1. health and fitness

Paper C
Health Education East Midlands Governing Body
20 May 2015
Transformation and Vanguards
Purpose of this paper
Following the publication of HEE Workforce Planning Guidance 2015/16, it is clear that our
role in supporting the Five Year Forward View is central to facilitating service transformation
at scale and pace. This requires more targeted investment in our existing workforce as well
as commissioning new roles for the future. In order to do this, HEE will need to redirect
investment into the new models and settings of care, rebalancing investment between the
future and current workforce, and supporting the promotion of wellbeing/prevention of illhealth, including the pivotal role of self-care and management.
The LETB role in meeting the needs of today’s patients whilst delivering the future workforce
that maintains safe staffing levels as well as supporting the service transformations
necessary to improve quality of care is a challenging one.
Our approach to transformation, using workforce innovation to support service change –
needs to be reviewed alongside our use of workforce development funding. The HEE
Workforce Planning Guidance 2015/16 seeks to ensure that we are supporting service
delivery requirements and are aligning mandate, business plan priorities and local plan
priorities to transformation programmes, supporting wider workforce and current workforce
development as well as future workforce issues.
Why is it important?
This framework will be supplemented shortly to provide more comprehensive guidance
expanding on:
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how many of any given group there are currently (stock), and where they are;
the demographic characteristics of that stock and how these influence labour
market behaviour (so HEE can model flows);
forecast demand for the group concerned; and
how they are currently or might in future be trained, and how long it takes / will
take.
two to four large medical specialties upon which HEE intends to focus will be
agreed and announced and we will initiate stakeholder engagement;
small specialties which HEE will focus on will be agreed with LETBs, leads within
LETBs will be identified, and stakeholders informed; and
the professional groups for which planning will be led at national and at cluster
level will be agreed and stakeholders informed.
To support provider organisations including primary care providers and public health
providers we need to develop and deliver an effective workforce strategy to meet
patients’ needs, including shorter term supply initiatives.
How it links to our strategic priorities?
The combined leadership of the NHS has signalled that the NHS must develop a
workforce able to work across acute and community boundaries and beyond traditional
professional demarcations, with flexible skills and with the ability to adapt and innovate.
The NHS leadership has also established a new Workforce Advisory Board with senior
membership from across the system to develop a health and care workforce with the
skills to support the implementation of new models of care and 29 ‘vanguard’ sites have
been selected to pioneer new models of care delivery;
The over-riding aim of the HEE Mandate and Business Plan for 2015/16 is to deliver high
quality, effective, compassionate care; through the development of the right people with the
right skills and the right values. Delivering world class compassionate care is dependent on
the quality of the education and training available both formal and informal throughout a
healthcare professionals career.
HEEs Forward View into Action makes clear that:
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We will work together to accelerate the design of new models of care, with a
structured programme of support.
The workforce will be central to the development of the new models of care: the
provision of health and care is delivered by people not buildings.
We expect providers and commissioners to engage with their Local Education
and Training Boards (LETBs) to work together to identify their current and future
workforce needs. For those economies that wish to put themselves forward to cocreate the new care models, we expect to see plans to develop the existing and
future workforce plans to develop these models. In challenged health care
economies, a plan to deliver workforce needs will also be a key ingredient of
success.
Planning assumptions must be shared between commissions, providers, LETBs
and other partners to ensure alignment, with LETBs triangulating their plans with
local commissioners and providers before submitting them to HEE.
The Workforce Advisory Board (WAB) has identified four area of focus:
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additional actions to retain existing staff and attract returners in roles
experiencing shortages such as Emergency Medicine, nursing and GPs;
provide support to challenged economies where workforce shortages are
impeding improvement;
identify the flexibilities that will need to be developed in order to deliver new care
models as well as opportunities to reskill the existing workforce;
identify new roles that may need to be commissioned to deliver on the aspirations
of the Forward View.
East Midlands Vanguards
There are 5 vanguards proposals in the East Midlands. These are:
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Integrated Primary and Acute Care Systems (Mid Nott’s)
Multispecialty Community providers (Derbyshire Community/Principia/Lakeside)
Enhanced Health in Care Homes (Nottingham City)
Two day site visits have been held in each Vanguard site facilitated by NHS England. HEEM
have been represented at all visits as part of NHE England’s subject expert’s panel. These
have aimed to reach collective agreement on what is required in order to deliver
demonstrable improvements in patient care locally and within a one, two and three year time
horizon. This has included:
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The aims, objectives and expected clinical and non-clinical outcomes for the
new care model
The progress to date and current position against the objectives;
The support required to enable the Vanguard to overcome identified barriers
and accelerate delivery;
To start the dialogue about what the compact between the New Care Models
team and Vanguard will look like.
What are the implications/options/possibilities/risks/consequences/impacts?
The consequences of not supporting the transformation agenda and the identified vanguard
sites are that there will be a shortfall in appropriately trained staff across our health
communities with mismatched investment and a slower pace of change in service
transformation.
What action/output/come is required?
The Governing Body need to identify the support it can give to deliver the 5 Year Forward
View alongside the HEE Mandate and Business Plan for 2015/16. Supporting
Transformation through workforce development is key for health communities to reshape the
healthcare workforce, support service integration and deliver new models of care. The
HEEM Governing Body need to ensure that our plans:
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demonstrate how service transformation will be driven through a combined set of
actions with regard to the numbers, skills, values and behaviours of their
workforce;
show the local component of any activity and investment agreed collectively at a
national level; and
explain how any barriers to implementation, e.g. placement capacity or
sustainability of education provision, have been fully identified, discussed, and an
approach to overcoming any such barriers has been agreed
identify investment to support transformation and new care models
Suggested resolution
The Governing Body are requested to agree the themes and timelines for discussion within
the Governing Body Cycle to ensure timely agreement on investment, workforce plans,
transformational support whilst supporting and developing our current workforce. It is
suggested that the Governing body should develop an approach to understanding supply
and demand including demographics in each area including:
Nursing Supply and Demand,
AHP/Clinical Scientist Supply and Demand
Mental Health workforce priorities, parity of esteem and mandate requirements
Primary and Community Care, including – baselining and developing workforce models
Supporting Seven Day Working – including radiology and radiography workforce
David Farrelly, Local Director
Date: May 2015
GOVERNING BODY DISCUSSION BRIEF
Discussion Theme
Purpose /Objectives
Primary Care Challenges and Vanguards
General practice and wider primary care services face increasingly
unsustainable pressures and needs to transform the way it
provides services to reflect these growing challenges. These
include:
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an ageing population, growing co-morbidities and
increasing patient expectations, resulting in large increase
in consultations, especially for older patients, e.g. 95%
growth in consultation rate for people aged 85-89 in ten
years up to 2008/09. The number of people with multiple
long term conditions set to grow from 1.9 to 2.9 million from
2008 to 2018;
increasing pressure on NHS financial resources, which
will intensify further from 2015/16;
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growing dissatisfaction with access to services. The
most recent GP Patient Survey shows further
reductions in satisfaction with access, both for in-hours
and out-of-hours services. 76% of patients rate overall
experience of making an appointment as good;
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persistent inequalities in access and quality of primary
care, including twofold variation in GPs and nurses per
head of population between more and less deprived
areas;
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growing reports of workforce pressures including
recruitment and retention problems.
General practice will need to play an even stronger role at the
heart of more integrated out-of-hospital services that deliver better
health outcomes, more personalised care, excellent patient
experience and the most efficient possible use of NHS resources. .
The implementation of the Five Year Forward View and the New
Deal for primary care sets our specific commitment to tackle the
workforce issues to be accelerated through the development of cocommissioning of primary care.
Through the New Care Models Programme (vanguards), complete
redesign of whole health and care systems are being considered.
This could mean fewer trips to hospitals with cancer and dementia
specialists holding clinics in local surgeries, having one point of
call for family doctors, community nurses, social and mental health
services, or access to blood tests, dialysis or even chemotherapy
closer to home.
The 5 vanguards supported in the East Midlands are in the areas
of:
 Integrated Primary and Acute Care Systems (Mid Nott’s)
 Multispecialty Community providers (Derbyshire
Community/Principia/Lakeside)
 Enhanced Health in Care Homes (Nottingham City)
Building the workforce – the new deal for general practice has
identified 10 areas for development including :
 Improving recruitment into general practice
 Retaining doctors within general practice
 Supporting those who wish to return to general practice
The HEE National Workforce Planning Guidance for 2015/16
states:
For General Practices, the development of a locality-level demand
forecast covering General Practitioners, and clinical and nonclinical support, should be informed by General Practices as
employers. In recognition of this as a new requirement and the
differing maturity levels across the country relating to workforce
planning in General Practice, as a transitional arrangement
General Practices, Area Teams and LETBs are encouraged to
develop their local systems and processes to produce a locality
plan, while recognising that the planning guidance may be revised
to be more prescriptive following the publication of the Primary
Care Workforce Commission report.
Considerations for
HEEM
LETBs are encouraged to develop their local systems and
processes to produce a locality plan for the General Practice
workforce. There is an expectation that progress towards
developing the forums for stakeholder engagement (where they do
not already exist) and information flows to and from Practices
(recognising the introduction of the workforce Minimum Data Set)
will be taken forward through the 2015 planning round.
The HEE Mandate identifies that a Primary Care Workforce
Commission will develop models of primary care to meet the
needs of the future NHS. This will inform priorities for HEE
investment in education and training to deliver a primary care
workforce that is fit for purpose, flexible and able to adapt to new
models of primary care. The commission will highlight good
examples of integrated, patient focused out of hospital care –
which will influence service commissioners and regulators.
The HEE Mandate also states that HEE will continue to build on
the work already started in 2014/15 to deliver the workforce
development commitments required of it in Transforming Primary
Care, working with a wide range of partners across the health and
social care system.
HEE Workforce Planning Guidance for 2015/16 recognises a new
requirement in relation to workforce planning in general practice
for GPs and clinical and non-clinical support.
HEEM need to consider:
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Their investment plan to support primary care
Their support for the development of new models and a
new workforce to support them
The approach to Workforce Planning for Primary Care
Outcome
SMT Lead and
contact details
The LETB Investment Plan must demonstrate how service
transformation will be driven through a combined set of actions
with regard to the number, skills, values and behaviours of their
workforce.
The Governing Body should consider these requirements when
identifying priorities and investment for 2015/16.
David Farrelly, Local Director
David.farrelly@nhs.net