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
1
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
2
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
3
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.
4
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.
5
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
6
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
7
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:
8
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
9
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
10
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:
11
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
12
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.
13
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
14
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
15
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
16
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
22
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
30
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
31
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
32
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
33
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.
34
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.
35
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.
36
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”.
37
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.
38
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
39
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
40
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.
41
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
43
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
Top Related