FEATURE
interviews from a wide range of stakeholders, and a review of relevant literature.
The report was undertaken because of concerns about the skills and knowledge deficit of the workforce looking after patients.
The study explores what the health service used to look like in 1948, when its role was largely to treat patients for one-off episodes of illness such as infectious diseases, and get them fit to return as quickly as possible to their daily lives and jobs.
Now the typical NHS patient in the 21st century is much older, frailer and sicker, often with multiple co-existing conditions, and likely to return numerous times to hospital. With this in mind it is widely recognised that the NHS needs new and different models to deliver care to these patients – and this report explores how the workforce can be reshaped to achieve these objectives.
Three routes pinpointed in the study as key to workforce change are:
• Producing larger numbers of the same types of staff.
• Developing the skills of the existing workforce.
• Producing new types of workers.
Traditional workforce planning, the report observes, has focused on the first of these routes – but long training times of professional healthcare workers mean this is a costly, inflexible and slow solution. In addition, as doctors only make up 10% of the more than 1.3 million-strong NHS workforce, the report points out that the solution does not lie in changing medical school curricula.
The best way to expand and enhance the workforce is to focus on the workers already within the NHS.
Support Workforce The report explores ways to enhance the NHS support workforce, which includes healthcare assistants. The study cites evidence
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that support workers can provide good-quality, patient-focused care, whilst reducing the workload of more highly qualified staff.
Extending Skills of Registered
Healthcare Professionals Report authors also say nurses, pharmacists, physiotherapists and paramedics could work to manage the growing burden of chronic disease more effectively. They also say there is evidence that these new ways of working could release some savings and help bridge the workforce gaps that are forecast, particularly in primary care.
An example of this can be found at South East Coast Ambulance Service where a new role of paramedic practitioner (PP)was created in 2006, after observing a significant shift in its workload from providing solely an emergency service to mainly dealing with patients with long- term conditions. The PPs train on an 18-month part-time course and an eight-week GP placement, assess and treat patients with chronic illness, and treat patients with minor illness and injury – often in their own homes.
Advanced Practice
Roles for Nurses The report also explores the advanced practice roles for nurses who could provide opportunities to fill gaps in the medical workforce; provide mentoring and training for less experienced staff; and offer a clinically-facing career option for experienced nursing staff.
Physician Associate Finally, the authors examine the new role of physician associate, where non-medical staff who have studied on a two-year postgraduate degree programme work under the supervision of doctors and surgeons. They say that such staff open up a new workforce pool to the NHS – but that their potential numbers in the immediate future are small, and their impact is limited by lack of a
regulatory framework, which prevents physician associates from prescribing and ordering tests.
There are Risks However, the authors warn that reshaping the NHS workforce also carries uncertainties. There is a possibility that new and extended roles can increase patient demand, and cost money rather than save it.
In light of this the report lists ten important lessons for organisations seeking to redesign their workforce to avoid this, such as being realistic about the time and capacity needed to support change. In addition, the authors argue that the Health Education England (HEE) budget and specialist workforce planning expertise should be protected by ring-fencing monies to support local workforce design.
Launching the report, Candace Imison, report author and Nuffield Trust Director of Policy, said: “Our research shows that reshaping the NHS workforce can offer huge opportunities – for patients, through improved health outcomes, and for staff, through more rewarding roles and better career pathways. But we stress in our report that this is not simply a ‘nice to do’ – it is urgent, and essential if the Health Service is to find a sustainable balance between available funding, patient needs and staff needs, and deliver services fit for the 21st century”.
Daniel Mortimer, Chief Executive, NHS Employers said: “As the voice of workforce leaders in the NHS, NHS Employers commissioned the Nuffield Trust to have a thorough look at where we are in terms of workforce development, drawing on the already strong practice across the NHS. I am delighted with the final report, which explores where we can further develop our workforce to get the greatest benefit for patients and clients. Our challenge now is to take forward the learning and recommendations in the report.”
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