www.england.nhs.uk

Workforce and

delivering 7 day

services

Jo James

Programme Delivery Lead, North Region, Sustainable Improvement Team, NHS England

17th January 2017

.

www.england.nhs.uk

• Work to date has shown a key risk to delivery of 7DS

within the hospital setting is workforce.

• Workforce risks are most acute with respect to:

• Consultant workforce

• Diagnostic workforce

• This webinar will provide examples of ongoing work

to address these issues:

• Nationally and Regional supported by Health

Education England

• Locally in acute organisations

Purpose of the Session

3

• The 10 clinical standards were developed by the NHS Services, Seven Days a Week Forum led by Professor Sir Bruce Keogh.

• Priority standards are those identified as the minimum set of clinical standards needed to tackle variation in mortality. Selection is supported by the Academy of Medical Royal Colleges.

• Standard 2: Time to consultant review • Standard 5: Diagnostics • Standard 6: Consultant directed interventions • Standard 8: On-going review in high dependency areas

• Standard 1: Patient Experience • Standard 3: MDT Review • Standard 4: Shift Handover • Standard 7: Mental Health • Standard 9: Transfer to primary, community and social care • Standard 10: Quality Improvement

Priority clinical standards

Clinical standards which enable sustainable delivery

7 Day Hospitals – Clinical Standards

A set of clinical standards were identified to support seven day hospital services

www.england.nhs.uk

Kevin Moore

Head of Workforce Transformation, Health Education England

Miss Fiona Kew

Consultant Gynaecologist,

Modernising the Workforce: Physician's Associates

Darren McGuiness

Endoscopy Manager Royal Liverpool & Broadgreen NHS Trust

Seven Day Services in Endoscopy

Nicky Taggart

General Manager, Radiology and Imaging, Royal Liverpool &

Broadgreen NHS Trust

Seven day services in Radiology

Today’s speakers

HEE, Workforce and 7 Day Services

Kevin Moore

Head of Workforce Transformation

Yorkshire & Humber

Our purpose

"Health Education England exists for one reason only: to

support the delivery of high quality healthcare and health

improvement to the patients and public of England by

ensuring that the workforce of today and tomorrow has the

right numbers, skills, values and behaviours, at the right

time and in the right place."

Board

Executive

Team

LETBs

LWABs

Regional

Directors

HEE

co-chairs Local

Teams

Key Partners/

Advisory

Accountable

Support

Executive

Advisory

ALBs

Our place in the system

STPs

Workforce

Advisory

Board

ALB

Oversight

(HEE RDs)

FYFV

Board

Some of the HEE Initiatives

Nurse

Associates

Emergency

Medicine fill

rates

Record GP

Numbers Paramedic

Education

Project

The Care

Certificate

Come Back

to Nursing

Widening

Participation

Pharmacy

Reform The Quality

Framework

Healthcare

Support

Workers Physicians

Associates Genomics

Dementia

Awareness

Training

CEPNs Shape of

Training

The world has changed

Place based services and partnerships to meet

the quality, health and financial challenges.

The CSR reformed non-medical

undergraduate funding, cut our running

costs and gave us flat cash for five years.

The system needs HEE to be about the

current, not just the future.

Thinking and Leading…

Being proactive policy makers and

responsive problem solvers.

Being Thought Leaders, alone and with

others; using research, evidence and our

expertise to make a difference.

Turning the cutting edge of science into

real health interventions

Analysing and Influencing

Using our knowledge, analysis and expertise

to influence choices made about current and

future workforce solutions.

Providing an evidence based modelling,

intelligence and analysis service to the system.

Publishing regular data and intelligence

updates and reports.

Changing and Improving

Our workforce transformation and

leadership offer to LWABs and STPs.

Creating space for staff and stakeholders to

shared innovative and transformational

practice through technology.

Building leadership capacity and

capability for the NHS.

Delivering and Implementing

Our Priorities: Mandate: FYFV; improved medical

education and training system and sufficient

supply of the staff the NHS needs

Manage the education and training system for

thousands of individual clinicians, effectively

and safely.

Always being positive about the value we can add

including internationally, clinical academics, talent

management and careers not just jobs.

Focusing on Tomorrow

Always looking ahead: One Year;

Five Years; Fifteen Years…

Always about the new: roles;

professions; education and training

routes; career paths and new technology

Recognising that the workforce of today

is also the workforce of tomorrow

STPs and LWABS

• The LWAB is the means by which workforce issues arising from

the STP area based plans are addressed

• Broad membership – providers, commissioners, universities,

local authorities, third sector

• Developing workforce strategies to address particular challenges

• Shared Responsibility

Three options for change:

• Grow the workforce – example: an additional 75 Core EM

doctors commissioned per year for 3 years (2016 is third year)

• Upskill the existing workforce – £1.2m investment in advanced

practice training for existing paramedics

• Transform the workforce – examples: Nursing Associates and

Advanced Practice in Neonates

HEE Response to U&EC Review

• Additional EM doctors

• Paramedic training (PEEP)

• Physician Associates

• Clinical Pharmacists in ED

• Advanced Practice in ED

• HEE Local Office initiatives

South Yorkshire Workforce Initiatives a) Excellence Centre Development for Bands 1- 4 to support new role

development and excellence in training

b) Area Wide Career Pathways – using a lead employer model enable

staff to move between organisations within an area to develop their

skills and expertise e.g. Paramedic secondments into urgent care

centres and emergency departments as part of their career rotation

c) CCG sponsorship of training places and development of a

preceptorship year to enable newly qualified PAs to take up new roles

in primary care

d) Continued development of new ACP roles and prioritisation of

funding to support such initiatives

North West - Workforce Transformation

• New ways of working • Up-skilling staff

• Workforce

Repository and

Planning Tool

(WRaPT)

• Population health

workforce planning

training

• International

recruitment

• OSCE Train

the Trainer for

International

Recruits

• Accelerated

registration of

overseas

qualified

nurses

• Developing supply

• Pharmacy

Technicians in

general practice

• Innovation

fundamentals

training

• Transforming

workforce culture

• Barratt’s

organisationa

l culture

assessment

• Team based

COM-B

approach to

changing

culture

• Assistant

Practitioners

• Advanced Clinical

Practitioners

• ED Pharmacists

• Community

Specialist

Paramedics & EMT

development

• Apprenticeships in

general practice

Contact: Kirstie Baxter, Head of Workforce Transformation

kirstie.baxter@nhs.net 0161 625 7283

@NHS_HealthEdEng

• Mental Health

Peer Support

Workers

• Nursing

Associate

• Physician

Associates

• Medical

Assistants

• New Roles

Articulating HEE’s

transformation offer:

the STAR tool

The STAR tool is a menu

of products and activity to

support workforce

transformation. The STAR

is a dynamic tool and will

be populated further with

developments to deliver

solutions to meet the

workforce challenges

emerging from STPs.

Transformation Challenge

• Why we need to transform is well known

• What we can transform into is known

• But How is the challenge addressed

Many of the workforce solutions have to be developed at

service level and accepted at service level if the change

is to effective.

Use the STAR tool to

identify and develop

workforce solutions

In Yorkshire & Humber we are

addressing the ‘How’ by using the

Calderdale Framework

Key Elements

• Facilitators trained in the use of the methodology

• Partnership working

• Sharing of learning and best practice

• Repository of competencies and job descriptions.

Application

• York Trust used the framework to develop the role of

the support workers – thereby releasing health

professionals within community services, emergency

services and laboratory services

• Define new ACP roles in Harrogate Trust

• Used within the 111 service to define new structures

and career frameworks. Currently being piloted

• Support worker roles within endoscopy services

• Supporting health professionals to work to scope of

practice

So what can you do?

• Engage with your local LWAB

• Through the LWAB develop area based workforce

strategies in partnership with all agencies

• Support other organisations with their plans and roll

out

• Share best practice

Any Questions?

Kevin Moore kevin.moore@yh.hee.nhs.uk

Modernising the Workforce: Physician Associates

Miss FM Kew

Consultant Gynaecologist, Sheffield Teaching Hospitals

Physician Assistant

Briefly

• 1965 – Duke University

• WW1

• Vietnam War

• a health professional who practices medicine with the supervision of a licensed physician

• The PA is distinguished from other health care professionals by his education as a generalist, by the breadth of his clinical knowledge, by the extent to which he is given decision-making authority regarding patient care, diagnosis, and treatment, and by the depth of his clinical experience.

What do physician associates do? work within a defined scope of practice and limits of competence. They:

> take medical histories from patients

> carry out physical examinations

> see patients with undifferentiated diagnoses

> see patients with long-term chronic conditions

> formulate differential diagnoses and management plans

> perform diagnostic and therapeutic procedures

> develop and deliver appropriate treatment and management plans

> request and interpret diagnostic studies

> provide health promotion and disease prevention advice for patients.

What can’t they do

• Prescribe

• Order ionising radiation

• Practice without clinical supervision

What does ‘my’ PA do

Megan’s timetable

Monday Tuesday Wednesday Thursday Friday

Outpatients (oncology)

Theatre Theatre (robotics)

Outpatients (2ww clinic)

Outpatients (2ww clinic)

MDT meeting Theatre Theatre (robotics)

Outpatients (gynae oncology)

CPD

What does Megan say? Good

• Clear expectations

• Good job plan, reflecting all abilities

• Flexibility and re-assessment

• Working with a steady group of small consultants

• Close working relationships

• Being treated as a clinician and not a trainee

• Not being on the trainee rota

• No adverse affect on junior doctor training

Could be improved?

• Orientation and access to computer systems

• Not a nurse or a doctor!

• Make available an informational summary about what a PA is

What do I say?

• When can I get some more?

• Currently trying to draw up possible job descriptions for new graduates

• Plan to use them in general gynae

• Recognise that they will not be Megan, at least not for quite a while

• Make sure they have a close working relationship with permanent medical staff

• They are trained in a medical model – they are not advanced nurse practitioners, and they are not junior doctors

• They form a complementary part of a team, they are not a replacement

7 Day Services

7 Day Service

Seven Day Service Provision

• Level 0 – Five days a week – Routine service

Mon-Fri

• Level 1 –Departmental level, extended hours e.g.

8am – 8pm

• Level 2 – Services are delivered seven days a

week, but limited range of services on a Saturday

and Sunday. This limited range of services goes

beyond “on call”

• Level 3 – Services offered seven days a week

with several departments working together to

provide services across the organisation

• Level 4 – An integrated seven day service across

the organisation

7 Day Service

Level 1 - 3 Session Day Working

• Monday to Thursday

• 3 Sessions working (8.30 am to 8.30pm)

• Increase Capacity-16 lists per week.

• Increase Capacity- In-patients – with Evening lists

• Increase Capacity- Complex work- Move diagnostics to evening increase daytime lists for complex

7 Day Service

Level 2 & 3 – Inpatients & 7 Day

Service • Increased Clinician and nursing workforce

• Reviewed all job plans and made it

equitable

• Increased PAs for on-call for consultants or

time-back

• In-patient List only

• Weekend- Ward Round/In-patient List on

Sat, Sunday, BH (Inc. X-mas)

• Re-issued 7 day contracts for endoscopy

nurses/HCA following consultation

• Centralised Decontamination to Endoscopy

Unit

Workforce 2005 2015

Consultants 6 13

Associate Specialist 0 1

Fellow 0 2

Nurse Endoscopists 1 5

Band 8A 0 1

Band 7 2 2

Band 6 2 5

Band 5 12 22

Band 4 1 3

Band 3 6 17

7 Day Service

In-Patient Referrals

Patterns

0

2

4

6

8

10

12

14

16

Friday Saturday Sunday Monday

Pre-Working

Weekend Working

UGI Bleeding Mortality Comparison National & RLH

199

3

200

7

200

9

201

1

201

3

201

5

Nationa

l

14% 10% N/A N/A N/A N/A

RLH 5% 3% 0% 0% 0% 0%

For more details please contact:

Royal Liverpool and

Broadgreen University

Hospitals NHS Trust

T: M: E:

Thank you.

0151 706 2800

07342073613

Darren.mcguiness@rlbuht.nhs.uk

Darren McGuinness

Directorate Administrator

Acknowledgements Dr Sanchoy Sarkar PhD. FRCP

Endoscopy Lead & CD of BCSP- Royal Liverpool

Hospital

Seven Day Services In

Radiology

Patient safety Mortality rate

ED at front door , inner city trust Trauma team, stroke service,

Improved access to diagnostics Reduce delays

Prompt diagnostics aide decision making

Improved clinical outcomes Right thing to do for acutely ill patients

Reduces peaks and troughs and batching

Improved Patient experience Reduce frustration anxiety

Support working population

Improved efficiencies Equipment fully utilised

The Case for Change

Informatics metrics

Radiology demand and year on year largest growth within NHS Trusts

over four years:-

• X-Ray 8%

• CT 38%

• MR 41%

• USS 19%

Effective job planning. Radiologist/radiographer flexibility skill mix/impact of MDT/ on call

Creative approach retention /recruitment

Focus on robust training programmes

Organisational change processes HR - Business change leads

Understanding of contractual obligations and AFC rules/overtimes

Support for work life balance

Leadership challenges Engagement and buy in

Communication to teams

Communication across the Trust /business units.

Workforce challenges

Effective business planning Resource implications

Impact of other care groups

Business cases – board support

Improved efficiencies Improved scheduling

Reduce DNA- Text reminder – patients choice

On line vetting

Accurate data - remodelling of service Demand and capacity

Create enhanced inpatient services Prioritising care – KPI

Expedite discharges

Service delivery

• Inpatient Liaison nurse within IR

• On line vetting

• Radiologist Clinic

• Manager of the day

• USS reporting directly

New initiatives

For more details please contact:

Royal Liverpool and

Broadgreen University

Hospitals NHS Trust

T: M: E:

Thank you.

0151 706 2909

Nicky.taggart@rlbuht.nhs.uk

Nicola Taggart

General manager Radiology and Imaging

www.england.nhs.uk

Any Questions?

www.england.nhs.uk

The next #NHS7DS webinar is:

The importance of Clinical

leadership in establishing Seven

Day Services It will be held on 7th February 2017, 13:00 – 14:00.

Please email england.si-7ds-support@nhs.net for details

of how to register or register here http://bit.ly/2k7ZIFM

The Next Webinar