11/04/2014 General Practice Primary Care Workforce Planning & - - PDF document

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General Practice

Primary Care Workforce Planning & Development Community Education Providers Network Abdol Tavabie

Dean of Postgraduate General Practice Education

April 8th 2014

General Practice

Heath Service Needs strong General Practice

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Primary care is considered to be the bedrock of NHS care provision, offering entry into the system for all new needs and problems….(it) provides person focussed (not disease oriented) care over time, provides for all but very uncommon or unusual conditions, and coordinates or integrates care provided by

• thers’

Starfield, 1998

General Practice

The NHS

• Demands on general practice have never been greater
• Primary care sees more patients than ever with complex needs
• Constant drive to meet higher standards of safe care and report back
• Primary care's share of NHS funding has fallen. The budget for the NHS

is unlikely to increase any time soon.

• Changing workforce and challenges in recruitment and early retirement

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General Practice

2012 Provider driven survey in KSS

• 640 practices, of which approximately 100 are single handed.
• 3,350 GPs (approx. 3,000 WTE); 22% are over age of 55
• 1,800 practice nurses occupying 1,000 WTE ;20% are over

age of 55

• 1,000 ‘other direct care’ staff occupying 560 WTE.
• 7,000 admin staff occupying 4,300 WTE.
• Large vacancies of practice nursing and health care assistants
• Shift of services and long-term conditions dealt with in primary

care; A need for longer consultation time

• Workforce work patterns is changing to be more Less Than

Full Time

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Primary Care: Mission Critical to the NHS

There are 4.3 million people in Kent, Surrey and

• Sussex. On a typical day such as today:
• 80,000people will visit their GP or primary care

nurse

• 3500people are referred by GPs to specialists
• 5,000people will attend Accident and Emergency

departments

• 800 people will be admitted acutely to hospital

Variation in Primary Care provision has a disproportionate effect on secondary care

General Practice

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HEE Future Workforce Trends

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KSS Future Workforce Trends

8 Health & Social Care Information Centre Census 2013 9

National Picture

• 2014- 51% of Drs in England are female.
• By 2021 - 16,000 GPs short - RCGP annual census

figures show greater number of female GPs than male counterparts for the first time.

• UK trained Drs, Nurses and AHPs choosing to move

abroad.

• Medical Procedures and Information Technology

changing type of work.

• National Quality Board - Safe Staffing Levels
• 24/7 Service– skills mix, new ways of working
• Better Care Fund
• Integrating Health and Social Care – One Team

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www.hee.nhs.uk www.hee.nhs.uk Our starting point is that GPs make up around 20% of the Primary and Community Services Workforce

• 75.8% of the community and primary care professional workforce are nurses.
• GPs represent 19.9% of this workforce and AHPs 4.3%.
• These figures do not include the pharmacy workforce as there is currently no reliable measure
• The setting of care in which Consultants, GPs, and qualified nurses practice has remained broadly static
• ver the past seven years. Currently this is 62.8% in Hospital and 37.2% in community & primary.
• Rapid growth in the community nursing workforce has been offset by the growth in the hospital

consultant workforce.

Qualified Nurses, Consultants and GPs in Health and Care Workforce 2012 2005 FTE % FTE % Hospital Based 275590 62.8% 267007 62.1% Primary & Community Based 163280 37.2% 162883 37.9% All Medical & Nursing 438870 429890 31578 14695 31269 6381 18035 50000 6884

Primary and Community Care Registered professionals

GPs Practice nurses Community nurses District nurses Community MH and LD nurses Nurses in social care settings AHPs The pharmacy workforce has not yet been quantified

Coulter (2013) in Ziebland et al Understanding & using health experiences OUP

Listening to patient experience Medical advances Complexity & fragmentation Medical advances

General Practice

Seventh National GP Work life Survey 2012

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Job satisfaction The level of overall job satisfaction reported by GPs in 2012 was lower than in all surveys undertaken since 2001. On a seven-point scale, average satisfaction had declined from 4.9 points in 2010 to 4.5 points in 2012 in both the cross-sectional and longitudinal samples. This change is robust to the changing age-sex composition of GPs, which has remained relatively stable in recent years. The largest decreases in job satisfaction between 2010 and 2012 were in the domains relating to ‘hours of work’ and ‘remuneration’. The changes were much smaller in the other specific domains of job satisfaction.

Intentions to quit The proportion of GPs expecting to quit direct patient care in the next five years had increased from 6.4% in 2010 to 8.9% in 2012 amongst GPs under 50 years-old and from 41.7% in 2010 to 54.1% in 2012 amongst GPs aged 50 years and over. Conclusion The 2012 survey reveals the lowest levels of job satisfaction amongst GPs since before the introduction of the new contract, the highest levels of stress since the start of the survey series, and a substantial increase over the last two years in the proportion of GPs intending to quit direct patient care within the next five years

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www.hee.nhs.uk www.hee.nhs.uk

• 50.0%
• 30.0%
• 10.0%

10.0% 30.0% 50.0% 70.0% 90.0% 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Other Community Nurses Community Mental Health Practice Nurses GPs District Nurses

Rate of Growth in the Community & Primary Care Workforce 2002 -2012

Over the last decade, the number of GPs has risen by 18% and the number of nurses in community settings by 32%

• The total number of qualified nurses in community settings has increased at a faster rate than all other

professions except hospital consultants and hospital pharmacists.

• The picture for the different components of this nursing workforce is mixed, ranging from a 39% decrease in

District Nurses to a 71% increase in other Registered Community Nurses.

• The main driver of these changes are the decisions of local commissioners and providers in terms of how

they have chosen to staff community teams and services.

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RCN “Frontline First More than just a number March 2014 special report” published 11/3/14

Create the capability to lead patient experience and outcome focused education and development Move from historic strategies based on each professional group in isolation To integrated education strategies focused on patient care groups, that are evidence based and evaluated Integrated Education Strategies Service Redesign

Patient care groups Evidence based Evaluated

Medicine Dentistry Pharmacy GPs AHPs Nursing Bands 1 - 4 Healthcare Scientists

HE KSS

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Key Messages

• Workforce must be aligned to service – not

vice versa.

• Care closer to home through care

pathways.

• Effective teams are more important than

individual excellence.

• Funding should align with training need –

not based on history.

• Most of the future workforce is already

working in the NHS – CPD Spend should reflect this.

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HE KSS

• HEE - £5b annual budget, spending over

£9,500 a minute on education and training.

• HE KSS £280m annual budget, spending
• ver £528 a minute on education and

training.

HE KSS SDS Priorities

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• 1. Dementia care

Ensure staff have assessment and diagnostic skills so that people with dementia benefit from early diagnoses; Ensure those looking after people with dementia have support and training to provide excellent care; Develop supportive and effective on-going care planning and case management skills from diagnosis to end of life care.

• 2. Primary care

Ensure the primary care workforce is able to meet the challenges of the future by developing a primary care workforce strategy

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• 3. Emergency care

Realise the potential of the whole emergency workforce team to maximise their contribution; Support providers with workforce and education interventions to develop alternative models of emergency care provision.

• 4. Children and Young People

Contribute to the health and wellbeing of children and young families by supporting growth in the health visitor workforce.

• 5. Compassionate care

Recruit and educate students with the right values and behaviours so that patients and their families experience compassionate and dignified care.

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HE KSS Priorities

Service Driver Workforce Priorities Skills Development Strategy Older People Dementia

• Diagnostic Skills
• Awareness Training – over 15000 by Dec 2013
• Education and Training for Carers
• Dementia Fellowship programme
• Student/Trainee Shadowing.

Improved Mortality Emergency Care

• Additional Emergency Care medicine
• Improved Clinical Decision Making – eg 111

programme.

• Increased paramedic commissions.

Long Term Conditions Primary Care

• Community Education Providers Network
• Practice Nurse Development – common pathway
• Increased placement capacity for students and trainees
• Oral Hygiene programme with nursing/care homes.

7 Day working – safety and access Children & Young People

• Health Visiting
• Asthma UK
• Joint working with social care and education.

Francis & Berwick Compassion & Patient Safety

• Resilience – Swartz rounds
• Florence Nightingale Fellowships - Bespoke
• Quality Improvement methodology training/AHSN

General Practice

Primary and Community Care Workforce Planning and development

• Phase one- Primary Care based in General

Practice

• Phase two- Community clinicians and other

Providers including Dental Practitioners, Pharmacists and Optometrists and their staff

• Phase three- Cross boundary working

between primary and secondary care services

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General Practice

Primary Care Workforce Planning and Development

The underpinning aims of the Health Education England is to:

• Improve Quality of patient Care
• Develop a whole workforce responsibility
• Develop a multi-professional ethos- team based care

The HEKSS is signed up with the above principles & 1. To improve education and training for all the workforce 2. To increase placements in primary care and community for the future generation of clinicians including Nurse students, GP Trainees and Paramedic Practitioners students and Health Care Assistants 3. To put in place a robust plan for the future workforce planning in primary care and community

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Developing Community Education Providers Network (CEPN)

–Designed to train staff for where population will need

• care. (closer to home)

–A Network of Community Providers which:

• Offers all students, trainees, staff

and the public a new exposure to population based healthcare

• Multi-professional education and

training

• Inter-professional working &

learning

Academic input from AHSN& HEIs Public health Third sector Other providers Specialist training & placements Local Authority CCG alignment Palliative Care, mental health

Population CS Cc SS Ph REGISTERED PATIENTS Teaching & innovative practices and smaller GP surgeries Social Services Paramedics Pharmacists Community Consultants Community Services A centralised unit, Within which services Maintain autonomy

Community Education Providers Network (CEPN)

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General Practice

Potential advantages of Community Education Providers Network (CEPN)

• A solution to premises constraints
• A positive approach to multidisciplinary workforce.
• Improving the provision of training for healthcare working together for local

community

• Encouraging the use of limited resources to improve workforce planning and

development.

• Collaboration will deliver large scale change
• Enable provider-led change and improvement
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General Practice

Supportive services to deliver CEPN

• Identify and train practice nurses to be Nurse Mentors (5 days training)
• Setting up local learning sets for Nurse Mentors
• Creating a Primary Care Tutor post (half time)
• Placement of nurse students with Nurse Mentors in general practice
• Negotiation to set up Practice Nurse Banks to create capacity
• Tasters for secondary care nurses in General Practice
• Setting up Primary Care Academic Unit in University of Kent
• Setting up a common practice nursing education pathway in universities
• Setting up a common Health Care Assistants training

26 General Practice

Supportive services in implementing CEPN

• Free 5 days Nurse Mentor training in any of universities (Greenwich,

Canterbury Christ Church University, Brighton and Surrey universities).

• Bursaries to Practices to release practice nurses to be trained
• Placements Tariff rate(£83.55) per student/per week
• Funding for CCG to appoint a Primary Care Tutor ( half time)
• Setting up Local Learning sets

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General Practice

Progress so far

• Clinical Leads &Accountable Officers have been visited 21/21

CCGs; all positive

• 14 CCGs have signed up the Memorandum of Cooperation

with HEKSS in 2014 and others later.

• All four universities are visited and fully supportive to train

Nurse Mentors and place student nurses in CEPN

• Community NHS Trusts have agreed to extend the nursing

bank to include Practice Nursing.

• A Primary Care Project Board with membership of all

stakeholders has been set up and met three times.

• Appointment of a project manager: Mr Nicholas Barry-Tait

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Progress so far Continue 2

• An agreement has been reached to set up the University of

Kent University Primary Care Academic unit in Partnership with the HEKSS to support primary care workforce in their education &training, research activities and innovation.

• We have appointed Professor Patricia Wilson as the

Professorial Chair for Primary Care Academic

• A four universities working party has produced a common

educational pathway for Practice Nurses with aspiration becoming Advanced Community Nurses in future

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Health Education Kent Surrey and Sussex

working in partnership with

Canterbury Christ Church University University of Brighton University of Greenwich University of Surrey

COMMON EDUCATIONAL PATHWAY FOR PRACTICE NURSES

PROPOSAL for Presentation to the Primary Care Programme Board Members

March 2014

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General Practice

Progress so far (continued)

A four universities working party has been set up to create a common educational pathway for Practice Nurses with the aspiration to become Advanced Community Nurses in future.

• Practice Nurse education pathway
• Nurse Practitioners in community pathway
• Advanced Community Nurse Specialist pathway
• And Physician Associates pathway for Health Care Assistants

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General Practice

Supportive services in implementing CEPN

• Free 5 days Nurse Mentor training in any of the universities (Greenwich,

Canterbury Christ Church University, Brighton and Surrey).

• Bursaries to Practices to release practice nurses to be trained
• Placements Tariff rate(£83.55) per student/per week
• Funding for CCG to appoint a Primary Care Tutor ( half time)
• Setting up Local Learning sets

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General Practice

Progress so far (continued)

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An agreement has been reached to set up the University of Kent Primary Care Academic Unit in partnership with the HEKSS to support primary care workforce in their education and training, research activities and innovation;

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General Practice

Future Workforce (continued)

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• Establishment of Intercalated BSc for medical students from all medical schools in particular

Kings and St Georges.

• Development of 4 months block GP academic taster experience for the Foundation Year 2
• Enhanced GP specialty training-4 years including “out of programme” experience of MD ,and
• r PhDs
• Integrated approach with other professional groups including formal multi-professional

academic MSc degree.

• Joint appointment between the NHS and universities for GPs and Practice Nurses and

Practice Managers

• New Post- Doctoral Clinical Lecturer Posts (Nurses and doctors) (50% academic & 50% clinical

NHS services)

• Building on the current GP Department MSc degree in the Strategic Leadership and Medical

Education to be accessible to all professionals in order to act as the future clinical and educational supervisors “ Strategic Leadership and Multi-Professional Education”

• Increased recruitment of all trainees especially GP trainees who are motivated, capable

practitioners

• Multi- professional Perceptorship programmes for newly qualified GPs and practice nurses

for working and learning together, in order to manage the transition

Impacting Positively on Health and Well-Being For All

Invert the care pyramid for better

• utcomes at lower cost

Acute Episodes Poor escalation management Low level intermediate services Low level of supported care Self-care low

Existing model of care

11/04/2014 13 Invert the care pyramid for better

• utcomes at lower cost

Future model of care

Acute episodes Best practice escalation management Nurse care co-ordination Supported self-care Self-care