Transcript Document

Health Education England
Developing the GPN role
Nursing in Primary Care Conference
Context
www.hee.nhs.uk
www.hee.nhs.uk
Introduction
“HEE will provide leadership for the new education and training system.
It will ensure that the shape and skills of the future health and public
health workforce evolves to sustain high quality outcomes for patients
in the face of demographic and technological change.”
“HEE will ensure that the workforce has the right skills, behaviours and
training and is available in the right numbers, to support the delivery of
excellent healthcare and drive improvement. HEE will support
healthcare providers and clinicians to take greater responsibility for
planning and commissioning education and training through
development of the Local Education and Training Boards (LETBs) which
are statutory committees of HEE.”
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www.hee.nhs.uk
HEE’s purpose…
HEE exists for one reason and one reason only: to help improve
the quality of health and healthcare by ensuring that our
workforce has the right numbers, with the right skills, values
and behaviours, at the right time and place.
Investing in our current and future workforce is the only way to
‘future proof’ the NHS. The healthcare workforce is the means by
which the ambitions of the NHS are realised.
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www.hee.nhs.uk
Accountability of HEE
Department of Health
NHS England
(NHS
Commissioning
Board)
Monitor
National
NHS Trust
Institute for
Care
Quality
Development
Health and
Commission
Authority
Care
Excellence
Public
Health
England
Health
Research
Authority
•
•
Health and
Social Care
Information
Centre
NHS Blood
and
Transplant
Health
Education
England
Medicines
and
Healthcare
products
Regulatory
Agency
NHS
Business
Services
Authority
We are one of 15 ALBs in health
HEE is accountable to the Secretary of State for Health
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NHS
Litigation
Authority
Human
Fertilisation
and
Embryology
Authority
Human
Tissue
Authority
HEE’s roles and responsibilities
Workforce
Planning
NHS
Careers
£4.9bn per annum =
£10,000 per minute
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www.hee.nhs.uk
Recruiting for
values and
behaviours into
education and
the workforce
Commissioning
undergraduate and
postgraduate
education (numbers
and content)
Leadership
of CPD
Education, training
and development
strategy for the nonprofessionally
qualified workforce
159,000 students directly or
indirectly funded by HEE
LETBs
• Total of 13 LETBs
• Committees of HEE
• Not Statutory Bodies
• Provider led
• Stakeholder representation
• Core leadership of:
Managing Director
Independent Chair
Director of Education and Quality
Head of Finance
• Dispersed HEE leadership
• Deaneries part of LETBs
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www.hee.nhs.uk
HEE’s Priorities for Workforce Planning
• Establish a clear and robust workforce planning process
• That enables us to make pragmatic decisions during transition
whilst delivering our wider strategic objectives
• Underpinned by effective and inclusive governance structures to
enable better decision making
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www.hee.nhs.uk
Features of the historic system
• Separation of Medical and Non-medical planning
• Separation of planning for future workforce supply from planning for
service / workforce transformation.
• No ability to compare priorities and risks across professions
• Medical planning had limited local or employer engagement (and
therefore challenges to implementation)
• Medical planning strongly influenced by supply side issues (due to reliance
on training grade doctors for service delivery)
• Non-medical planning local with limited national sense check or shared
intelligence.
• Significant opacity and duplication - not clear who is accountable
• Mainly focussed on future workforce numbers
• Lack of confidence in forecasting and analysis
• Lack of provider engagement and senior leadership input
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www.hee.nhs.uk
And of course, nobody even thought about
the GP Nurse workforce
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www.hee.nhs.uk
Workforce Planning & Development System – AS IS POSITION
Governance / Operational
SHA Boards
Regulatory / Advisory
Medical Education England
Ministerial
NHSOB
Planning & Prioritisation
Employers groups / LMCs
Workforce Leadership Group
DH Medical / MEE Programme Boards
HENSE - RG
Joint Working Group
WAPPIG
Medical Royal Colleges
HENSE / HEFCE / BIS / QAA
Staff Side – RCN / BMA..
Service Commissioners
SHAs
DH – MPC and MSC
Programmes
PABs
DH – METP team
Academy of HC
Scientists
Workforce Development
C
f
W
I
Regulators
Dean’s Groups
Deaneries
Medical and Dental
Schools
Medical School Council/DSC
Council of Deans / UUK
HEIs
Skills Funding Agency / NAS
FE / Providers
Skills for Health / SSCs
Placement Providers and workplace training – Trusts, Community and Primary Care
Apprenticeship/NVQ
Non-Medical Placements
CPPD
Junior Doctors
Medical Students
Service Networks re CPPD
AHSNs / HIECs / CLERHCs
HEE Governance and Advisory Structures
HEE Advisory Groups
SoS /
DH
Medical
Nursing & Midwifery
Mandate
AHPs
HEE Board
Senior
Leadership
Team (SLT)
Healthcare Scientists
DEQs Group
Pharmacists
Strategic
Advisory
Forum
Dental
National
External
Advisory
Groups
Public Health
Mental Health
Patient
Advisory
Forum
Medical Workforce
Advisory Group (ex JWG)
Planners Network
Students / Learners
Education Commissioners
Network (inc HEE Deans)
Finance Leads Network
HCS Lead Commissioning (W Mids)
LETB input to
National WP
LET Board
LETB Executive
LETB
Workforce
Planning
Primary Decisions / Overarching Governance
Board recommendations & decision under Scheme of delegation
Executive Action
Advisory & Decision Support Bodies
LETB Education
Commissioning including
Deaneries
LETB advisory and
stakeholder structures
Local
External
Advisory
Groups
Designing our new
workforce planning approach
Making better decisions - The new arrangements will ensure that:
- Our decisions are driven by the needs of current and future patients
- Informed by the advice and expertise of our stakeholders
- With clarity about where accountability for decisions lie
- A stronger connection between local workforce requirements and national
policy and advice (and visa versa)
- Reduced duplication of effort
- Safe transition but geared to deliver our ‘2028 Strategy’
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www.hee.nhs.uk
Workforce Planning Guide 2013
•
Workforce Planning Guidance Launched June 2013
•
Aims to secure future workforce to maintain safe staffing
levels whilst supporting transformation of services.
•
First comprehensive workforce planning guidance for the
NHS
•
Clarity of roles, responsibilities, milestones, and timelines
•
Transparent, evidence based, and risk assessed decisions
•
Creates the opportunity to consider priorities;
• between professional groups
• between current and future workforce
• between numbers and skills/values /behaviours
•
How we undertake planning – open conversations
between providers, commissioner and other stakeholders
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www.hee.nhs.uk
Workforce Trends 2002 - 2012
Phases of service and workforce growth;
• Wanless – 2002-2005
• Hewitt / NHS Financial Deficit – 2005-2007
• Wanless II – 2007-2010
• QIPP – 2010 onwards
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• Francis – 2012 onwards?
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Investment Wrong Direction
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GP Nurses
Competent, confident nurses for the 21st
Century Practice Setting.
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Role Models
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SPENDING REVIEW:
NHS protected but
must save £20bn
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Rising life expectancy
Rising numbers of older people
More people living on their own
Population lifestyles present significant risks to their
health
Growing numbers of people with long term conditions and multiple conditions
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PRIMARY <-> SECONDARY CARE
RELATIONSHIP
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•
•
•
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General Practice 310m consultations per year
90% of NHS contacts
20m contacts per year in A&E
Typical day in Y&H
• 150,000 consultations GP
• 5,000 OPD and A&E attendances
• 600 admissions
Even marginal shift from primary to secondary
care has potential to overwhelm NHS
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“Our analysis of the
available evidence on the
demand for GP services
points to a workforce
under considerable strain.
The existing GP workforce
has insufficient capacity to
meet current and expected
patient needs.” Centre for
Workforce
Intelligence
2013
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THE DAILY TELEGRAPH
“10,000 more GPs needed” for the NHS to
cope with increasing workload
Ten thousands more GPs are need for the NHS to
cope with its increasing workload and ensure
patients are properly cared for out of hours , the head
of the Royal College of GPs has said.
The Daily Telegraph, 16th February 2013
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GP WORKFORCE
Unbalanced growth in medical workforce 1995 to 2012
Consultants more than doubled
GP workforce increased by 21%
GPs per 100,000 population
64
62
60
58
GPs per 100,000
population
56
54
52
50
1995
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www.hee.nhs.uk
2009
2013
NHS HCHS Census 2012
GPN head count increased from 20,983 in
2002 to 23,458 in 2012 (12% increase)
GPN WTE increased from 11,998 in 2002 to
14,695 in 2012 (22% increase)
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GP and GPN Workforce
Whole Time Equivalent NHS HCHS Data 2012
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
0
2002
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2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
WRT Primary Care Futures
2008
Skill mix scenario for future General Practice
Increase ratio of Practice Nurses to GPs
1995 ratio 0.37
2002 ratio 0.41
2012 ratio 0.41
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www.hee.nhs.uk
Practice Nurse Age Profile
56% aged over 45 and over
Compared with 42% of all nurses
Ref: RCN (2007) Holding On – Nurses’ employment and morale
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Figure 1: Age profiles of practice nurses and all qualified nurses in the NHS, England
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Practice Nurse Banding
42% Band 6 compared with 27% all nurses
26% Band 5 compared with 52% all nurses
Ref: RCN (2007) Holding On – Nurses’ employment and morale
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Catch 22 – No training pathway
No job without skills : no skills without job
“I applied for a job as a practice nurse, but was
told I didn’t have the appropriate skills”
“I applied for training, but the PCT told me I
needed to be employed in General Practice”
“A nurse is a nurse is a nurse, how hard can it
be to be a practice nurse?”
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NESC Primary Care Taskforce Plan
Create a training pathway for nurses into general
practice
Based on model of the GP VTS
Workplace based training with equivalent day
release course, developed from WIPP competency
framework
Recruited GP training practices to host the training
and employ the nurses (NESC salary contribution
plus GP trainers grant)
Procured HEI for accredited training provision
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www.hee.nhs.uk
Practice Nurse Development
Career Pathway
Career Structure
Professional Recognition
Continuing Professional Development
What can HEE do to support?
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www.hee.nhs.uk
Transferring Care into the Community
DH/NHS England Stategy for GP Nursing
Community Nursing Advisory Group
Training pathway for GP Nurses
Primary care placements for Student Nurses
Not just “foundation” but career progression
Health Care Assistant Nurse Practitioner
Mentorship for GP Nurses
Recommendation of GP Taskforce
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Questions
[email protected]
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