaboratively with NHFT. The ambition is

to embed a mental health worker as a member of the practice team triaging and treating patients with low level

mental health problems. Once the pilot is completed and the issues around sharing information and interoperability

across GP and NHFT systems have been resolved this approach will be rolled out to other clusters by reconfiguring

parts of the mental health team at NHFT. This will mean that the target of 17 mental health workers will be met by

supporting direct access to mental health through primary care homes or practices clusters by March 2019.

In addition to this new resource, the primary care workforce needs to be trained to ensure they are fully supported

to lead the delivery of multi-disciplinary mental health support in primary care.

5.2.5 Other

Apprenticeship programmes can be a cost-effective means of creating a skilled, flexible and motivated workforce.

These programmes can also help improve the diversity of the workforce and provide employment opportunities for

the local community to enter the healthcare sector. Apprenticeships are work-based training programmes available

to anyone over the age of 16. They enable learners to demonstrate their competence while gaining a recognised

qualification, which span a range of levels from level 1 (GCSE equivalent) to level 7 (Masters level), achieved through

a mix of on the job training and study, whilst at the same time being in employment.

The government is committed to increasing the growth of apprenticeships and there is a commitment to achieve 3

million apprenticeship starts in the UK economy by 2020. To facilitate this there are major changes in apprenticeship

national policy and the introduction of some significant reforms. All public sector organisations will have a legal duty

to support apprenticeship starts and will be set a target of 2.3% of their workforce. It is estimated that to meet the

target of 2.3% over 4000 apprenticeship starts will need to be achieved by Northamptonshire’s NHS organisations.

Whilst apprenticeships are well established in NHS Trusts, there has been less use of these programmes in primary

care, so a targeted approach is currently being deployed by HEE to increase the numbers of apprenticeships within

this sector. Northamptonshire CCGs recognise the opportunity to utilise apprenticeships to develop the skill mix

within primary care and to specifically develop the non-clinical workforce, including practice managers. The CCGs will

work with primary care providers, HEE and education providers to enable an increased usage of apprenticeships

within primary care and to support the government’s ambition and targets.

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5.3 New Ways of Working

The Northamptonshire STP is currently undergoing a reset following both the publication of the Five Year Forward

View refresh and a local change in STP leadership. An output of the reset will be a local plan for new care models. In

the meantime local federations have taken the lead in signing up to the NAPC Primary Care Homes programme. This

is supported locally by the CCGs as both complementary to the local implementation programme for the GPFV and a

pragmatic way for general practice to engage locally in the development of a new care model from the ground up.

5.3.1 The Primary Care Home (PCH) Model

The National Association of Primary Care (NAPC) developed the Primary Care Home (PCH) model is based on four

defining characteristics:

Provision of care to a defined, registered population of between 30,000 and 50,000;

An integrated workforce, with a strong focus on partnerships spanning primary, secondary and social care

inclusive of patients and the voluntary sector;

A combined focus on personalisation of care with improvements in population health outcomes; and

Aligned clinical and financial drivers through a unified, whole population budget with appropriate shared risks

and rewards.

The model was developed in response to the triple aims of STP delivery and learning from a variety of other

attempts to transform primary care over the years.

The PCH shares some of the features of the new multi-speciality community provider model whilst also being flexible

enough to be considered as a standalone unit or as a foundation or delivery unit for other at scale models of care.

The PCH programme is bringing together practices to work at scale to provide general practice services. This scale

also enables community services and others to configure their services as the “extended” primary care team in a way

that was previously impossible working with individual practices. Workforce modelling conducted using the SWiPe

model will help to determine the core skills needed in this “extended team” and the transition programme required

to establish teams who work in this way across the whole county.

At the time of writing Northamptonshire has 12 PCHs that are part of the national programme, however all practices

will be taking part in some form of “at scale” same day care delivery as part of a cluster or PCH by the end of 17/18.

For Northamptonshire the PCH model is part of our implementation of the GP Forward View in getting practices to

work together in partnership to deliver services like same day access, extended hours and collaborative care teams.

It is also seen locally as a key building block to developing new care models by creating practice clusters that allow

community services to organise themselves around populations of 30-50,000 and integrate with general practice

much more fully and successfully than previously.

We recognise that due to the geography and the demographics in Northamptonshire, the locality cluster models will

need to be slightly different across localities, with core components and standards of access being the same across

each home.

It is clear that extended primary care access requires the support of alternative workforce models to ensure that the

right persons with the appropriate skillsets are used to treat the full range of patients that can be seen in primary

care.

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The PCH workforce model will be a key output of the next phase of workforce modelling through the SWiPe tool. The

modelling will allow us to test and flex a hypothetical core workforce model for PCHs built on existing local data and

other national data (for example safety ratios).

Roll out of the SWiPe model to 3 primary care homes in Northamptonshire will provide additional data to support

primary care home workforce planning. The project will test the hypothetical model in Table 7. The project will begin

in Oct 2017 and complete in March 2018. Critically the outputs will be used to revise this workforce strategy ahead

of finalising the workplan for 18/19.

Staff Group Skills Group No of wte today No of wte 2020

GP Advanced 31 32

Practice Nurse (prescriber) Advanced 9 15

Practice Nurse (non-prescriber) Enhanced 13 17

HCA Foundation 10 20

Clinical Pharmacist (prescriber) Advanced 1 3

Mental Health Worker Core 1 1

Physiotherapist Core 1 3

District Nurse Core 10 15

Health Visitor Core 3 3 Table 7: Hypothetical Primary Care Home Clinical Workforce Model (Assumes 50,000 registered list, 4 practices no more than 2 miles apart and a 1% growth in

population year on year)

The 18/19 commissioning intentions will signal changes to local acute and community providers around primary care

home development. The aim is that our local providers begin considering how their teams might need to be

configured around the “onion” clinical model to provide community and specialist support as part of a “extended” or

“enhanced” primary care team.

The example that follows provides a hypothetical illustration of how the primary care home model described above

might translate into practice for people with diabetes in Northamptonshire.

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Fig 12 A primary care home “onion” care model for diabetes

Fig 13 A hypothetical primary care home diabetes segmentation model

The aim is for a specialist diabetes workforce, comprised of Clinical Nurse Specialists (CNS), Allied Health

Professionals (dieticians and podiatrists) and diabetologists, to support the core primary care workforce of each of

the county’s emerging Primary Care Homes (PCHs) with specialist advice/support/guidance in managing the needs of

the population living with diabetes.

Although the number of PCHs remains fluid, it is reasonable to expect in the region of 20 to cover the county in

populations of 30-50k over time. On this basis, assuming the same level of need from each PCH, each PCH could

expect to receive support from the equivalent of approximately 1.1 WTE specialists in the ratio 1:0.6 CNS: AHP and

CNS: Specialist Support Workers to support core primary care staff in managing a diabetic population of c 2,350 per

PCH (on average).

Although theoretically possible to apportion staff to each PCH in this way, the nature of the support required for its

patients (e.g. specialist advice/guidance throughout the week, for a range of individual/group consultations, etc.) will

mean PCHs will need to work together on specialist service delivery models to meet patients’ needs within the

available resources.

The Primary Care Home model helps us to define a vision for a primary care workforce in Northamptonshire:-

“To create and sustain a multi-professional workforce with the right knowledge, skills, values and behaviours,

built around the needs of a defined population that ensures high quality and consistent care for the people of

Northamptonshire”.

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The Primary Care Home is a longer term vision for how a proactive, population focussed primary, community and

social care model of care is offered to people in Northamptonshire. Meanwhile there are more pressing demands on

the primary care workforce.

5.3.2 Pathway Redesign

Musculoskeletal (MSK) conditions make up to 30 per cent of a GP’s caseload, rising to 50 per cent for patients over

75. There is increasing evidence of the role that physiotherapists can take as part of primary care teams to support

the management of MSK problems.

Physiotherapists are autonomous practitioners able to assess, diagnose, manage and discharge patients. Increasing

numbers of physiotherapists are independent prescribers and are able to administer injections or prescribe drugs as

part of a treatment plan. However, rapid referral to physiotherapy reduces levels of medication and therefore having

access to physiotherapy as part of the primary care team can help to reduce levels of unnecessary prescribing.

As autonomous practitioners, physiotherapists can be accessed through self-referral schemes, reducing the demand

on GPs. This streamlines pathways of care and saves time and money. Self-referral schemes in physiotherapy have

been well evaluated and have been shown to reduce DNAs, increase access, reduce administration costs and

increase patient satisfaction. One evaluation found that 85% of MSK patients seen by a physiotherapist in primary

care did not need to see a GP.

Northamptonshire CCGs are working to identify approaches to enabling patients with MSK problems to access

physiotherapy in a more timely and effective way at a location which is easily accessible to them. Self-referral to

physiotherapy is already in place across Northamptonshire, but is exploring the idea of co-locating physiotherapists

in practices or for primary care providers to employ them directly. The CCGs are working collaboratively with

community and secondary care providers to identify where the development of physiotherapy roles may enhance

primary care MSK provision.

The outputs of the SWiPe modelling work in March 2018 will provide future workplans with a suite of activities that

are needed to develop our existing primary care workforce to take on these new ways of working and support

practices to share their workforce across primary care homes.

5.4 Organisational Development

Effective working of a multidisciplinary team within a PCH working should result in:

Continuity of care, even when different aspects of care are delivered by different individuals or providers;

Good communication between primary, secondary and tertiary care;

Good data collection, both for the benefit of the individual patient and for the purposes of service planning

and evaluation

Improved equality of outcomes as a result of better understanding and awareness of patients’ characteristics

and through reflective practice;

Patients being assessed and offered the level of information and support they need to cope with their

condition in a timely manner;

Adherence to national and local clinical guidelines;

Promotion of good working relationships between staff, thereby enhancing their job satisfaction and quality

of life;

Opportunities for education/professional development of team members (implicitly through the inclusion of

junior team members and explicitly when meetings are used to devise and agree new protocols and ways of

working);

Optimisation of resources – effective MDT working should result in more efficient use of time which should

contribute to more efficient use of NHS resources more generally.

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Without the development of a wider multi-professional workforce, the risk is that highly skilled professionals, such

as GPs and practice nurses, undertake tasks that could be completed by other parts of the workforce. By taking a

competency based approach to workforce design, consideration can be given to changes in skill mix and working

practices or new roles to streamline patient care without compromising on quality and safety.

This approach means that where professionals are performing tasks or duties that others could competently

undertake, consideration should be given to how these activities can be passed on safely and effectively. In many

instances, existing members of staff can be trained to develop new competencies and where this is not possible new

roles may be required. It is recognised that the very nature of general practice requires the workforce to work in a

holistic way. When considering new roles and skill mix changes, the underpinning approach must be to improve, not

compromise, patient care.

Through the SWiPe modelling project and other GP Forward View and STP programmes primary care providers will

be encouraged to review the skill mix within the practice teams and across neighbouring practices. They will be

asked to identify where new ways of working can be introduced, specialised workforce might be shared or new roles

developed to ensure that the skills and competencies of the whole primary care workforce are being utilised

effectively, whilst maintaining a high quality service for patients.

The primary care workforce needs to develop a wider skill set than those related directly to the delivery of patient

care. This includes training and development in:

Quality improvement

Research and innovation

Leadership

Enhanced use of technology

Risk management

Clinical system training

Coding

Role redesign within general practice teams is a way of increasing efficiency and effectiveness in primary care. The

development of new and amended roles has been demonstrated to address workload issues, improve patient

experience and sometimes deliver savings.

We will continue to work with the LMC and the Training Hubs to assess training needs, which will then be fed into

the Education Strategy for Northamptonshire being overseen by the LWAB .

5.4.1 Practice Reception and Administration Staff

5.4.1.1 Care Navigation

We are commissioning training and managing the roll out of care navigation across Northamptonshire practices

using our allocation of the national investment of £45 million. In 17/18 we will also be using this funding to

commission training for every practice to support the development of clerical staff to play a greater role in handling

clinical paperwork to free up GP time. These schemes will continue over 18/19 to ensure that all practices have

trained adequate members of staff and that staff are appropriately supported in practice to implement these

changes.

5.4.1.2 Clinical Administration Support

Excessive administration in general practice is a major problem and many GPs cite that non-clinical workload is a

major factor in them leaving primary care roles. It has been estimated that GPs spend 11% of their time on

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administrative duties, which could be delegated to other parts of the workforce to enable GPs, and other clinical

staff, to focus more time on direct patient care. Clerical staff in the practice will be offered additional training in

order to support the GP in clinical administration tasks. This will include tasks such as processing incoming hospital

correspondence, ordering tests, chasing results and outpatient referrals, liaising with other providers and explaining

care processes to patients. It is anticipated that this will commence in early 2018 and continue throughout the year.

5.4.2 Healthcare Assistants

The Local Workforce Action Board has committed significant investment for 2017/18 to scope proposals for a

development pathway to make it more accessible for Health Care Assistants to become Nurses. This is possible

through achieving a Healthcare Certificate regardless of prior educational attainment, and from this APEL directly

into the second year of a nursing degree programme (or onto the nursing apprenticeship). The programme has been

in place and resulted in increased retention and attraction at St Andrews, and the certificate will now be further

developed to include modules making it suitable across the NHS community and acute trusts, and for HCAs in

Primary Care. Alongside this, the LWAB are scoping plans for a Northamptonshire wide ACP Academy, which will

enable nurses to develop their masters level qualifications in advanced clinical practice across health, upskilling and

developing a more mobile workforce.

5.4.3 Nursing

The Primary Care Workforce Steering Group has identified a programme of work to support nursing mentors for

primary care. This project is intended to develop the capacity and confidence of mentors in primary care working

with the CCG Leads, general practitioners and GPNs. The deliverables of the project will result in an increase in

general practices willing to take nurse students, ultimately leading to an increase in weeks provided for nurse

placements in primary care across the county, with the overall aim that this will increase nurses choosing general

practice as a career choice.

The project once funded will deliver; a baseline of nursing mentors available in primary care across the county and

status of their qualification, a communications programme to promote mentorship and placements, a local training

event practice nurse and explore the potential development of an online bridging module to promote being a

mentor to align to the current standards.

The 3Sixty training hub in Northamptonshire will work with stakeholders to identify key obstacles to nursing

placement provision in primary care. This will include contributing to the nursing training needs assessment, and

developing a strategic approach to upskilling general practice nurses at scale through mentorship training.

Critically practice nurses are usually the main point of contact for long term conditions management and care for

people with the most complex needs within the practice. The Primary Care Workforce Steering Group will pay

particular attention to the outputs of the SWiPe work in terms of support for practice nurses to network directly

with an extended primary care team to care for these groups and revise the workplan in April 2018 accordingly

The CCGs have this month launched a Practice Nurse Forum. This is the first event being held by NHS Corby & NHS

Nene Clinical Commissioning Groups (CCGs) and was launched in to practice nurses in a video from the Head of

Nursing and Safeguarding and the Medical Director

(https://www.youtube.com/watch?v=Fc1P5UU_dWk&feature=youtu.be )

The Forum is aimed at nurses, with or without current registration, or people with like interests and will be inclusive

of all those interested in the safe and effective delivery of care. The forum has been created as an opportunity to

share good ideas and practice within a safe and supporting, if suitably challenging, environment. It will also have one

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eye on the horizon, ensuring that nurses and allied professionals are kept abreast of future innovations and plans,

both locally and nationally.

5.4.4 Medical Assistants

Medical Assistants are trained to perform both clinical and non-clinical duties to support GPs. ‘The future of primary

care – creating teams for tomorrow’ report identified Medical Assistants as a key area to pilot and evaluate its

impact in primary care. It is anticipated this role will work closely with GPs to reduce the administrative tasks they

undertake, therefore freeing them up to provide more clinical time. Within the county, it is expected that the first of

these roles will start to be developed within General Practice by March 2018. However, it is recognised that

education and training to support these roles, within a defined career framework, is not standardised and this

should be explored further, specifically to understand the core competencies needed for this type of worker.

Northamptonshire CCGs will continue to work with HEE and primary care providers to explore opportunities this

type of role could bring to primary care. Evaluation of the impact will be undertaken and good practice will be

adopted and spread via feedback through the Primary Care Workforce Group.

5.4.5 Physicians Associates

Northamptonshire does not use Physicians Associates currently. This is largely because they are not a regulated

professional body at present which means they can’t be indemnified. Locally it is felt that any benefit a physicians

associate would give to practices would be negated by this lack of regulation and open the practices up to risk.

However with the recent government consultation and potential increase in university courses for Physician

associates the primary care workforce group is reviewing the use of this group of health care professional in primary

care.

5.4.6 Clinical Leadership Development

The GPs in clinical leadership positions within our county have a great deal of experience within their roles and all

recognise the need to ensure that there is an effective succession plan to encourage and develop the new cadre of

multi-skilled clinicians into these roles in the future. These roles present different challenges and require a great deal

of personal resilience. Since 2005, with the advent of at scale commissioning by GPs in various organisational forms,

the leadership positions are primarily as commissioners, but with the national direction of travel towards

Accountable Care Systems, these leadership roles will also sit within provider organisations. We are just setting up a

STP Primary Care Board and we will accelerate the creation of a local clinical leadership development programme,

working with East Midlands Leadership Academy, in order to ensure we have effective clinical leaders in the medium

and longer term.

5. Primary Care Workforce Programme Governance The Northamptonshire Primary Care Workforce Steering Group (NPCWSG) was relaunched with a stakeholder event

in May 2017. The group involves a wide range of stakeholders and has been meeting monthly since then (Terms of

Reference and Membership are include as Appendix 1).

The NPCWSG determines the annual workplan for the primary care workforce programme and tracks delivery

against each of the project milestones. The workplan can be found in section 7.

The group also act as support and help to unblock issues as they arise and regularly monitor the programme risk

register (Appendix 2). Progress is also reported bimonthly via highlight report to the Local Workforce Action Board

(LWAB) and monthly to the CCGs GPFV Programme Oversight Group and Primary Care Co-commissioning

Committees.

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6. Finance Recruiting additional staff and creating new roles in primary care will create cost pressures for practices where these

are above and beyond the usual staffing complement. Some of these schemes (like the international recruitment

and clinical pharmacists in general practice) are being pump primed through national GPFV schemes. Some will be

addressed through at scale and partnership working with other providers across the Northamptonshire system

rather than general practice having to directly employ and therefore hold the risk for its entire wrap around support.

There are 3 major areas of cost associated with the workforce strategy that are outlined below.

Implementation and co-ordination of the workforce strategy activities to ensure maximum value for money,

avoid any duplication of effort and ensure activities are integrated with all other GPFV and STP activities

Costs of recruitment of additional staff in primary care to meet the requirements of the GPFV and Northants

STP

Organisational development costs to, develop skills in the existing workforce and establish fully functioning

multidisciplinary teams in each primary care home.

6.1 Implementation Costs

These costs cover implementation and co-ordination of the workforce strategy activities to ensure maximum value for money, avoid any duplication of effort and ensure activities are integrated with all other GPFV and STP activities. Item Estimated Annual

Cost Funding Available (Y/N)

Comment

Programme Management

£60k N Role is current covered by existing staff but this may not be sustainable as more strategy projects come on stream

Clinical Leadership £30k N Role is covered by a clinical exec director with other responsibilities included in their portfolio but this may not be sustainable as more strategy projects come on stream

Practice engagement

£15k N Workforce modelling and engagement in planning of strategy activities requires input from the member practices which need adequate resourcing

Total £105k Table 8 Implementation Costs for Primary Care Workforce Strategy

6.2 Costs of additional staff needed in primary care

Commissioning of general practice is already delegated to Corby CCG The member practices of Nene CCG have

chosen to remain in joint commissioning arrangements of primary care with NHSE for now and will consult its

membership about the level of delegation in late 2017. We are aware that there are potential cost pressures

associated with delegation which will also need to be mitigated along with finding resources to support workforce

development in general practice.

To meet the stated targets of additional staff in the GPFV the estimated the annual additional cost of these staff is

listed below based on current rates.

Staff Group Number in target

Estimated annual cost

Funding Available (Y/N/Partly)

Comment

GPs 54 £5,500,000 Partly A proportion of these will come from the IR scheme for the first 3 years and this is therefore AMBER rated as part funded but need to ensure retention at the end of the scheme.

Clinical Pharmacists

17 £900,000 Partly These are initially funded from the national scheme and this is therefore AMBER rated as part funded but need to ensure retention at the end of the scheme.

Mental Health Workers

17 £820,000 Y These will need to be realised through working differently with our current IAPT provider.

42

Total £7,220,000 Table 9: Programme Costs for Primary Care Workforce Strategy

In addition to these staff groups specifically listed in the GPFV our SWiPe workforce analysis to be completed by

March 2018 will give us some idea of how many additional staff from other staff groups such as nursing will be

required and the level of competence we are likely to need for each group. This modelling will be linked with the STP

business case around the development of primary, community and social care to support people outside hospital.

6.3 Organisational Development Costs

The Primary Care Workforce Strategy Group has already presented a range of business cases to LWAB associated

with delivery of the 17/18 workplan. These are a direct result of the strategy.

The table below lists these cases and estimated future costs it also lists other workplan activities that are likely to

need funding in future years for strategy implementation to be successful

Initiative 17/18 Cost (£000)

18/19 Cost (£000)

19/20 Cost (£000)

Comment

SWiPe Modelling

£19 £20 £0 Funding confirmed for 17/18. It is likely that roll out to another 3 clusters will be needed in 18/19 to gain sufficient high quality data to support planning and workforce transformation

GPN mentorship

£30 £15 £10 No funding obtained to date

IR support

£15 £10 £0 Business case presented for 17/18. Future years funding will be determined by 17/18 experience but additional support is likely to be needed over the 3 year contract

Clinical Pharmacists in General Practice

£15 £10 £0 Business case presented for 17/18. Future years funding will be determined by 17/18 experience but additional support is likely to be needed in 18/19 to support full integration of pharmacists into general practice

Development of Community Clinics

£15 £15 £15 Business case presented for 17/18 Future years funding will be determined by 17/18 experience but local demand management plans are promoting the roll out of community clinics as an alternative to hospital care where appropriate and therefore support for associated skills development in primary care is therefore likely to be needed for next 3 years

Locum Software/Staff Bank

£10 0 0 Business case presented for 17/18

General practice nurse development including improving training capacity in general practice.

Specific funding requirements still to be confirmed

Support for practices to take on the support for pre-registration nurse placements

Specific funding requirements still to be confirmed

Development of local competency framework for

£30 £15 £10

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HCA's Table 10: Current Project Funding for Primary Care Workforce Strategy

6. Workplan 17/18 and 18/19

Priority

1 = High

priority

Write workforce strategy (Include

practice nurses )

Completed

strategyAll 1

Beth

GeorgeJul-17 Sep-17

For consultation following

the Sept working group

meeting

Scope/promote and increase number

of apprenticeships (bands 1-4) in

general practice

Increased no of

apprenticeshipsStrategy 2 LMC Jul-17 Ongoing

Targeted / international recruitment

campaignsSuccessful bid Strategy 1

Julie

LemmyJul-17 Nov-17

Joint bid with Leicester

based on the Lincoln model

being submitted in

November. Julie Lemmy

leading for Nene & Corby.

An expression of interest

has already been

submitted.

Identify fellowship opportunities for

18/19

2 Fellowships

offeredStrategy 3

Naomi &

SanjayApr-18 Ongoing

Mental health therapists to work in

primary care by 2020,

17 in place by

2020

Care

Navigation1

Richard

SmithApr-18 Mar-20

STP Delivery plan states 10

by Mar 18 and 17 by Mar

19

Secure funding from national sources

to support general practice nurse

development including improving

training capacity in general practice.

Funding

obtainedStrategy 1

Sharon /

TinaTBC TBC

GP Nurse Development

StrategyPublished (10 point

plan) by end July - used to

get around £30k LMC have

found a bit of money for

trainin g from Sept 17

Yes

Identify sources of funding for

practices to take on the support for

pre-registration nurse placements

Funding

obtainedStrategy 1

Sharon /

TinaTBC TBC

Limited funding to support

practices for the amount of

work needed from the

practice

Yes

In light of PCH and MDT working

improve access to funded training for

practice nurses and other health

professionals (PLT)

Revised offer

for PLTStrategy 2

Louise

TarpleeAug-17 Mar-18 Yes

Identify sources of funding to support

delivery of the Local competency

framework for HCA's

Funding

obtainedStrategy 2

Sharon

FirminTBC TBC

20 HCA's have gone

through this. Exists but

money ran out. What has

happened as a result of this

Yes

Ensure leadership training is being

used to support PCH

Training is

adaptedStrategy 2

Louise

TarpleeTBC TBC

LMC have paid £2000 to

EMLA so this can be

accessed

Enhance support for GP locum posts -

Support for practices to share locums

easily

Locum pack

systems in

place

All 1Beth

GeorgeSep-17 Mar-18

Evidence for revalidation,

evening for locums

Promote current retainer scheme

opportunities for nurses through

communication campaign.

Scheme

promotionStrategy 1 Sharon Ongoing Ongoing

Communication needed -

Re below

Positively promote returner scheme

to attact retired GPs back into

practice

Scheme

promotionStrategy 1

Julie

LemmyOngoing Ongoing

Awaiting an update from

Lamont (NHSE)

Roll out SWIPE Tool across selected

clusters

Identification

of roles and

competencies

required

withing general

practice

Strategy 1Jane

FinchSep-17 Mar-17 SWIPE Funding via LETC

To explore the potential for

expanding the scope of CEPNs

beyond pre registration education -

How do they support GPFV/NCM etc

CEPN Workplan

aligned and

shared

All 1Jane

FinchSep-17 Mar-18

Training for reception and clerical

staff

Local stakeholder

workshops and clinical

template complete. Online

training in progress with

face to face training due to

commence 15 Aug

Care Navigation

Next steps to investigate

training for document

management

Document Management

Vulnerable practices

Practice

entered into

scheme

Strategy 1Julie

LemmyOngoing Ongoing

Funding is no longer

available

What needs to be done? Deliverable

Cross-

referenced

projects

Lead Start Date RAGComments on delivery of

the action

Investment Needed -

Primary Care bid to

support action

All practices

Care Navigating

and

implemented

document

management

learning

Strategy 1Jane

FinchJul-17 Jul-18

Delivery / Review Date

44

Table 11:Northamptonshire Primary Care Workforce Steering Group Workplan 17/18 to 18/19

Note that the workplan will be refreshed to incorporate actions that result from SWiPe Primary Care Home Explorer

Sites in April 2018.

Appendix 1 – Steering Group Terms of Reference

1. PURPOSE

The purpose of this group is to;

a. Take forwards the GP 5YFV for the County and identify strategic primary care workforce supply, education priorities and risks.

b. Co-ordinate and input into the workforce activities within Northamptonshire which support the Sustainability and Transformation Plan (STP) with key stakeholders and HEE in relation to future and current workforce development in respect to the Primary, Community and Social Care portfolio.

c. Facilitate workforce planning and education development for Northamptonshire Primary Care workforce to support the delivery of the local STP strategic direction and service transformation.

d. Identify key workforce and education issues and risks and make recommendations to LWAB on solutions and priorities for Primary Care work programmes.

e. Oversee and develop the implementation of collaborative solutions and action plans and recommend business cases to the Workforce Transformation and Education Group for approval where required.

f. Work collaboratively across the commissioning groups, Local Medical Committee and other Local Professional Committees, Federations/ Super practices and other service providers.

g. Lead on primary care workforce planning and education development and provide recommendations to HEE and Northamptonshire LWAB (through the Workforce Transformation and Education sub-group) LWAB as the decision making body.

h. Influence HEE investment on primary care workforce education for the County and to oversee utilisation of local funding allocations in respect to Primary Care

i. To act as the workforce reference group for Northamptonshire Primary Care Co-Commissioning.

The principles underpinning the Northamptonshire Primary Care Workforce Group for developing the current and

future workforce are to deliver and ensure:

• Clinical outcomes: Improved clinical outcomes for patients across Northamptonshire • Patient experience: Improved patient experience across Northamptonshire • Equity of care: Aiming for consistency of service provision, variability will be minimised in access to quality

and sustainable services; • Population health needs: Are met across the whole of Northamptonshire; • Value for money: Cost effective service delivery and maximisation of available resources; • Strategic fit: Services meet nationally defined standards; • Sustainable services: Clinical, operational and financially sustainable services.

The overarching purpose of the group is to support the development of sustainable (clinical, operational and financial)

primary care workforce plans for the benefit of the Northamptonshire patients and population served.

2. ACCOUNTABILITY

The Primary Care Group will co-ordinate and inform a series of work programmes to support the development of the

primary care workforce across Northamptonshire, ensuring that organisations work together collaboratively to address

the challenges and deliver solutions.

Primary Care Workforce Delivery Group (PCWG) A delivery group of the Workforce Transformation and Education

Group of the Northamptonshire Local Workforce Action Board

45

The group is accountable to the Northamptonshire Local Workforce Action Board (LWAB) through the ’Workforce

Transformation and Education’ sub-group for local delivery of agreed initiatives, actions and funding allocations (CCG

and LMC representatives to attend this meeting and link back to PCWG).

3. OPERATING PRINCIPLES

LWAB will agree the priorities of specific projects to be developed that are aligned to the STP timetable for the

programme of expected service change and implementation for delivery. Any specific projects developed will be

supported with project documentation such as a project initiation document, risk register and appropriate delivery

monitoring and reporting schedules. The Workforce Transformation Group will support the Primary Care group to:

Act as an expert reference group, to share experience and best practice for primary care workforce

transformation to support delivery of the workforce elements of the Northamptonshire STP.

Work collaboratively to support solutions of the LWAB and workforce transformation activities across

Northamptonshire.

Provide professional and service leadership for the design, testing and implementation of the project

proposals

Manage successful delivery of approved project milestones aligned with the requirements of the STP, within

an allocated budget and meeting the agreed HEE (ME) investment principles and framework whilst

implementing appropriate actions to mitigate identified risks and highlighting any risks to the LWAB via the

Workforce Transformation and Education Group.

4. SCOPE

a. Northamptonshire Health Community

b. Initially to focus on the Primary care workforce but also liaising with dentistry, Ophthalmic and Community

Pharmacy networks in respect to the wider primary care workforce.

5. LOCAL GOVERNANCE STRUCTURE The group will:

Provide assurance to the LWAB via Workforce Transformation and Education Group that appropriate

workforce activities/programmes are in place to deliver Northamptonshire primary care workforce

requirements link to the STP as timetabled within the STP programme of service changes.

Ensure appropriate arrangements and robust processes are in place to meet HEE(ME)governance

requirements for assessing and reviewing proposed investment projects and their supporting documentation

Local LWAB and Sub-group governance arrangements;

46

CONFLICTS OF INTEREST AND DECISION MAKING

The Group will ensure all interests are considered and ensure any conflicts between different interests are

reconciled. This is an advisory group and all decisions will be through the LWAB via WTG/Education

Group. The Chair of this group is a member of LWAB.

6. MEMBERSHIP

Job title Organisation

Training Lead/CEPN Representative Principal Medical Limited

Assistant Director of Safeguarding NHS Corby & Nene CCG

Training Lead/Representative Lakeside Healthcare

Clinical Executive Director for Primary Care NHS Nene CCG

Training Lead/Representative GP Alliance

Medical Director NHS Nene CCG

Local Medical Committee Manager Local Medical Committee

GP Board Member NHS Corby CCG

Deputy Director of Primary Care NHS Nene & Corby CCG

GP Dean (or Deputy) Health Education England - East Midlands

Commissioning Development Manager NHS Corby CCG

Pharmacy Lead NHS Nene & Corby CCG

Training Lead/CEPN Representative 3Sixty Care

Workforce representative Health Education England - East Midlands

Workforce or Service Representative NHFT

Northants STP HR Director Representative TBC

The Chair and Deputy Chair to be nominated from the above members.

Ad hoc representation as required from the following groups;

Practice Nurse

Practice manager

STP Oversight

Group Local Workforce Action

Board to support Northamptonshire STP

OD Group HR

Collaborative Group

Workforce Transformation and Education Group

Primary Care Group

Talent for Care

Education Reference

Group

Medical Education

Group

HEE Midlands and East Governing

Body

HEE-EM Strategic Prioirities Steering

Groups

Northants representatives to

link to LWAB

47

Dental

Ophthalmic

Community Pharmacy

Community Education Provider Networks

GP Federations

Social Care

Voluntary and Community Sector

The tenure for members will be for a twelve month period from commencement of the group. At this point in

time all representation will be reviewed and any members not contributing or attending meetings on a

regular basis will be replaced.

7. MEETINGS AND ATTENDANCE The meetings will be held on a bi - monthly basis with extra-ordinary meetings arranged as and when

necessary agreed by the membership.

The representatives should make every effort to attend; in exceptional circumstances when this is not

possible deputies will be allowed. A meeting attendance list will be collated

8. ROLES AND RESPONSIBILITIES The main function of the Group is to ensure the delivery of the aims and objectives for the primary care

workforce aligned with STP priorities. Each area of work needs to be approved by the Workforce

Transformation and Education Group, authorised by the LWAB and subsequently to be assured by the

HEE Midland and East Integrated Assurance and Performance Committee.

9. INFORMATION FLOWS AND REPORTING Members of this group have responsibility for consultation and communication with their organisations,

stakeholders and networks.

The project progress reporting will be in accordance to the meeting frequency. Any risk or issue needs to

be escalated to the LWAB via the Workforce Transformation and Education group.

The Group will be responsible for reviewing progress against key performance indicators/milestones in

respect to primary care provision and be engaged in the design of metrics and performance monitoring

processes. The Workforce Transformation and Education Group will be provided with regular updates in

order to monitor performance.

10. SECRETARIAT Agendas and papers will be circulated 7 days in advance or in extreme circumstances 3 days prior to the

meeting. Nene CCG Localities Team will provide secretariat support

11. QUORUM The meeting will be deemed quorate under the following circumstances:

Attendance of the Chair or the Deputy Chair

50% attendance from representatives or their deputies

Additional members may be co-opted as required to develop particular areas of work.

The Chair or Deputy Chair will make decisions on quoracy for individual meetings depending on the items

for discussion, members present and decisions required. Additional members may also be co-opted as the

group develops.

12. REVIEW & APPROVAL

48

These Terms of Reference are subject to ongoing review by Workforce Transformation and Education

Group on behalf of LWAB:

Date of review and approval by WTG & Education Group

Next review date:

March 2017 March 2018

49

Appendix 2 – Workforce Risk Register Risks arising from the Primary Care Workforce Strategy have been added to the GPFV programme risk register to

ensure that they are considered as part of the wider programme.

The Northamptonshire GPFV risk register is embedded below.

Northamptonshire

GPFV Risk Register Nov 2017