NHS DORSET CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE PRIMARY CARE WORKFORCE PLANNING

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1 NHS DORSET CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMISSIONING COMMITTEE PRIMARY CARE WORKFORCE PLANNING 7.3 Date of the meeting 06/06/2018 Author Purpose of Report M Attridge, Senior Workforce Lead T Collinson, Workforce Redesign Lead, Primary Care To provide an update on developments related to primary care workforce, including Dorset Workforce Action Board (DWAB); workforce planning support provided to practices and localities; Primary Care Workforce Centre (PCWC) to support the delivery of their transformation plans. Recommendation Stakeholder Engagement Previous GB / Committee/s, Dates The Committee is asked to note the report. Each locality has been contacted in regards to the workforce planning support available. Practices vary in terms of the level of support received as this is dependent on the progression of their transformation plans and their state of readiness. August 2017, October 2017 Monitoring and Assurance Summary This report links to the following Strategic Principles All three Domains of Quality (Safety, Quality, Patient Experience) Prevention at Scale Integrated Community and Primary Care Services One Acute Network Digitally Enabled Dorset Leading and Working Differently Yes [e.g. ] Any action required? Yes Detail in report Board Assurance Framework Risk Register Budgetary Impact Legal/Regulatory People/Staff Financial/Value for Money/Sustainability Information Management &Technology Equality Impact Assessment Freedom of Information I confirm that I have considered the implications of this report on each of the matters above, as indicated No Initials: MA/TC

2 1. Introduction This report provides an update as at May 2018, on the developments related to Primary Care workforce planning and development provided to practices and localities alongside developments to support the delivery of the Integrated Community and Primary Care Services (ICPCS) Portfolio Board priority projects and key milestones. 1.2 The Dorset Workforce Action Board (DWAB) is responsible for the strategic direction and delivery of Dorset s Workforce Strategy across the Sustainability and Transformation Partnership. Dorset CCG has a responsibility to support Primary Care workforce planning and development. 2. Background and context 2.1 The Sustainability and Transformation Plan (STP) sets out how we will deliver health and social care services in Dorset. The Leading and Working Differently (LWD) strategy is a collective response to the STP on behalf of all health, social and primary care organisations, carers and Dorset s voluntary services organisations. 2.2 The ICPCS developed a model of care underpinned by workforce modelling. Alongside this Primary Care have been asked to develop workforce profiles to establish community and primary care workforce baselines. The principle being to cross reference the ICPCS modelling with the locality workforce profiles in order to validate workforce planning assumptions. 2.3 The Dorset Workforce Action Board (DWAB) was established in May 2016 with senior leadership representation from NHS and LA partner organisations, STP portfolio Directors and Trade Unions. DWAB is responsible for the strategic direction and delivery of Dorset s LWD Strategy and the Workforce Capacity and Capability Plan. In February 2018 it was acknowledged that the existing LWD approach could be improved to better meet the needs of the STP and a review of the current arrangements was undertaken. 2.4 The review highlighted that the existing LWD work streams are operating in isolation; DWAB is not operating effectively as it is grappling with workforce strategy versus delivery as well as system versus sub system. Furthermore, the staff employed to support the delivery have differing employment and line management arrangements and their work is not entirely aligned. 2.5 A proposal to change the emphasis of the LWD approach was presented to DWAB in April 2018 to align priorities and actions to other STP portfolios: One Acute Network (OAN); Integrated Community and Primary Care Services (ICPCS); Prevention at Scale (PAS) and Digital (appendix 1). 2.6 The proposal includes changes to the Governance arrangements of DWAB alongside establishment of a system Workforce Delivery Team. The proposal was presented to the Senior Leadership Team on 17 May 2018 and the revised operating was agreed.

3 Integrated Community and Primary Care Services (ICPCS) 3.1 There is a need to build consensus and address concerns about reshaping the workforce across the Sustainability and Transformation Plan (STP). Health systems need to plan for a workforce to support the health and care needs of whole populations rather than serve the needs of patients in the care of individual organisations. To do this, there is a need to review and align priorities and actions with specific workforce groups to inform workforce planning, education, training and development of health and care staff across Dorset. 3.2 An Integrated Community and Primary Care Services (ICPCS) workforce strategy and delivery plan for Dorset have been developed which will require organisations and employers across the system to work together in dynamic ways and engage with staff to ensure that new care and workforce solutions are understood, accepted and deliverable. 3.3 The ICPCS workforce delivery plan is an iterative plan which is aligned to the ICPCS High Priority Project areas and milestones and will evolve to cover all clinical service areas. An ICPCS Workforce Delivery Group for Dorset has been established to oversee workforce planning and delivery of the ICPCS workforce strategy and plan, recognising and connecting what should be done as a system verses what actions remain the responsibility of individual organisations. 3.4 The group will be accountable to the ICPCS Portfolio Board and Dorset Workforce Advisory Board (DWAB) and core membership will include representation from the Clinical Commissioning Group; Dorset HealthCare Trust; Public Health; and Council for Voluntary Services (see appendix 1). The inaugural meeting of the group is scheduled to take place on 31 May On 17 May it was confirmed that the CCG Governing Body and SLT have approved the 3 ICPCS business cases. This will result in an annual 6.5m investment into the primary and community setting in Dorset to support the delivery of the ICPCS model of care. This investment will strengthen the focus in Primary Care in moving forward with their transformation plans to develop out of hospital services. 4. Primary Care Workforce Profiles background and update on progress 4.1 Workforce Profiles were developed for all localities and circulated in October 2017 to each locality with a request to validate the primary care workforce baseline. Each profile included the baseline data for General Practice, included a line for the Community Provider data to be added and detailed the latest iteration of the ICPCS modelling work version The Workforce Redesign Lead, Primary Care was appointed in October 2017 to work with colleagues in primary care to develop the workforce profiles for practices and localities and inform the workforce redesign to support the new models of care delivery. Updated profiles, including the Community Provider data were recirculated to localities from December 2017 with the offer of a

4 7.3 follow up meeting to discuss validation of the baseline data and use of the Wessex LMC Practice Healthcheck tool to support development of their workforce plans. 4.3 Localities are moving with varying levels of urgency on their workforce plans and there are different levels of ambition being shown, linked to their transformation plans. As at May 2018, 58% of the localities have completed or are progressing with completion of the Wessex LMC Practice Healthcheck tool to validate the baseline workforce and gain an understanding of the gap between current and the workforce recommendations by the ICPCS Modelling (v7). The Plans need to be owned by all practices within the Locality and the Workforce Team are able to assist the development from baselines to meaningful conversations. 4.4 Four localities (Poole Central, Weymouth & Portland, Purbeck and Poole North & East Dorset) are working with the Workforce Redesign Lead to analyse the data and begin to develop their locality workforce plans. The plans will align to the Dorset system transformational changes and Workforce Capacity and Capability Plan. 4.5 Practices continue to be supported by the CCG Workforce team in terms of their current recruitment requirements with the main mechanism for this being Doorway to Dorset. The site was launched in April 2016 and continues to be an innovative source of recruitment advertising for Dorset practices. Role Type As at 18/09/17 (last update to PCCC) Current as at 31/05/18 Admin and Managerial 4 6 Allied Health 2 1 Professionals GPs Nursing 2 12 Total The Workforce team provide papers and updates to PCOG, PCSIG, the ICPCS Portfolio Board and the Primary Care Practice Profile meeting. 5. International GP Recruitment Programme (IGPR) 5.1 NHS England (NHSE) is leading on the international recruitment campaign for GPs. NHSE aims to recruit around 2,000 GPs from overseas by The overseas recruits will work alongside GPs trained in England to develop an exciting range of services away from hospitals in local community settings. 5.2 Recruitment to the programme is being centrally coordinated and organised in phases across England. Dorset CCG submitted a bid on 28 February 2018 to be included in the programme. The Dorset bid for 33 international GP recruits is included in the national teams considerations to plan delivery based on the demand across all STPs.

5 6. Primary Care Workforce Centre The Primary Care Workforce Centre (PCWC) was established in April 2016 and continues to support Primary Care in Dorset to develop innovative ways to meet current and future workforce challenges. Progress to date: Doorway to Dorset continues to prove successful in supporting practices to fill a variety of vacancies. In the last 2 years there has been a reduction in length of time from advert to vacancy filled, from just under 3 months 2 years ago to just under a month currently. The website has also increased interest and applications from people outside of Dorset and created an essential portal for communication with those wanting to work in Dorset, who cannot find the right role advertised. Locum Chambers has been successful in increasing the amount of locums working in Dorset with 100+ now registered on the chambers. 60+ practices have advertised and filled sessions using the chambers and the chambers has also supported the local Out Of Hours service has seen the need for locum work reduce as practices have established more relationships with GPs through the chambers and used intelligence provided for the PCWC to offer salaried positions with greater flexibility. Physician Associate - Dorset programme recruit, train and retain in Dorset. Demand scoped and pilot agreed for cohort of 20 to be placed across all 4 trusts. Bournemouth University (BU) have come forward to provide the education programme. The programme was validated in April 2018 to commence delivery January BU now recruiting students in collaboration with NHS Trusts. A system-wide group, facilitated by the PCWC, are meeting regularly to support and oversee the planning and delivery of the programme; Paramedics - development of an approved pathway for paramedics working in primary care and on-going support through an education programme. Introduction of an Appropriate Admissions course piloted with paramedics working in primary care. Evaluation scored high and confidence and capability increased when referring/admitting to secondary care. Two further pilot sessions in planning for multidisciplinary groups in late spring/summer In addition to this, we have negotiated a number of funded places on education programmes provided by Bournemouth University for paramedics working in general practice (e.g. minor illness, long term conditions); Clinical Pharmacist - Supporting roll out of national pilot in Dorset and on-going support through education programme; MSK Practitioner - MSK Practitioner Bank set up in collaboration with Dorset HealthCare (DHC); In addition to the bank set up with DHC, there are also local arrangements in place between most acute settings and practices in the local area;

6 7.3 Apprenticeships The PCWC continue to support practices to utilise apprenticeships to develop existing staff and recruit new staff. By linking up with the System Apprenticeship Development Lead and the Apprenticeship Steering Group, the PCWC are giving practices a voice in this forum and ensuring the benefits of system working are realised in general practice/primary care. GP Career Flex Scheme - brief produced describing the Scheme with Localities encouraged to get involved. This is an opportunity to bring enthusiastic, newly qualified or experienced GPs into specific projects or pieces of work where they can add value. The Scheme is proving successful in engaging and retaining newly qualified GPs and GPs considering leaving general practice, increasing support through national retention scheme and increasing opportunities for GPs to utilise their skills in specialised roles. Initial steps being taken to widen offer to other professionals e.g. nurses. GPwER The PCWC is working closely with the RCGP on the development and roll out of a number of new GPwER accreditation programmes. In doing so, we have been able to secure funding to support six GPs in Dorset to undertake the newly launched GPwER Dermatology accreditation. Work is currently underway to align this with ICPCS work. GP Return to Practice The PCWC undertook research to understand the impact of long term leave, specifically maternity/parental leave, on the GP workforce. Opportunities were identified to provide support to GPs and practices in order to improve the return to practice process and increase the retention of returners and the number of sessions undertaken will see the launch of pilot development sessions designed to increase the confidence of GPs before returning to practice or having recently returned to practice. In addition, we will be launching a supportive guide for GPs and practices. The first Dorset Nursing Conference was launched by the PCWC on 15 th May 2018 with a focus on the future of integrated nursing. The event was open to all nurses, including final year student nurses, with a strong focus on primary care/icpcs nursing. During and following the conference the PCWC have received enquiries from around 50% of the student nurse attendees about working in primary care/general practice. Today s Student Tomorrow s Workforce campaign was promoted at PCWC s Dorset Nursing Conference on 15 th May to encourage more student / trainee placements, work experience and taster sessions to be offered in general practice, in order to increase the number of newly qualified professionals selecting general practice/primary care as a career.

7 7.3 Career Promotion The PCWC are leading the Alliance Group which is made up from representatives from across the system and is focused on working collaboratively with a system approach to promoting careers in the NHS and attracting school students to careers in health and social care. We continue to deliver the Introduction to Medicine and Introduction to Healthcare programmes which are always full and evaluated highly. The work of the Alliance Group brings the benefits of system working, reducing duplication and costs and increasing efficiency. Leadership Development Working in collaboration with Bournemouth University, the PCWC has delivered a series of Bite Size leadership modules designed with practice managers in mind. Each session was well attended with mostly practice managers in attendance and a small number of GPs and nurses. In addition to this, we launched the Post Graduate Certificate in Leading and Developing services in 2017, with the option to attend individual modules or undertake all three modules and complete the PG Cert. Each module has received full attendance with mostly GPs attending and some practice managers, all of whom have a leadership role wider than that of their individual practice. As we move into 2018 further opportunities are being explored and the PCWC are currently offering to support the cost of the Diploma in Advanced Primary Care Management in return for commitment to bring the learning back to Dorset and support the development of a local programme so more may benefit from the learning. Education & Development The PCWC continues to coordinate, commission and promote education and development opportunities for colleagues in primary care. The CPD and training calendar on the PCWC website has been particularly busy with lots of positive feedback around bringing as much of this activity as possible into one place. The PCWC has continued to increase the availability of funded development through HEW and BU, such as the Minor Illness and Long-Term Conditions courses. Blood Test Analysis course developed in response to a suggestion from a GP to provide training for nurses in their practice to upskill and increase their capability and job fulfilment, whilst reducing pressure on GPs, and establishing there was a demand across all practices. As a result, 4 cohorts have been scheduled with care taken to ensure those who are best placed and supported to apply the skills and new ways of working in their practice are prioritised. 2 cohorts have been completed to date with very promising evaluation scores. A follow up evaluation of impact on practice is planned for 3 to 6 months.

8 7.3 Pilot of Paediatric education sessions were rolled out during the Autumn, Winter and Spring of 2017/18 during PLT sessions across localities, led by local consultants. The pilot was very successful and received very good evaluation scores and attendance figures. A good mix of professionals from practices have attended GPs, nurses and AHPs. Additional benefits have also been realised from bringing general practice colleagues together with secondary care specialists opening up additional channels for support and sharing of knowledge. TNA - Shared Learning Events following the success of the paediatric education sessions pilot, a training needs analysis is currently underway with a focus on Diabetes, MSK & Pain, Cancer, Integrating Mental Health and Physical Health and Frailty and Long Term Conditions. Delivery will take place during PLT sessions and will adopt a multi-disciplinary approach encouraging attendance from all practices to ensure the learning can be taken back to all colleagues. In addition to addressing clinical competence and confidence, the sessions will also focus on the Clinical Commissioning Local Improvement Plan (C-CLIP) and variation. GP Passporting work is currently underway on developing a platform and a way of working to enable GPs to utilise their skills and experience across the system without the need to complete separate recruitment processes for each Trust. This will incorporate all four NHS Trusts in Dorset and SWAST notifying those with the right skill set of sessions they could undertake. It is anticipated that this work will increase the mobility of the workforce, increase the number of sessions GPs undertake outside of general practice, enable more GPs to work in a flexible way, increase job fulfilment, increase retention through a varied working week and increase attraction to Dorset. Following what is expected to be a successful pilot with GPs, this will be rolled out across all roles in general practice. 7. Conclusion 7.1 There will continue to be a focus on supporting localities to complete workforce profiles and develop their workforce plans to support their transformation plans. The Primary Care Workforce Centre will continue to work with and alongside practices and wider stakeholders to design and implement innovative workforce initiatives across Dorset. 7.2 The development of the ICPCS Workforce Delivery Group and the establishment of the system Workforce Delivery Team will ensure a clearer focus and provide assurances that workforce planning and development is connected across the system in line with the new system workforce operating model. Author s name and Title: Tina Collinson, Workforce Redesign Lead Date: 23 May 2018

9 7.3 APPENDICES Appendix 1 Appendix 2 Appendix 3 Dorset Workforce Action Board Objectives and Deliverables Dorset Workforce Action Board Proposed Governance Primary Care Workforce Centre Draft Delivery Plan 2018/19

10 7.3 Appendix 1 Dorset Workforce Action Board Objectives and Deliverables The proposal is to change the emphasis of the LWD approach by building consensus with STP portfolio directors, SLT, CRG and their teams The overarching objective is to develop an integrated, strategic workforce plan for Dorset which is reflective of our system transformation plans. Alongside this, delivery will focus on: New recruitment approaches, including Doorway to Dorset, working with schools and colleges (on behalf of the system) New models of workforce development, shared learning / clinical confidence (based on pathways/new models of care) development L

11 7.3 Appendix 2 Dorset Workforce Action Board Proposed Governance The proposal is to change the governance in order to distinguish and more appropriately reflect workforce strategy and workforce delivery as well as system and sub system/organisational workforce delivery DWAB Remit: Strategic System Workforce Development Membership: STP partners and portfolio directors Frequency: 2018/2019 bi-monthly moving to quarterly *Talent Management Board System Leadership Team DWAB will work with: HEE Board, Clinical Reference Group, STP Portfolio Boards Dorset Workforce Action Board The Workforce Delivery Team will work in partnership with: DoNs, HRDs, Deputy HRD Group, Learning and Development Leads, STP Communications Group, Primary Care Workforce Centre *ICPCS Workforce Delivery Group *OAN Workforce Delivery Group Workforce delivery through established & *new groups operating at system and sub system level, as appropriate, with sponsored leadership from DWAB members

12 PRIMARY CARE WORKFORCE CENTRE (PCWC) DELIVERY PLAN APRIL 2018 TO MARCH 2019 LEADING AND WORKING DIFFERENTLY STRATEGY DEVELOPMENT OF OUR LEADERS AND ORGANISATIONS We will communicate and engage with transparency. RECRUITMENT AND RETENTION OF OUR STAFF We will support our staff to stay, live and work in Dorset. PCWC OBJECTIVE ACTION LEAD SUPPORT ENABLER DEADLINE 1. Continue to develop and build upon the communication strategy to market the PCWC and engage practices and key partners and stakeholders. 2. Develop and implement a strategy to address the recruitment and retention challenges in general practice in Dorset, which aligns to the wider system recruitment and retention plan. Maintain the PCWC website to ensure is up to date, accessible and informative. Continue to add content in order to provide a single point of information for all primary care workforce related needs. Continue the provision of regular communications updating people on progress and ways to get involved. Run regular events and networking opportunities to progress the ambitions of the PCWC. Engage others via social media and increase the number of connections and followers Continue to develop the Doorway to Dorset site, related social media activity and recruitment campaigns. Continue to provide direct recruitment support to practices, monitoring progress of recruitment and following up as required. Continue to partner with Dorset Healthcare on the provision of a bank of medical and non-medical PCWC Implementation Plan April 2018 to March 2019 Page 1 of 7

13 LEADING AND WORKING DIFFERENTLY STRATEGY PCWC OBJECTIVE ACTION LEAD SUPPORT ENABLER DEADLINE staff for practices to access and use for their staffing needs. Continue to support the provision of an infrastructure to increase the availability of locum support and increase the ease of access to locum work for locums in Dorset and those wanting to work in Dorset. Build on work with GPs to widen offer to more professionals working in primary care e.g. nurses. Continue to drive forward and support the implementation of local education and development programmes to enhance Dorset s opportunities to recruit, train and retain. Continue to develop the Career Flex service and widen the offer to more healthcare professionals and increase the reach of opportunities. Develop a programme to provide greater support to GPs and practices for return to work/practice. Continue to support the development and implementation of apprenticeships. Develop the current Ambassador programme and Introduction to programmes in collaboration with the newly formed Alliance Group to PCWC Implementation Plan April 2018 to March 2019 Page 2 of 7

14 LEADING AND WORKING DIFFERENTLY STRATEGY DEVELOPING OUR STAFF We will develop roles, skills and competencies to meet future service demand. PCWC OBJECTIVE ACTION LEAD SUPPORT ENABLER DEADLINE 3. Lead on the development and enhancement of new and innovative roles to support general practice; GPs Nursing qualified and unqualified Pharmacists Paramedics Student/Trainee Placements Physician Associates MSK Practitioners Apprenticeships enhance the promotion of Careers in primary care and increase attraction. Lead the Alliance Group to develop a One Dorset approach to attraction activity such as career promotion, future workforce engagement and work experience. Develop a solution to better mobilise GP workforce across the wider system that supports the passporting of documentation and training. Develop the Career Flex service in line with strategic system workforce plans to support the development of future workforce, ensuring the appropriate mentorship, supervision and support structure is in place. Continue to develop relationships with students/trainees and stakeholders across the system to ensure continued success of the service. Continue to support the development of GPwER roles aligned to the ICPCS workforce strategy and delivery plan and the system workforce capacity and capability plan. Continue to develop a support framework for paramedics working in general practice. PCWC Implementation Plan April 2018 to March 2019 Page 3 of 7

15 LEADING AND WORKING DIFFERENTLY STRATEGY PCWC OBJECTIVE ACTION LEAD SUPPORT ENABLER DEADLINE Continue to develop a workforce plan to increase the number of paramedics trained locally to increase local recruitment aligned to the system workforce capacity and capability plan. Continue the development and implementation of the workforce plan to enhance nursing skills and develop roles aligned to the workforce strategy for integrated community and primary care services. Continue to support the national pilot and local workforce plans for clinical pharmacist roles in general practice. Continue to develop a framework of support for clinical pharmacists working in general practice. Continue to increase the number of work placements in general practice for students and trainees to increase the number of people choosing to work in general practice at the start of their career. Continue to support the development and implementation of a Dorset Physician Associate programme. PCWC Implementation Plan April 2018 to March 2019 Page 4 of 7

16 LEADING AND WORKING DIFFERENTLY STRATEGY PCWC OBJECTIVE ACTION LEAD SUPPORT ENABLER DEADLINE 4. Develop a leadership programme for general practice staff, to develop leaders in primary care, which aligns to the wider system development plan. Support the evaluation of the PA programme and share findings. Continue to support the development of the role of MSK Practitioners working in general practice. Continue to support the development of a framework of support for MSK practitioners working in general practice. Continue to support the adoption of apprenticeship roles/development in general practice. Continue to support the leadership development of GPs, Practice Managers and other professionals in general practice in Dorset aligned to local workforce plans, the ICPCS workforce strategy and delivery plan and the system workforce capacity and capability plan. Ensure both academic and practical components are considered. Develop new leadership roles in general practice aligned to the ICPCS workforce strategy and delivery plan and the system workforce capacity and capability plan. Develop education, training and support framework to develop the PCWC Implementation Plan April 2018 to March 2019 Page 5 of 7

17 LEADING AND WORKING DIFFERENTLY STRATEGY PCWC OBJECTIVE ACTION LEAD SUPPORT ENABLER DEADLINE 5. Enhance the infrastructure and insight of general practice to support and enable transformation through the development of workforce plans. 6. In response to the outcome of the skills audit develop, design and commission appropriate development and education to respond to the workforce needs. workforce needed for these new roles. Continue to develop the skills audits across general practice to identify the top priority areas. Ensure the analysis is aligned to the ICPCS workforce strategy and delivery plan and the system workforce capacity and capability plan. Continue to conduct workforce planning analysis, providing support to practices to ensure the right information is collated. Continue to support the development of accurate locality workforce plans. Continue to ensure the analysis is aligned to the ICPCS workforce strategy and delivery plan and the system workforce capacity and capability plan. Continue to design, develop and commission programmes to address the needs. Continue to work with delivery partners to increase the availability of development and education. Continue to identify and develop new ways of delivering development and education to increase PCWC Implementation Plan April 2018 to March 2019 Page 6 of 7

18 LEADING AND WORKING DIFFERENTLY STRATEGY PCWC OBJECTIVE ACTION LEAD SUPPORT ENABLER DEADLINE 7. Actively research and review the effectiveness of the Primary Care Workforce Centre, responding to the needs of local workforce plane, the ICPCS workforce strategy and delivery plan and the system workforce capacity and capability plan to ensure the future sustainability of the workforce in Dorset. accessibility without reducing quality. Continue to look for ways to improve the accessibility and standardise the quality of statutory and mandatory training. Continue to research and secure feedback to review the impact of each action in the delivery plan. Regularly review and respond to the key learning points identified from the research. Share the learning with system partners and wider within the NHS. PCWC Implementation Plan April 2018 to March 2019 Page 7 of 7