Reshaping the healthcare workforce - Candace imison
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Transcript of Reshaping the healthcare workforce - Candace imison
© Nuffield Trust 11 March 2016
Reshaping the healthcare
workforce
The Nuffield Summit
3rd March 2016
Candace Imison, Director of Policy
Twitter: @cimison
© Nuffield Trust
The challenges we face – the need for
transformation
• Ageing population + rising burden
of chronic disease/co-morbidity
• Changing relationships with
patients & staff
• Impact of new medical and
information technologies
• Growing gaps in medical and
nursing workforce + 24/7 working
• Productivity challenge – £22bn by
2020
© Nuffield Trust
New models of care rely on significant change in the
workforce
“We can design innovative new
care models, but they simply
won’t become a reality unless
we have a workforce with the
right numbers, skills, values and
behaviours to deliver it” (Five
Year Forward View, 2014)
© Nuffield Trust
Most of the workforce in 10 years time – here today
Current
Staff Mix
Numbers
Roles,
Skills
Skill Development: Role enhancement Role enlargement
Skill Flexibility: Role substitution Role Delegation
New Roles
Future
Staff Mix
Numbers
Roles,
Skills
Current training pipeline
© Nuffield Trust
Important opportunities at all levels in the non-medical
workforce
Expand number of
advanced roles
Extend skills – work to top of
license
Develop and expand support
workforce
© Nuffield Trust
There is a lot happening: NHS Employer’s conference
feedback
• “Paramedics working in A&E
resus”
• “MRI assistant practitioners”
• “Advanced nurse
practitioners leading out of
hours”
• “Generic apprentice”
• “Holistic worker”
• “Assistant practitioner,
maternity”
• Physicians associate
© Nuffield Trust
Band 4 Associate Practitioners, Bradford District Care
• Driven by vacancies in band 5 mental health
workforce (wards)
• Used Calderdale framework to develop
competencies for APs
• Work on ward and in community
• APs in community run physical health clinics
Enablers Barriers
LETB and CCG funding Professional resistance
Relationships with local GPs Concerns from GPs
Supportive leadership
Robust template for physical
checks
© Nuffield Trust
Physician Associates, St George’s Hospital (with a focus on the
neurosciences care group)
• 10-15 PAs – driven by lack of jnr doctors
• Attend ward rounds, assess patients and organise aspects of the management plan
• PAs and senior clinicians positive about impact, particularly providing continuity of care and a flexible workforce
Enablers Barriers
Strong leadership Professional resistance
Post-grad training programme with
ongoing governance & supervision
Inability to prescribe or request
ionising radiation
Good consultant buy-in Lack of formal regulation
Career path flexibility
© Nuffield Trust
The opportunities from reshaping the workforce
• More patient focused care
• Improved health outcomes
• More rewarding roles & happier staff
• Improved collaboration and support
• Improved recruitment and retention
• Addressing workforce gaps
• Better use of resource
© Nuffield Trust
Lessons for implementation
• Build roles on a detailed understanding of patient needs and
necessary skills
• Strong communications and change management strategy
• Invest in the team not just the role
• Support task delegation - you may need to de-commission old roles if
commissioning new ones
• Build sustainability through clear career pathways and evolve to make
the best use of new skills
• Evaluate the impact of your workforce redesign
© Nuffield Trust
Messages to National Bodies
• Needs dedicated and protected investment – HEE
• More consistent nomenclature and national competence frameworks
• Need for consistent messages from system regulators – new and extended roles
• Bridge the current regulatory gap – professional and system regulators
• Help resolve legal indemnity challenges in primary care
• National research and evaluation – with guidance for local evaluation
© Nuffield Trust
Looking to the future
• New service models -- increasing no. of boundary spanners
• Professional focus => patient focus - professional boundaries breaking down
• Growing delegation of decision making rights
• New training models – “half-life” of knowledge falling
• Increasing importance of peer and carer support networks
• Increased focus on population health
• Information and medical technologies support change
© Nuffield Trust
One vision of the future:
“The paradox of the future health system is that we will have
much more primary care, and primary care will be more important
than ever, but it will be supplied predominantly by patients and
non-physicians, with back up from specialized primary care
providers who are master diagnosticians and clinical decision
makers, powered by health information and organizational
supports”
David Blumenthal, Medical Professionalism in the New Information Age