Primary Care Trust Workforce: Planning and Development
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A changing demographic profile means an increase in age-related conditions, such as dementia and cancer.
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In addition, the consequences of behavioural and lifestyle choices, including alcohol consumption, sedentary lifestyles, persistently high smoking rates in some parts of Wales and rising obesity rates across the country will result in an increased prevalence of a range of chronic and potentially life-limiting conditions. The pressures on the healthcare system from an increase in chronic conditions and co-morbidity resulting in complex healthcare needs will be significant.
Changes to the retirement age also mean the NHS workforce will have to work longer and many may have healthcare needs of their own. Skills for Health identified the main skills and employment challenges facing the health sector. Candice Imison has stated:. The surprise over the past 50 years is how little traditional patterns of working and service provision have changed in this context.
Twenty-first century medicine is being delivered using structures and processes that have changed little since and the inception of the NHS.
The public is increasingly accessing technology and becoming more knowledgeable, which is increasing expectations and changing relationships with health professionals. Self-diagnosis and treatments have become as common as online shopping and are widely available. Digital imaging, stem cell therapy, genetic screening, robotic surgery and tissue regeneration are just some of the innovations in treatments and developments in technology which will continue to transform care services and influence working practices.
The NHS is the largest employer in Wales. It is a labour-intensive public service with staff drawn from many professions and occupational groups working in a variety of settings. Staff are directly employed by the NHS and there are also a range of contractor professions providing NHS services, including dentists, opticians, pharmacists and more than 2, GPs. Figure one shows the increase in the workforce over the last seven years. Despite current difficulties in recruiting doctors in certain specialties, there has been growth in overall numbers of consultant medical staff.
Medical training is undergoing a significant review across the UK — the Shape of Training review — and there are substantial areas of shortage and risk providing opportunities to drive development of other professions and staff groups. The Health Professional Education Investment Review, commissioned by the Minister for Health and Social Services, will report during February and is likely to have significant implications for the future provision of education for the healthcare workforce. The review will consider how the Welsh Government obtains value for money and a secure supply of staff for the NHS.
The outcome will support NHS Wales in planning, developing and providing the workforce required to meet the needs of the citizens of Wales.
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The education and training of the healthcare workforce has been the foundation on which the NHS is built and will continue to be a critical component in the drive to raise standards of care. The workforce is trained and educated around current organisational and professional structures, which inhibits flexibility and creates professional silo-working.
Eighty per cent of the staff NHS Wales will need for the next decade are already working in the service, therefore the need for training and skills development is essential. It is not known how much is spent on the social care workforce and the number of volunteers and family members who provide some form of care is greater than all the professionals combined and yet there is little or no investment in their training.
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While there are many examples of workforce redesign, these are usually ad-hoc and reactive to either local or national pressures. New roles have been introduced and yet the old roles have remained, resulting in increased costs and confusion; new categories of workers with poorly-defined roles, especially in relation to the roles of others have sprung up, resulting in the duplication of functions or services. Over the years, the drive worldwide in health has been for an increase in specialist roles rather generalist roles.
This has limited the flexibility of the workforce and, in some cases, career development for individual practitioners. In many cases, highly-educated and skilled health professionals spend significant amounts of their time undertaking aspects of care, which could more appropriately be undertaken by others with different skills who may be less expensive to employ.
The reasons for this are multi-factorial but must be resolved if we are to succeed in modernising the workforce and achieving a prudent healthcare approach to workforce and service delivery. However, this medical model of healthcare is becoming increasingly difficult to sustain because of the difficulties in recruiting sufficient doctors in certain specialties. The majority of care is currently delivered on a see-and-treat basis, following an episode of ill health and, to a lesser degree, a rehabilitate model.
In the future, the balance will need to shift towards an active preventative and maintenance model. The Horizon work being undertaken by CfWI 8 provides an example of a different way of thinking about the workforce and how the workforce and healthcare is designed via a skills and competencies lens to meet this future challenge. The NHS is data rich but information poor.
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Getting the right workforce information to the right people is crucial to support decision making. Current systems of workforce and service continue to be fragmented and are not fully integrated for planning and delivery purposes. Nationally, tools designed to help managers look at their data alongside other NHS organisations to enable easy analysis and benchmarking are not routinely used. The workforce planning process has tended to focus on the numbers of regulated professions required to inform education commissioning rather than on the needs of patients and the skills and competencies required to support independence.
The design of the workforce around the key decision points in patient pathways will need to underpin future workforce planning. The future workforce may not look very different to that of today, in terms of the broad professional groups — doctors, allied health professionals, nurses and support roles will always be needed. However, the skills of these individuals; where services are delivered in the future and the workforce model and makeup of clinical teams, will need to be very different. This will ensure that individual staff only do what only they can do. Professional demarcations and boundaries will be redefined resulting in less duplication of, improved continuity of care and reduced risk to patients.
Improved integration will mean that staff from different disciplines and services are working together more effectively in multi-disciplinary and multi-agency teams. This will mean the skills, competencies and experience of staff are being used in the most effective and efficient way resulting in a more prudent use of the workforce. To support the delivery of high-quality care across a wide range of different settings investment in the education and development of the workforce is imperative. This will include initial preparation for roles, at whatever level and whether regulatory requirements exist or not.
Investment and development of the workforce will not stop once initial preparation has been completed and all staff will keep themselves updated and abreast of the latest evidence, whatever their role in NHS Wales. Education programmes leading to professional registration will have curriculum and specific outcomes set by regulatory bodies, however there will remain scope for the Welsh Government and NHS Wales to identify specific requirements to be included in the programmes.
Not only will the principles of prudent healthcare be embedded within the curriculum of the future but the principles will be applied across the delivery of the education provision. This will result in:. Medical training is undergoing a significant review across the UK Shape of Training review and there are substantial areas of shortage and risk and this provides opportunities to drive development of other professions and staff groups.
The Nursing Midwifery Council will report on its review of nurse training in and the review of education provision in Wales will report in February Development of a skilled local workforce is one of the five priority areas for action. We need to plan for a sustainable GP workforce to meet population need and focus on ensuring the wider primary care team who provide care around the individual patient is right, supporting an increase in numbers and skill mix of all professionals.
Systems will be redesigned and consultants will work beyond traditional boundaries in delivering care outside of hospitals as suggested in the Kings Fund report Specialists in Out-of-Hospital Settings. Heath and social care will increasingly work together and will have to continue to re-examine the content of work and re-design care pathways to ensure seamless care is delivered across the sectors.
There will be agreement between the sectors to ensure there is no duplication, harm is reduced and continuity of care maximised. Team roles will be clearly identified, care will be based on available evidence and staff will be working to the top of their competencies.