Download Primary Care Workforce Strategy

1
Executive Summary ....................................................................................................................................................... 6
1.0
Introduction.......................................................................................................................................................... 7
2.0
Context and drivers ............................................................................................................................................ 8
2.1
National context .............................................................................................................................................. 8
2.1.1
Five Year Forward View ........................................................................................................................ 8
2.1.2
General Practice Forward View ........................................................................................................... 8
2.1.3
Health Education England Workforce Plan ........................................................................................ 9
2.1.4
‘The Future of Primary Care – Creating Teams for Tomorrow’..................................................... 10
2.2
Regional context ........................................................................................................................................... 11
2.2.1
Greater Manchester Health and Social Care Partnership ............................................................. 11
2.2.2
Health Education England (North West) Primary Care Workforce Transformation ................... 12
2.3
Local context ................................................................................................................................................. 13
2.3.1
Salford Locality Plan – Start Well, Live Well, Age Well .................................................................. 13
2.3.2
NHS Salford Clinical Commissioning Group .................................................................................... 14
2.3.3
Salford Together ................................................................................................................................... 15
2.3.4
Salford Primary Care Together .......................................................................................................... 16
2.3.5
Salford Standard................................................................................................................................... 17
3.0
Vision for primary care workforce .................................................................................................................. 18
4.0
Principles ........................................................................................................................................................... 19
4.1
Building the workforce around the local population ................................................................................ 19
Figure 1: The Population Centric™ Workforce Planning Model ................................................................... 20
4.2
A competency-based approach to workforce redesign .......................................................................... 20
4.3
Primary care as a learning organisation ................................................................................................... 21
4.4
Widening participation ................................................................................................................................. 21
Strengthening foundations for primary care workforce development....................................................... 23
5.0
5.1
General practice workforce data ................................................................................................................ 23
5.1.1
Primary care workforce data collection ............................................................................................. 23
5.1.2
Locality workforce data ........................................................................................................................ 24
Figure 2: Summary of general practice workforce (March 2016) ................................................................. 26
5.2
Skills review................................................................................................................................................... 26
Figure 3: Clinical skills of nursing staff (March 2016) ..................................................................................... 28
5.3
Future staffing models ................................................................................................................................. 29
Figure 4: Emerging primary care staffing model ............................................................................................. 29
6.0
Enabling workforce transformation ................................................................................................................ 30
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6.1
Developing future supply............................................................................................................................. 30
6.1.1
General Practitioners ........................................................................................................................... 30
6.1.2
General Practice Nurses ..................................................................................................................... 32
6.1.3
Enhanced training practices ............................................................................................................... 33
6.1.4
Pre-employment programmes ............................................................................................................ 34
6.2
Upskilling the current workforce ................................................................................................................. 35
6.2.1
Primary care learning and development programme ..................................................................... 35
6.2.2
Enabling career progression ............................................................................................................... 35
6.2.3
Advanced Practitioners........................................................................................................................ 36
6.2.4
Talent for Care and Care Certificate ................................................................................................. 37
6.2.5
Developing the non-clinical workforce............................................................................................... 38
6.2.6
Developing wider skills ........................................................................................................................ 39
6.3
Developing new roles .................................................................................................................................. 40
6.3.1
Clinical Pharmacists............................................................................................................................. 40
6.3.2
Physician Associates ........................................................................................................................... 41
6.3.3
Paramedics ........................................................................................................................................... 41
6.3.4
Mental health workers.......................................................................................................................... 42
6.3.5
Physiotherapists ................................................................................................................................... 43
6.3.6
Medical Assistants................................................................................................................................ 44
6.4
New ways of working ................................................................................................................................... 44
6.4.1
Productive General Practice ............................................................................................................... 45
6.4.2
Asset-based care and care navigation.............................................................................................. 45
6.4.3
Empowering patients and the public ................................................................................................. 46
Implementation of strategy.............................................................................................................................. 47
7.0
7.1
Delivery plan ................................................................................................................................................. 47
7.1.1
Year 1 ..................................................................................................................................................... 47
Table 1: Year 1 delivery plan .............................................................................................................................. 48
7.1.2
Year 2-3 ................................................................................................................................................. 48
Table 2: Year 2-3 delivery plan .......................................................................................................................... 48
7.2
Risks ............................................................................................................................................................... 49
Table 3: Risks ....................................................................................................................................................... 49
Appendix 1: General Practice Workforce Headlines .......................................................................................... 51
Appendix 2: Feedback from patient and public engagement ............................................................................ 53
3
Foreword
With its highly skilled workforce, effective multi-disciplinary teams and welldeveloped IT systems, the NHS is in an unparalleled position to develop a
modern primary care system that is truly world class.
‘The Future of Primary Care: Creating Teams for Tomorrow’, Primary Care Workforce
Commission
We are pleased to introduce this Primary Care Workforce Strategy for Salford.
Primary Care is at the heart of the NHS and the public has high levels of trust in their
GP and practice team. However, we know that Primary Care is under increasing
pressure due to a growing number of patients with complex health needs and rising
public expectations. Salford CCG has a clear vision for primary care to enable it to
transform in a way that is sustainable and fit for the future. Our Primary Care Strategy,
published earlier this year, recognises that workforce development is a key enabler for
primary care transformation.
Our locality plan ‘Start Well, Live Well, Age Well’ sets out our approach to improve
health and wellbeing across the city and remove health inequalities in Salford. We are
committed to working with our partners to develop a highly skilled, flexible workforce
which can deliver the ambitious objectives detailed in the plan to provide more
integrated services, closer to home. This means that we must support the primary care
workforce to train, learn and work differently.
We know that practices are finding it increasingly difficult to recruit GPs and Practice
Nurses, so we will work collaboratively with our partners to make Primary Care in
Salford an attractive place to learn and work. Our goal is that practices can recruit and
retain the best primary care professionals in the right numbers to meet local needs. At
the same time, our aspiration is to expand the skills within primary care by developing
new roles and new ways of working to complement the traditional general practice
team.
Salford has a strong history of innovating and collaborating to improve the quality of
services delivered in primary care. A number of activities and local projects have
already been initiated to support the development of the primary care workforce,
including the introduction of advanced practitioner and physician associate roles into
primary care and the development of an Enhanced Training Practice, operating across
a number of practices across the City. By March 2017 we will have mobilised our new
practice pharmacy service, commenced a pilot to explore the role of paramedics in
primary care, increased the number of apprenticeships within primary care and
established consistent workforce data across all practices.
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This strategy sets out how we will support and enable our member GP practices to build upon the
innovative work to date and develop a highly skilled multi-disciplinary workforce. The development
of Salford Primary Care Together provides additional opportunities for practices to work together
to enable workforce development and innovation. Over the next two years, the CCG will work
collaboratively with our member practices and Salford Primary Care Together to support the
development of a city wide education hub with a bespoke learning and development programme,
support more practices to become training practices and enable the development of new clinical
and non-clinical roles.
The Primary Care Workforce Strategy provides a framework to achieve our vision of a
multi-disciplinary workforce, built around the needs of a defined population, which has
the right knowledge, skills, values and behaviours to enable primary care
transformation at scale and pace and ensure high quality care for the residents of
Salford.
Dr Tom Tasker
Chair
Anthony Hassall
Chief Accountable Officer
5
Executive Summary
Primary care has been described as the foundation of the NHS and general practice is
at the heart of our communities. However, the demands on general practice are
increasing, particularly for people with multiple, complex problems. The Five Year
Forward View describes a vision for developing new models of care, with primary care
working more closely with community services and hospitals to integrate services
around the person and deliver more care closer to home. Following this, the recent
General Practice Forward View defines a plan to stabilise and transform general
practice to enable it to deliver high quality services as part of these new models of
care.
Alongside national drivers, the Salford locality plan ‘Start Well, Live Well, Age Well.
Our Salford’ sets out a strategy to improve the health and well-being of the citizens of
Salford with a key focus on delivery of integrated services. The development of an
integrated care system across Salford provides both opportunities and challenges for
primary care. One of these challenges is a chronic shortage within the general
practice workforce, specifically for General Practitioners and practice nurses. It is
recognised that the transformation of primary care at scale and pace will not happen
without workforce transformation.
This Primary Care Workforce Development Strategy (for the purposes of this strategy
primary care refers to General Practice) describes how Salford CCG will enable the
development of a multi-disciplinary workforce, built around the needs of a defined
population, with the right knowledge, skills, values and behaviours to deliver high
quality care within general practice, leading to increased choice, improved access and
better outcomes for patients.
The Strategy provides a comprehensive outline of how Salford CCG will work with
partners within primary care and across the locality to:
 Strengthen the foundations for primary care workforce development
 Develop primary care as a learning organisation
 Ensure the future supply of GPs, primary care nurses and the wider workforce
 Up-skill the current primary care workforce, including both clinical and nonclinical roles
 Develop new roles and new ways of working within the general practice team
The development of Salford Primary Care Together, a federated entity for general
practice within Salford, offers many opportunities to transform the primary care
workforce and this Strategy sets out how the CCG will support providers to develop
their workforce, to ensure that there is sufficient capacity, with an effective skill mix, to
deliver emerging new models of care.
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1.0 Introduction
Salford is a growing, vibrant city with an ambition to become a place where people live
happy and healthy lives. More people than ever before are choosing Salford as a
place to live, work, invest and visit. But Salford is a city of inequalities with some of
the poorest health outcomes in England. 70% of the local population are living in
highly deprived areas and people living in poorer areas live up to 14 years less than
those living in the richer neighbourhoods.
The Salford locality plan, ‘Start well, live well, age well’ aims to “improve health and
wellbeing across the city and remove health inequalities”. However, the plan
recognises that the availability of a suitably skilled workforce across all areas,
including primary care, is a key enabler for achieving service transformation across
health and social care.
Primary care has been described as the foundation of the NHS and general practice is
at the heart of our communities. National and local strategies are driving more out of
hospital care, meaning that primary care will need to collaborate with partners to
develop new models of care as part of an integrated health and social care system.
However, the demands on general practice are increasing, particularly for people with
multiple, complex problems. Workload projections suggest that older people with long
term conditions, including people with frailty, will be the major source of increasing
work for primary care in coming years. In addition to this, patients and the public have
rising expectations in relation to access and treatment. The situation is amplified by
chronic shortfalls in the general practice workforce, specifically in terms of numbers of
general practitioners (GPs) and practice nurses.
Salford Clinical Commissioning Group’s (CCG) Primary Care Strategy recognises the
need to support and develop primary care to deliver a service that addresses its
population needs and to ensure a primary care that is sustainable and fit for the future.
The strategy highlights that workforce development is a key enabler for primary care
transformation.
This Primary Care Workforce Strategy sets out how Salford CCG will support and
enable primary care providers to develop a multi-disciplinary workforce, in the right
numbers with the appropriate knowledge, skills and values, to provide high quality
primary care for the residents of Salford.
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2.0 Context and drivers
2.1
National context
2.1.1 Five Year Forward View
The Five Year Forward View, published by NHS England in 2014, sets out a new
shared vision for the future of the NHS based around new models of care. It sets out
how the NHS needs to adapt and evolve to meet new challenges, of people living
longer with more complex health needs, and to take advantage of the opportunities
that science and technology offer patients, carers and those who serve them. It
specifically seeks to address gaps in three areas:

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The health and well-being gap
The care and quality gap
The funding and efficiency gap
The Five Year Forward View emphasises that primary care will remain the foundation
for the NHS, but recognises that a ‘new deal’ is needed to expand and strengthen
general practice. The strategy also sets out the need to reduce the divide between
primary care, community services and hospitals to integrate services around the
person and highlights how primary care is a key element within new models of care,
whether these are multi-speciality community providers or primary and acute care
systems.
The Forward View acknowledges the need for a suitably skilled workforce to deliver
these new models of care. It highlights that whilst there has been a growth in the
overall healthcare workforce since 2000, this growth hasn’t been equitable across all
parts of the system, with hospital consultants having increased around three times
faster than GPs. The ‘new deal’ for general practice includes a commitment to expand
as fast as possible the number of GPs in training while training more practice nurses
and other primary care staff.
2.1.2 General Practice Forward View
Building on the Five Year Forward View, the General Practice Forward View,
published by NHS England in 2016, sets out a plan to stabilise and transform general
practice through additional investment and support in relation to workload, workforce,
infrastructure and care redesign.
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The document sets out how NHS England, in partnership with Health Education
England (HEE), Royal Colleges and other stakeholders, will grow the GP workforce
whilst accelerating use of the wider, multi-disciplinary workforce. It sets out a bold
ambition to create an extra 5,000 doctors in general practice and a further 5,000 nonmedical staff over the next 5 years.
In relation to the GP workforce, the Forward View describes plans to increase
recruitment and retention of GPs by:
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Increasing training capacity
Promoting general practice as a career choice
Offering flexibility of career paths
Supporting post CCT (Certificates of Completion of Training) fellowships
Developing a new portfolio route for GPs with previous UK experience
Addressing workload concerns to support GPs to stay in practice
Investing in leadership development, coaching and mentoring skills
Offering targeted financial incentives to GPs to work in areas of greatest need
The plan recognises that the success of general practice in the future will also rely on
the expansion of the wider non-medical workforce, including investment in nurses,
pharmacists, practice managers and administrative staff and the introduction of new
roles, such as physician associates and medical assistants. The plan describes how
NHS England and HEE will:
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Invest in general practice nurse development, including support for return to
work schemes, improving training capacity in general practice and increasing
the number of pre-registration nurse placements
Extend the clinical pharmacist programme to enable every practice to access a
clinical pharmacist
Invest in additional mental health therapists to work in primary care
Provide funding to support reception and clerical staff to play a greater role in
care navigation
Invest in practice manager development.
2.1.3 Health Education England Workforce Plan
The role of Health Education England (HEE) is to provide system wide leadership and
oversight of workforce planning, education, and training. The overarching aim of HEE
is to support the delivery of excellent 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.
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Each year, HEE publishes a workforce plan to set out its investment in education and
training across the system. The 2016/17 plan ‘Investing in People’ sets out three key
challenges for the healthcare workforce in England:
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Future workforce supply
Service and workforce transformation - designing sustainable services and the
teams that deliver them to deliver on the aims set out in the Five Year Forward
view
Current workforce capacity and supply - establishing the mix and numbers of
funded workforce posts capable of delivering the volume of services to
standards required
The Workforce Plan for 16/17 recognises that investment into the primary care
workforce is essential to ensure that primary care remains as the foundation for the
NHS. It sets out a vision to ‘ensure that we will provide challenging and fulfilling
careers as part of a modern, innovative primary care system’. HEE’s workforce plan
defines the additional investment into GP training to support the GP ten point action
plan, published by NHS England in 2015, which aims to:
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Increase recruitment into general practice
Retain more doctors within general practice, and
Support more doctors to return to general practice
In addition to investment into GP training, HEE acknowledges that a wider, multiprofessional workforce is required in primary care. The Workforce Plan highlights that
new clinical roles such as Physicians Associates, Clinical Pharmacists and
Paramedics and the creation of the new administrative support roles will ensure an
integrated, diverse workforce for the emerging service models.
2.1.4 ‘The Future of Primary Care – Creating Teams for Tomorrow’
In 2015, HEE commissioned an independent review of the primary care workforce, led
by Dr Martin Roland. The Primary Care Workforce Commission was asked to identify
workforce solutions that would meet present and future needs of the NHS primary care
workforce. Through the submission of evidence, site visits and conversations with local
and national organisations, the commission found that many areas had created new
and innovative ways of working and recommended that these examples of good
practice be rolled out more widely. The report ‘The future of primary care – creating
teams for tomorrow’ includes three key recommendations:
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1. A multi-disciplinary workforce. The report sets out how new clinical and support
roles can enhance the skill mix in primary care. It specifically highlights the
contribution that clinical pharmacists, physician associates, physiotherapists,
paramedics and medical assistants can make to patient care within general
practice
2. Better use of technology. With advances in technology, the report emphasises
that education and training will need to reflect the different skillsets required for
alternative forms of consultation
3. Organisational changes to the NHS primary care system. The commission
recommended that networks or federations of practices will enable primary care
to offer a wider range of services, as well as better opportunities for staff
development and training and the creation of new roles. It also highlighted that
the primary care workforce has historically been relatively unengaged in NHS
opportunities for leadership development and that this must be redressed.
2.2
Regional context
2.2.1 Greater Manchester Health and Social Care Partnership
In 2015 an historic devolution agreement was signed to give direct, local control to
public sector organisations in Greater Manchester. As part of this agreement, a
strategic Health and Social Care Partnership has been established across 37 NHS
and local authority organisations within Greater Manchester to manage the £6 billion
spend on health and social care. ‘Taking Charge of our Health and Social Care in
Greater Manchester’ sets out a five year plan to reform health and care across the
region, through the development of an integrated system.
A key focus within the ‘Taking Charge’ plan is the transformation of community based
care and support, with the aim of enabling more people to be cared for at home or in a
community setting and to drive up the prevention agenda. The vision is for primary
care to be part of an integrated system, including general practice, community based
services, social care and third sector organisations. This will require multi-disciplinary
neighbourhood integrated care teams, coordinating the care for a defined group of
people using evidence-based pathways.
The plan recognises that the workforce required to work within the transformed system
will need to be supported to develop new skills and new ways of working and that this
will impact on education programmes and workforce development activities.
From 2016, a Greater Manchester Health and Social Care Strategic Workforce Board
will be established to:
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Provide assurance on the workforce transformation programme for Greater
Manchester
Oversee the development and implementation of the Greater Manchester
Workforce Strategy
Develop new accountability arrangements to recognise that different ways of
working will be required to deliver the transformational ambition of Greater
Manchester
Deliver the workforce transformation programme
To support the transformation of community and primary care services, a Greater
Manchester primary care workforce strategy is currently being developed.
Additionally, there is an expectation that each locality across Greater Manchester will
develop a local workforce transformation plan, overseen by a locality workforce
transformation group (see section 2.3.1). These locality workforce groups will report to
the Greater Manchester Health and Social Care Strategic Workforce Board. As the
Greater Manchester and locality workforce plans evolve, Salford CCG will review its
approach to primary care workforce development to ensure alignment with the wider
health economy workforce strategy.
2.2.2 Health Education England (North West) Primary Care Workforce
Transformation
Within the North West, HEE has established a workforce transformation team to work
with care providers to support whole system service transformation, by developing a
workforce responsive to changes in care, now and in the future. This is delivered
through a framework which encompasses four pillars of workforce transformation:
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Developing a sufficient supply of highly skilled staff
Enabling up-skilling of the current workforce
Developing and promoting new roles
Developing and promoting new ways of working
HEE (North West) has developed a number of initiatives and funded activities to
support primary care providers to transform their workforce to support service
transformation. This includes, but is not limited to:
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A continuing professional development (CPD) cash allocation to CCGs to
support non-medical staff development in general practice
Ring fenced places for primary care applications to Assistant and Advanced
Practitioner programmes
Expanded commissioned places for the Community Specialist Practitioner
(General Practice Nursing) Programme
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Commissioning a Core Foundation Programme in Practice Nursing
Funding the education of a cohort of physician associate trainees
Funding the development of the enhanced training practice model
Expanded non-medical prescribing places for primary care
Salford CCG has supported the implementation of a number of these initiatives across
practices in Salford. These are described in later sections of this strategy.
2.3
Local context
2.3.1 Salford Locality Plan – Start Well, Live Well, Age Well
The locality plan – ‘Start Well, Live Well, Age Well’ - details the strategic approach to
improving the health outcomes of residents of the City, while also moving towards
financial and clinical sustainability of health and social care services. It is the blueprint
for the health and social care system in Salford for the next 5 years and supports the
development and delivery of the Greater Manchester Health and Social Care
Partnership plan.
The overarching aim of the plan is to “improve health and wellbeing across the city and
remove health inequalities” in Salford. One of the limiting factors for achieving the key
objectives within the plan is the availability of a suitably skilled workforce. The
development of seven day services, transforming primary care at scale and pace and
the integration of health and social care is likely to need new roles as well as a regular
supply of existing roles.
All health and social care partners across Salford, along with wider public sector
organisations, are engaged in the development of a locality workforce plan. Whilst the
development of this plan is in its infancy, it is envisaged that the key strands of the
plan will include:
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Leadership and management: Develop leadership capability and connect
primary and secondary care leaders together at all levels to help them think
differently and be open to new ideas and test concepts without the fear of
failure
Culture: Develop a shared culture that promotes asset based thinking, supports
innovative ways of working, enables employees to work differently and supports
staff to engage with citizens in a positive way
Employee engagement: Develop appropriate employee engagement strategies
that will enable the transition and transformation of services whilst maintaining
an engaged and motivated workforce
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Learning and development: Provide support to all employees, enabling them to
develop the skills, knowledge and behaviours to operate in different operating
models and across organisational and professional boundaries
Employment conditions: Achieve the best possible working conditions for the
workforce across the city, in order to improve health and well-being
Early thinking around the workforce transformation priorities to enable delivery of the
locality plan focuses on:
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An expansion of the workforce delivering primary medical services
Increased numbers of staff delivering care in a community setting
Staff with a broader range of skills that span health and social care
Exploring opportunities for integrated training and education
Exploring opportunities for staff to gain skills in working across all areas of care
delivery (hospital, community and primary care)
Exploring opportunities for the creation of new roles that will reduce duplication
and improve the experience of people using health and social care services
To oversee development of the locality workforce plan and to drive delivery of the
ambitions set out within this plan, a Salford locality workforce transformation group has
been established. As a key partner within the locality, Salford CCG has contributed to
the draft locality workforce plan and will continue to inform the development of this
through membership of the locality workforce transformation group. The CCG
recognises that the development of the primary care workforce must be considered in
the context of the wider workforce plan to enable integrated working across
organisations and sectors to ensure a sustainable workforce, fit for the future.
2.3.2 NHS Salford Clinical Commissioning Group
Salford CCG’s vision is to ‘commission and ensure delivery of high quality health
services and enable our population to live longer healthier lives’. The Strategic
Commissioning Plan 2014/15 to 2018/19 describes how the CCG will strive to improve
health outcomes and improve the quality of the health services commissioned over the
next five years, whilst doing so within a balanced budget.
Community Based Care is a strategic programme for the CCG. This programme aims
to support and invest in primary and community based care services to increase
integration and the scope and scale of care provided outside a hospital setting. To
enable this to happen, the CCG has developed a three stage approach to improving
the scope, capability and quality of general practice:
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General Practice Development Plan. This was developed in 2014 to support
practices to manage their existing workloads more effectively and help to
remove barriers to any future planning and service development
Primary Care Strategy. This provides a comprehensive plan on the
commissioning intentions of Salford CCG to transform primary care. The
strategy sets out how the CCG will:
o Commission high quality primary care which improves patient outcomes;
reduce variation in quality and improving the patient experience
o Improve access to general practice
o Improve the management of long-term conditions and help patients to
become empowered to self-manage.
o Support integration of primary care and its health and social care
partners to deliver seamless, fully integrated care
o Enable federated working across practices to share expertise, service
improvements and resource
Community Based Care Strategy. The final vision is that general practice
operates on a larger scale and works in a more integrated way with other
services with general practice being at the hub of local communities and
networks of services
The development of the primary care workforce is seen as a key enabler for the
delivery of the Community Based Care programme.
2.3.3 Salford Together
Salford Together is a partnership of Salford City Council, Salford Clinical
Commissioning Group, Salford Royal NHS Foundation Trust and Greater Manchester
West Mental Health NHS Foundation Trust. This partnership was established to
integrate health and social care for older people in Salford, bringing together services
and workforces from across the partner organisations into a more aligned system and
provide older people with the support they need to manage their own care. This is
being enabled through:
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The development of neighbourhood multi-disciplinary groups, to review and
problem solve complex cases, provide plans and anticipate care needs for
those using health and social care services
The development of a care home and supported living group, focussing on
those who require a high level of support from health and social care services
The creation of a centre of contact, to deliver a joined-up approach to health
information, advice and support for health and social care
15
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The establishment of a community assets group to strengthen the support
networks and groups already in place and also to help communities work
together to enable older people to remain active and independent members of
the community
In 2015, Salford Together was awarded PACS (Primary and Acute Care Service)
vanguard status by NHS England to build on the success of its partnership work. This
will enable further development of the integrated care system to encompass all
vulnerable adults across Salford. A key step in the future development of the
integrated care system is the establishment of an integrated care organisation (ICO) to
bring staff working in health and social care services together into one organisation.
The roll out of the integrated care system and the establishment of an ICO will require
a skilled and motivated workforce, who can work differently to deliver more integrated
care. An integrated workforce planning process across all providers, including primary
care, will be required to identify future workforce requirements to deliver new models
of care. As part of this process, it will be essential to identify the baseline workforce
across all parts of the system and consider new modes of education and training
across all parts of the workforce.
2.3.4 Salford Primary Care Together
Primary care currently sits outside of the ICO, but general practice is a key component
of the integrated care system. The CCG has been working with member practices,
through the General Practice Design Group, to develop a ‘blueprint’ of how general
practice might work more collaboratively to deliver primary care at scale and pace
within the integrated care system. Following a successful proposal to all member
practices regarding the creation of an out of hospital federated entity that will support
the delivery of the neighbourhood model, a business case is currently being developed
to progress the establishment of Salford Primary Care Together as the out of hospital
entity.
A federated, collaborative general practice model would enable many opportunities for
education, training and workforce development. These include:
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A city wide education hub
A learning and development programme for all general practice staff
Stronger links with education partners, including HEE and universities
Improved recruitment and retention of the workforce, specifically for GPs and
practice nurses
Broadening the skill mix within primary care through workforce innovation and
the establishment of new roles
16
2.3.5 Salford Standard
Salford CCG has recently launched the ‘Salford Standard’ for general practice to
reduce unwarranted variation in the quality of care across Salford and improve the
health outcomes for the people of Salford. There are 32 standards, across 10
domains, with a focus on long term conditions, medicines optimisation, public health,
children and young people, vulnerable groups, safeguarding, access, proactive care,
safety and experience and business management.
To support delivery of the Salford Standard, the CCG has committed to providing a
programme of education and training sessions to meet training needs identified by
practices. This will include programmes for GPs, practice nurses, practice managers
and the wider practice staff.
17
3.0 Vision for primary care workforce
In response to the national and local drivers outlined above and taking consideration of
the local challenges faced by primary care in Salford, Salford CCG’s vision for the
primary care workforce is:
To develop and sustain a multi-professional workforce, built around the needs of a
defined population, which has the right knowledge, skills, values and behaviours to
enable primary care transformation at scale and pace and ensure high quality care for the
This
will beofenabled
residents
Salford. through the four pillars of workforce transformation:
 Developing a sufficient supply of highly skilled staff
This will be enabled through the four pillars of workforce transformation:




Developing a sufficient supply of highly skilled staff
Enabling up-skilling of the current workforce
Developing and promoting new roles
Developing and promoting new ways of working
Later sections of this strategy set out how Salford CCG will work with primary care
providers and other partners to enable this vision to be achieved. The development of
Salford Primary Care Together, a federated entity for general practice within Salford,
offers many opportunities to realise this vision and to ensure the development of a
primary care workforce fit for the future.
18
4.0 Principles
A number of principles underpin the vision set out above. These are:




Building a workforce around the local population
Taking a competency based approach to workforce redesign
Developing primary care as a learning organisation
Supporting widening participation
4.1
Building the workforce around the local population
Long term planning for the primary care workforce requires a patient centred and
population based approach if it is to be effective. Traditional methods for workforce
planning, based simply on increasing numbers of the current workforce, reinforce
traditional ways of working and out dated service delivery models.
Salford CCG advocates a whole-system approach to the development of a future
workforce model, whereby partners from across the health economy work together to
build a workforce responsive to the needs of a particular population. This population
could be based on a geographical footprint e.g. a neighbourhood, a subset of the
whole population e.g. frequent A & E attendees or a cohort of patients within a defined
clinical pathway e.g. Chronic Obstructive Pulmonary Disease (COPD).
The Population Centric™ Workforce Planning Model (Gold Business Consulting Ltd),
shown in figure 1, provides a framework to identify the needs of the local population
and the services required to meet these needs and then to consider the skills and
competences required within the workforce to deliver these services. From this, roles
can be described and a gap analysis undertaken to allow workforce planning to be
completed for that defined population.
The CCG, along with partners from Salford City Council, Salford Royal NHS
Foundation Trust and Greater Manchester West Mental Health NHS Foundation Trust,
is at the early stages of testing this approach to workforce planning. The CCG is clear
that primary care must be a key partner within this methodology to develop an
integrated workforce plan which meets the needs of the local population and is aligned
to the Salford locality plan.
19
Figure 1: The Population Centric™ Workforce Planning Model
4.2
A competency-based approach to workforce redesign
Role redesign within general practice teams is a way of increasing efficiency and
effectiveness in primary care, through the development of new and amended roles,
which can address workload issues, improve patient experience and sometimes
deliver savings.
By taking a competency based approach to workforce redesign, teams can consider
where changes in skill mix and working practices or new roles can streamline patient
care without compromising on quality and safety. Without the development of a wider
multi-professional workforce, the risk is that highly skilled professionals, such as GPs
and practice nurses, undertake tasks that could be completed by other parts of the
workforce, working to a competency framework.
Salford CCG supports a competency based approach to workforce redesign,
underpinned by the ethos of ‘only do what only you can do’. This approach means
that where GPs, practice nurses or others are performing tasks or duties that other
roles could competently undertake, then consideration should be given to how these
activities can be passed on safely and effectively. In many instances, existing
members of staff can be trained to develop new competencies, but where this is not
possible new roles may be required. However, the CCG recognises that the very
nature of general practice requires the workforce to work in a holistic way and patients
20
should not have to ‘tell their story’ several times. Therefore when considering new
roles and skill mix changes, the underpinning approach must be to improve, not
compromise, patient care.
Salford CCG will encourage primary care providers to review the skill mix within their
local teams, and across the wider integrated care system, and identify where new
roles or new ways of working can be introduced to ensure that the skills and
competencies of the whole primary care workforce are being utilised effectively, whilst
maintaining a high quality service for patients.
4.3
Primary care as a learning organisation
With some exceptions, for example medical student teaching and GP training, little
priority has been given to training and professional development for staff working in
primary care. In addition to this, pressures of both capacity and capability in general
practice have historically hindered systematic engagement with healthcare training,
resulting in limited exposure of healthcare students to primary care.
The Primary Care Workforce Commission recommended that structured training
opportunities should be available for all primary care staff to develop extended clinical,
academic or leadership roles and that there should be more opportunities for joint
training of health and social care staff. The report also highlights that there should be
increased primary care exposure at pre and post-registration level through additional
placements in primary care.
Salford CCG believes that developing primary care as a learning organisation will lead
to improved recruitment and retention of the primary care workforce. The CCG
endorses the development of ‘Enhanced Training Practices’ (see section 6.1.3) which
are accredited to provide undergraduate and postgraduate training placements
through a hub and spoke model, whilst creating a multi-professional learning
organisation ethos. In addition to this, the CCG is committed to developing a primary
care learning and development programme for the whole primary care workforce to
support delivery of the Salford Standard. The CCG will identify priorities for training
and utilise its CPD allocation in the most effective way to deliver these.
4.4
Widening participation
Widening participation remains a continuing workforce priority to ensure that the
healthcare workforce represents the communities it seeks to serve. It is
acknowledged that within healthcare, a diverse workforce can ensure a better
understanding of patients' needs and lead to the delivery of joined up, personalised
care.
21
Unemployment rates in Salford are higher than the North West and national averages
and worklessness is recognised as one of the wider determinants of ill health. Salford
CCG is committed to maximising Social Value for the City’s residents. Salford’s
locality plan ‘Start Well, Live Well, Age Well’ sets out how partners will work together
to improve the economic prosperity of families to reduce the harmful impact that
worklessness and unemployment have on health and well-being.
The health sector is one of the largest employers in Salford, so supporting local people
into employment through widening participation activities is important for all healthcare
employers. Salford CCG is committed to working with partners across the City to
enable Salford citizens to become part of the local workforce across all health and
social care settings, including primary care.
22
5.0 Strengthening foundations for primary care workforce
development
To achieve the vision of a multi-professional workforce, based around the needs of a
local population, and to enable workforce transformation to take place, a number of
foundations need to be in place as a basis for further workforce development. These
foundations enable practices or neighbourhoods to consider where they are now and
where they would like to be in terms of their workforce. In summary, it is important to:



Understand the current workforce – roles and numbers
Identify skills and skills gaps within the current workforce
Consider the desired staffing model for a defined population
5.1
General practice workforce data
In order to fully understand the current workforce within primary care and to effectively
plan the workforce required to deliver care now and in the future, comprehensive
workforce information is required across all practices in Salford. Workforce data
needs to be collected in a way that information can be analysed over a neighbourhood
or locality footprint, providing an inclusive representation of the numbers of different
roles that constitute the current workforce.
5.1.1 Primary care workforce data collection
The Health and Social Care Act 2012 places a duty on all organisations that deliver
care funded by the NHS to provide data on their current workforce and to share their
anticipated future workforce needs. NHS England has developed a workforce census
module within the Primary Care Web Tool (PCWT) which practices can use to fulfil the
requirements of the workforce minimum data set and provide details of their current
workforce.
In the North West, HEE has also developed a General Practice Workforce Data
Collection tool, which feeds directly in to the WRaPT tool (see section 5.1.2). This
collects workforce information which meets the requirement of the minimum data set
(as above), but also collects additional data around roles, skill sets and vacancies.
The HEE GP Workforce Tool therefore provides a richer level of information and for
this reason practices within Salford have been encouraged to submit their workforce
data through this method. Practices are currently asked to refresh their workforce data
every six months.
In March 2016, 63% of practices submitted workforce data through the HEE GP
Workforce Tool, which was an increase from 41% the previous year. In comparison to
other CCGs, analysis of this data showed that NHS Salford CCG is broadly similar to
23
both the regional (Greater Manchester) and North West average position; however,
the age profile across the CCG is slightly younger, as is observed across all staff
types. Part-time working increases with age and a smaller proportion of staff work parttime hours across the CCG, including GPs. Despite this, the number of GPs is
average for the region (Greater Manchester), but low compared to the North West and
England averages. However, this is offset by a higher percentage of other direct
patient contact roles (e.g. advanced practitioners, Allied Health professionals). A high
level summary of analysis of this data is shown in Figure 2.
The CGG will work with primary care providers to identify the most effective way to
collect workforce data in a consistent way and to utilise this data to provide information
which is useful to the CCG, primary care providers and other partners. The CCG will
also continue to monitor which practices have submitted workforce data and explore
options for including workforce data as a key performance indicator within the Salford
Standard to encourage all practices to submit to the HEE GP Workforce Tool, aiming
for 100% completion.
Further information on the Salford general practice workforce is provided in Appendix
1.
5.1.2 Locality workforce data
As part of the evolving integrated care system, the CCG will work with its partner
organisations to develop an integrated workforce plan. HEE (North West) has
commissioned the development of a strategic workforce tool, WRaPT (Workforce
Repository and Planning Tool), which enables organisations to plan their workforce
based on anticipated changes in the delivery of care. WRaPT enables the collection,
analysis and modelling of workforce information across the whole health and social
care economy.
Salford Together partners are working with the WRaPT team to identify the baseline
workforce data across all parts of the system, including primary care, as a foundation
for workforce modelling to support delivery of new models of care. The work is at an
early stage, but having comprehensive primary care workforce data is a prerequisite
for the next phase of work, which will focus on a defined sub-population to establish
anticipated changes in services and activity and how the workforce may need to
change to reflect this.
24
25
Figure 2: Summary of general practice workforce (March 2016)
DPC = other direct patient contact roles
GPs (R&R) = Registrars and GPs on the retainer scheme
5.2
Skills review
‘The future of primary care – creating teams for tomorrow’ report highlights that there
is currently a lack of systematic data on who does what in primary care or data on
whether the primary care workforce has the appropriate training and skills to deliver
the necessary services.
Salford CCG recognises that a key enabler for delivery of the Salford Standard is a
suitably skilled workforce and is therefore committed to developing a primary care
learning and development programme for the whole primary care workforce aligned to
the domains and standards within the Standard.
Little information currently exists on the current skills within the primary care workforce
across Salford. Where practices submitted workforce data into the HEE (WRaPT) tool
some analysis of skills within the workforce is available. A summary of this for the
nursing workforce is shown in Figure 3. This highlights that, when compared to other
CCG areas, a higher number of nurses across Salford report that they have skills in
cervical cytology and family planning, but there are lower numbers of nurses who
report they are non-medical prescribers. It should, however, be noted that this data is
incomplete and has not been validated for these practices who did submit to WRaPT.
To identify where there are gaps in the knowledge and skills of the current workforce,
the CCG has recently carried out a training needs analysis across all practices by job
role, based on the Salford Standard. This highlighted that all parts of the workforce,
including GPs, nurses, practice managers and reception staff, feel that they require
training in a diverse range of topics. The results of this exercise will be used to inform
26
the development of a primary care learning and development programme, which will
be made available to the whole workforce.
Competency or capability frameworks, which describe the knowledge, skills and
expertise required to competently carry out a role, have been developed for a number
of roles within primary care, including GPs, General Practice Nurses, Advanced
Practitioners, Physician Associates and Health Care Support Workers. These can be
used as a basis for employers or individuals to assess a person’s current level of
competency and identify where training or development may be required, as part of a
personal development plan. These competency frameworks can also be used to
establish a baseline of current skills across a whole section of the workforce to inform
a standardised approach to training and development. The CCG supports this
approach to assessing and reviewing current skills and skills gaps to enable suitable
workforce and education programmes to be developed for the primary care workforce.
27
0%
28
Suture removal
Wound Care
Phlebotomy
New Patient Check
Health Promotion
GTT
ECG
50%
BP Check
50%
Diabetic foot check
50%
Antipsychotic Drug…
Ambulatory check
Treatment room
Telephone triage
Non-medical prescribing
Minor surgery
Minor illness
Family Planning
Cervical Cytology
LTC: Spirometry
LTC: Respiratory…
LTC: Insulin initiation
LTC: Hypertension
LTC: Heart Failure
LTC: Diabetes
LTC: CVD
LTC: COPD
LTC: CKD
LTC: Asthma
Figure 3: Clinical skills of nursing staff (March 2016)
Clinical Skills (nursing staff)
North West
25%
0%
The analysis is based on WRAPT
data. The data does not specify
what proportion of time is spent
within a clinical area, only whether
or not an individual has expertise
in one or more specific areas.
Greater Manchester
25%
0%
NHS Salford CCG
25%
5.3
Future staffing models
In order to enable them to move towards the vision of a multi-professional workforce,
practices need to be able to make informed decisions about their desired staffing
model, based on current activity and longer term planning assumptions. Whilst it is
recognised that there is not one ‘ideal’ staffing model – for example, based on ratios of
GPs or nurses per head of population - practices need support to consider how their
workforce should be configured to reflect the needs of their local population. The
Primary Care Workforce Commission recommended that ‘practices should analyse
their workload and clinical case-mix when deciding what skills they need to employ.
They then need to agree clear criteria for what each healthcare professional will do
and ensure that staff are fully competent in the roles they undertake’.
Salford CCG is keen to support practices to identify their desired staffing model and,
working in partnership with HEE (North West), has commissioned a piece of work to
develop, test and embed a model which can be used on a practice or neighbourhood
level to determine future staffing requirements. The emerging model, depicted in
figure 4, enables practices to review current activity, consider future ways of working
and make informed decisions on how their workforce should be shaped to deliver local
services. Following development with key stakeholders from the CCG and primary
care providers, the model and approach is being tested in 4 practices in Little Hulton.
Early feedback from these practices is extremely positive, but a more formal
evaluation will be undertaken.
Figure 4: Emerging primary care staffing model
29
This model reflects the principle of building a primary care workforce around the needs
of the population and therefore the CCG endorses the wider roll out of this approach.
6.0 Enabling workforce transformation
Workforce transformation is about developing a workforce responsive to changes in
care, now and in the future, taking account of national, regional and local drivers. The
Five Year Forward View, The GP Forward View, the Greater Manchester Health and
Social Care Partnership and Salford CCG’s Primary Care Strategy all highlight that
primary care workforce transformation is required to enable reform and change to
happen at scale and pace, in a sustainable way.
There are four key ways to transform the workforce:




Developing future supply
Upskilling the workforce
Developing new roles
Promoting new ways of working
6.1
Developing future supply
Salford CCG has an ambition to develop primary care as a career of choice and to
work with partners to ensure that Salford is as an attractive place to train and work. It
is essential that a wide range of professionals are exposed to primary care as part of
their pre- and post-registration training and that primary care is seen as a desirable
option for a post-registration career.
6.1.1 General Practitioners
GPs are the bedrock of general practice. Salford CCG recognises that the GP role is
core to the wider practice team and must be valued as the provider of holistic, patientcentred care for undifferentiated illness, across time within a continuous relationship.
For this reason the CCG wishes to promote and support GP training, recruitment and
retention within Salford.
The latest NHS England workforce figures (September 2015) show that there are
135.2 FTE GPs in Salford (excluding registrars, retainers and locums), with a fairly
even split by gender (54% of GPs in Salford are female). Information collected by
HEE, highlights that 11% of GPs are over the age of 55 and that 66% are under the
age of 45, with the CCG having a slightly younger GP workforce than the regional
(Greater Manchester) and North West profiles..
30
There is currently no consistent way of collecting GP vacancy data, but anecdotally
many practices across Salford report difficulties in filling GP posts. Practices also
report that where posts are filled, these are more likely to be salaried or locum GPs
rather than partners.
Salford CCG is committed to working with primary care providers and other partners,
including the Post-graduate Medical School and the Local Medical Committee, to
ensure there are sufficient numbers of GPs in Salford. This will be achieved through a
number of approaches:




Increasing training capacity. There are currently 20 GP trainers in Salford.
Previously, the number of trainers has not been the limiting factor in GP
training, due to a national shortfall in the number of filled GP training places.
However, NHS England has made a commitment in the General Practice
Forward View to increase GP training recruitment through national and
international campaigns. HEE has increased GP training capacity and in the
most recent recruitment drive, 70% of posts were filled in the first round, an
increase from previous years. Therefore, as the numbers of GP trainees
increase, more trainers will be required. Salford CCG will identify ways to
support GPs who wish to develop their practice as a training practice. This may
include encouraging more GPs to become trainers for the FY2 programme, to
enable them to start their journey as a trainer. There are opportunities to align
with the development of enhanced training practices (see below), which provide
a firm foundation for multi-professional learning placements
Promoting general practice in Salford as a career choice. The CCG will explore
options to work with partners to develop campaigns which promote primary care
in Salford as an appealing place to train and work. This supports broader
strategies across the City to make Salford an attractive place to work and live
Exploring flexibility of employment routes. With the development of the
integrated care system and closer working relationships between primary care
and other parts of the health and social care system, there are opportunities to
explore alternative methods of employment for GPs. Anecdotally, many GP
trainees do not wish to become a partner, but would prefer a more flexible
career path, which will allow them to work in other parts of the integrated
system, as well as in general practice, and access wider opportunities for
personal and professional development. The CCG would support the further
consideration of this approach
Induction and refresher scheme. GP Induction and Refresher Schemes provide
an opportunity for qualified GPs to be inducted into or return to general practice
in the UK. The scheme offers a bursary to an individual, whilst they are working
on a supervised placement in general practice. Whilst these schemes are
operated centrally by Post-graduate Medical Schools, the CCG will explore
options to support the scheme locally.
31

Targeting areas of greatest need. NHS England is offering bursaries to GP
trainees to work in areas that have been traditionally hard to recruit. The CCG
will work with practices to identify where there are high levels of unfilled
vacancies and consider how it may support future recruitment into these areas
6.1.2 General Practice Nurses
The nurse is a core part of the general practice team and, as care shifts from the acute
sector into community settings, will have an increasingly important role in the care of
patients, especially those with long term conditions. Development as a General
Practice Nurse is undertaken at a post-registration level, although increasing numbers
of nurses are undertaking supervised placements in primary care as part of their preregistration education (see enhanced training practices, below).
As with GPs, there are local reports of difficulties in recruiting to some practice nurse
posts and low retention levels. The reasons for this are multi-factorial and include:





Secondary care nurses not having had relevant experience in primary care,
therefore unable to work independently without further development
Primary care not seen as a preferred career path, due to a perceived lack of
support and personal and professional development
Previous absence of an agreed career development framework for primary care
nurses
No standardised approach to induction, supervision and training
A variation in pay and conditions across practices
Within the North West, there are two established education routes, funded by HEE, to
drive the supply of practice nurses. These are:


Core foundation modules, aimed at new practice nurses, whether newly
qualified or working in a different speciality
Community Specialist Practitioner (general practice nursing) programme,
enabling study at a post-graduate or degree level
Salford CCG recognises that these education programmes offer a standard approach
for practice nurse development and, as such, recommends that all new practice
nurses attend the foundation modules. In addition to these, the CCG supports practice
nurse development through its CPD cash allocation by funding additional training
which is felt to be essential to meet service needs e.g. vaccination and cytology
training. The CCG is committed to continue to support practice nurse training, to
ensure a sufficient future supply, and will agree priority areas for funding.
32
To increase and sustain the numbers of nurses within the primary care workforce,
Salford CCG is committed to working with primary care providers, partners across the
health economy and HEE to explore options to attract nurses to move into general
practice and to improve retention. This may include:






Supporting the development of a standard induction and preceptorship
programme
Supporting the development of a core local training programme
Enabling the local implementation of the nationally defined career pathway for
the primary care nursing workforce
Supporting a return to nursing scheme for primary care
Enabling the further development of the enhanced training practice approach
Facilitating opportunities for new models of employment for nurses
Recently, HEE has announced the creation of a Nursing Associate role. This new role
would support registered nurses in providing high quality person-centred care and
would be trained in a higher skill set than a traditional healthcare support worker. The
proposed education route for this role would be via an apprenticeship framework, with
a high level of work based learning, leading to a foundation degree. As well as bringing
direct benefits to patient care, the associate role is seen as enhancing the overarching
career framework for nursing, enabling progression for healthcare support workers and
providing an additional route into pre-registration training, thus increasing the supply of
registered nurses.
The CCG is keen to participate in further discussions about this new role and will work
with HEE and primary care providers to test, embed and evaluate the contribution of
the Nursing Associate role to the primary care workforce.
6.1.3 Enhanced training practices
Enhanced training practices are a practice or group of practices accredited to provide
undergraduate and postgraduate multi-professional training placements, operating
through a hub and spoke model. Hubs take the lead role in developing both sufficient
capacity and quality of learning environments, whilst also creating a multi-professional
learning organisation ethos as part of core business.
The purpose of an enhanced training practice is to increase exposure of healthcare
students to primary care and therefore provide an opportunity to harness and assure
future workforce supply. They are multi-professional, offering placements to support a
variety of pre-registration programmes, including nursing, medical and Allied Health
Professions students.
33
To support the establishment of enhanced training practices, HEE (North West)
recently invested in the development of a number of hubs across the region. Within
Salford, Salford Health Matters has developed as a hub and is working with other
practices to successfully deliver high quality learning placements to healthcare
students. Salford CCG endorses this innovative approach to increasing the future
supply of the primary care workforce. As further opportunities arise, the CCG will work
with higher education partners and others to develop additional capacity for learning
environments in primary care, at both a pre-registration and postgraduate level.
6.1.4 Pre-employment programmes
To support the widening participation agenda and ensure a primary care workforce
which reflects the diversity in the local population, the CCG is keen to explore options
to promote pre-employment programmes such as cadets and internships. By
facilitating opportunities for local citizens to work in the local health and social care
sector, this reflects the ambitions set out within Salford’s locality plan of improving the
economic prosperity of families, whilst also assisting with the future supply of the
primary care workforce.
In the North West, career engagement hubs have been established to bring together
local employers, schools and training providers and coordinate a number of activities
aimed at promoting healthcare careers to a range of people, including children, school
leavers and those not in employment. Salford CCG is part of the Greater Manchester
hub and through this is considering how it can work with primary care providers and
others to provide opportunities for the local population to become part of the local
workforce.
The Skills for Health Academy in the North West runs a 14 week pre-employment
programme. This aims to help unemployed adults, often from disadvantaged
backgrounds, to attain the skills, values and capacity required in order to secure
employment. Participants complete a four week study period in college, followed by a
10 week placement with a local healthcare employer. Traditionally these placements
have been in secondary care in NHS Trusts, but the CCG is considering how primary
care may be able to engage with this programme.
Internships are a relatively new approach to providing work experience within the
health and social care sector. A number of providers and charities are now working
with employers to develop internship programmes, often as part of a wider career
development programme, to enable individuals to be exposed to work and to develop
essential skills for career success. Salford CCG is keen to consider how these
internships may be useful in primary care as an approach to widening participation, but
also to enable future recruitment into roles within general practice.
34
6.2
Upskilling the current workforce
With national and local strategies driving more community based care, alongside the
launch of the Salford Standard to improve the quality of care offered by primary care in
Salford, the CCG recognises that the whole general practice team needs to be highly
skilled to deliver high quality care in an effective way. This includes up skilling both
clinical and non-clinical staff, to ensure the most effective skill mix is available to meet
patients needs.
6.2.1 Primary care learning and development programme
Following a recent exercise to identify training needs across the primary care
workforce, the CCG is committed to developing a primary care learning and
development programme for the whole workforce. This builds upon established
training programmes for the primary care workforce in several areas, including end of
life care, safeguarding and diabetes management.
This programme will focus on supporting delivery of the Salford Standard, with specific
educational events linked to individual standards e.g. respiratory care, dementia,
kidney disease and learning disabilities. A calendar of training events will be published
and promoted to all practices with targeted audiences where appropriate and sessions
will be evaluated to ensure that they are meeting the needs of the workforce.
Salford CCG receives a CPD cash allocation from HEE (North West), as well as
access to modules at North West universities through the CPD-Apply system. These
funding streams support the development of all non-medical clinical staff. Following
the recent Comprehensive Spending Review, there has been a significant reduction in
the CPD funding which has been made available to the CCG. Therefore the CCG will
identify priorities for education and development and will ensure that there is a
transparent process for allocation of the funding across the primary care workforce.
6.2.2 Enabling career progression
In 2015, HEE published ‘Transforming Nursing for Community and Primary Care’.
This education and career framework sets out the specialist knowledge and skills
needed to deliver and advance in district nursing and general practice nursing. This
Framework is part of a workforce transformation work programme for community and
primary care nurses to enable care to be delivered in out of hospital settings,
improving patient outcomes and the experience of patients, carers and staff. The
Framework also supports standardisation of roles by outlining core and specific
competencies, enabling practitioners to identify learning needs, plan and develop
careers.
35
The Framework clearly establishes the careers escalator for a general practice nurse,
from level 1 (pre-employment) to level 8 (advanced nurse practitioner) and as such
embraces the unregistered and registered nursing workforce. For each level, the
framework provides a clear role description, minimum professional and education
requirements and the scope of clinical practice, with a link to competency frameworks
where appropriate.
Across Salford practices, there are a number of different roles within the practice
nursing workforce, namely healthcare assistant, assistant practitioner, practice nurse
and advanced nurse practitioner. However for the majority of these roles, with the
exception of advanced practice, there is currently no standardised approach to role
definition and no agreed method to enable individuals to progress up the careers
escalator, although many practices have used in-house learning and external
development opportunities to support the development of their nursing workforce.
Salford CCG wishes to promote the local implementation of the HEE education and
career framework for general practice nursing to enable a consistent approach to role
definition, education and training requirements, competency levels and scope of
practice. As well as bringing clear benefits to service delivery and patient care at a
practice level, this would provide opportunities for the nursing workforce across Salford
to work in a more collaborative way across neighbourhoods, through pooling
resources and sharing skills. This could initially be across practice teams, but, with the
further development of the integrated care system, could also provide opportunities to
work more collaboratively with the wider community nursing teams. The CCG will
continue to explore options for promoting the further development of the general
practice nursing career framework to enable progression of individuals through the
various roles.
6.2.3 Advanced Practitioners
Over recent years, the Advanced (Clinical) Practitioner has become more important in
primary care and both the Primary Care Workforce Commission and the General
Practice Forward View highlight the contribution that non-medical clinicians with
advanced level skills can make to the general practice team.
An Advanced Practitioner is an experienced, non-medical, registered professional who
has developed their theoretical knowledge and clinical skills to a high standard.
Advanced Practitioners bring a unique skill mix to general practice teams, provide
patients with a broader range of choice and add capacity to service delivery to better
meet demand. They work in addition to, and together with, GPs and the wider practice
team.
36
In the North West, the recognised education route for Advanced Practice is a two year
MSc programme, with a significant amount of work based learning. This enables
individuals to develop high level knowledge, clinical skills and competencies as well as
critical analytical skills to risk manage and make safe, evidence-based decisions at a
high level. On completion of the programme, Advanced Practitioners are able to
independently assess patients with a wide range of clinical presentations, request and
review diagnostic tests, undertake differential diagnosis and treat patients, including
referral to other services where appropriate. Many Advanced Practitioners are also
independent prescribers.
Salford CCG supports the development of Advanced Practitioners and views them as
an essential part of the primary care workforce. HEE (North West) currently supports
the development of Advanced Practitioners through funding the education programme
plus salary costs while the individual is studying at university. To supplement this
funding, the CCG has invested £1,763,388, over three years, in a cohort of 14 primary
care trainee Advanced Practitioners, who are currently half way through their two year
programme. This training programme is hosted by Salford Health Matters with several
other practices providing placements. The multi-professional cohort consists of
nurses, physiotherapists and paramedics and anecdotal feedback from practices
about the value of the role is extremely positive. The CCG is committed to continuing
to work with partners to evaluate the role of Advanced Practitioners in primary care
and to support the further development of this role.
6.2.4 Talent for Care and Care Certificate
HEE has recently published Talent for Care, a strategy produced to recognise, support
and further develop the development of the healthcare support workforce. Talent for
Care was developed following wide consultation with national bodies, education
institutions, health and social care employers and healthcare staff and represents a
significant development, as it is the first ever national strategy for the development of
healthcare support staff.
One of the key pledges included in the Talent for Care strategy is the implementation
of the Care Certificate. The aim of the Care Certificate is to ensure that all new support
staff are taught and can demonstrate the right skills, knowledge, values and
behaviours to provide high quality and compassionate care. From April 2015 all new
NHS and social care staff providing direct support to patients and clients need to
complete the Care Certificate. However, the implementation of the Care Certificate
within primary care requires some consideration to ensure it can be integrated into the
support workforce and to enable providers to utilise it in a way that is meaningful to
individuals and practices.
37
The CCG is currently facilitating some work to identify where a standardised approach
to the development and training of healthcare assistants would add value to patient
care and the wider system. This includes consideration of how the Care Certificate can
be used and applied to best effect within primary care. The initial phase will review the
baseline competencies within the current healthcare assistant workforce, to enable an
informed decision to be made regarding future development of the role.
6.2.5 Developing the non-clinical workforce
The success of general practice in the future will rely on the development of the wider,
non-clinical workforce and Salford CCG recognises the contribution that practice
managers, receptionists and other non-clinical roles make to the practice team. The
administrative burden on primary care clinicians is well documented and it is estimated
that GPs spend 11% of their time on administration. ‘The future of primary care –
creating teams for tomorrow’ suggested that new support roles have the potential to
reduce the administrative workload of GPs and other clinicians.
Historically, the development of this part of the workforce has been overlooked and
practice managers have found it difficult to identify appropriate education and training
programmes to develop this part of their workforce. Salford CCG’s vision for the
primary care workforce is inclusive of non-clinical roles and therefore the CCG is
committed to supporting the development of this part of the workforce.
Practice managers provide a crucial senior administrative function within general
practice and, although the role can vary from practice to practice, they are usually
responsible for a number of key activities including business planning, handling
financial systems including payroll, selecting, training and supervising non-clinical staff
and the effective use of data and information. Practice managers can gain relevant
qualifications through external accredited providers, such as AMSPAR (Association of
Medical Secretaries, Practice Managers, Administrators and Receptionists ) which
offers a Certificate/Diploma in Primary Care and Health Management or the ILM
(Institute of Healthcare Management) which provides the Vocational Training Scheme
for General Practice Managers. However, a scoping study of the non-clinical
workforce across Salford in 2015 revealed that 42% of managers were not qualified to
level 3, highlighting that there are significant opportunities to up skill practice
managers within Salford practices. The recent General Practice Forward View
committed new investment to support practice manager development, although the
detail of this is not yet known.
Administrative roles within general practice are often used as an entry point into the
primary care workforce and can be used as a foundation for career development into
other roles. Practices cite that they are keen to develop their administration and
reception staff into healthcare assistants or into more senior administration roles.
38
Apprenticeship programmes can be a cost-effective means of creating a skilled,
flexible and motivated workforce. These programmes can also help improve the
diversity of the workforce and provide employment opportunities for the local
community to enter the healthcare sector. Apprenticeships are work-based training
programmes available to anyone over the age of 16. They enable learners to
demonstrate their competence while gaining a recognised qualification, which span a
range of levels from level 1 (GCSE equivalent) to level 7 (Masters level), achieved
through a mix of on the job training and study, whilst at the same time being in
employment.
The government is committed to increasing the growth of apprenticeships and there is
a commitment to achieve 3 million apprenticeship starts in the UK economy by 2020.
To facilitate this there are major changes in apprenticeship national policy and the
introduction of some significant reforms. All public sector organisations will have a
legal duty to support apprenticeship starts and will be set a target of 2.3% of their
workforce. It is estimated that to meet the target of 2.3% over 4000 apprenticeship
starts will need to be achieved by North West NHS organisations. In addition to this, in
April 2017 an annual Apprenticeship Levy will be introduced and applied to all
organisations with a pay bill of £3m or more.
Whilst apprenticeships are well established in NHS Trusts, there has been less use of
these programmes in primary care, so a targeted approach is currently being deployed
by HEE to increase the numbers of apprenticeships within this sector. Salford CCG
recognises the opportunity to utilise apprenticeships to develop the skill mix within
primary care and to specifically develop the non-clinical workforce, including practice
managers. The CCG will work with primary care providers, HEE and education
providers to enable an increased usage of apprenticeships within primary care and to
support the government’s ambition and targets.
6.2.6 Developing wider skills
Salford CCG recognises that the primary care workforce needs to develop a wider skill
set than those related directly to the delivery of patient care. This may include, but is
not limited to, training and development in:







Quality improvement
Research and innovation
Leadership
Enhanced use of technology
Risk management
Clinical system training
Coding
39
The recent training needs analysis provided an initial overview of where this training is
required, which demonstrated a need for both the clinical and non-clinical workforce to
develop a wider knowledge base and skill set in relation to the areas listed above. The
CCG will review this information and, through discussions with providers, will establish
the most effective way to meet these needs.
6.3
Developing new roles
The General Practice Forward View highlighted that the success of general practice in
the future will rely on the expansion of the non-medical workforce and the introduction
of new roles. This reflects the findings of the Primary Care Workforce Commission
which emphasised where new roles can bring benefits to patient care, through
enhanced models of service delivery.
Salford CCG has an innovative approach to the development of new roles within
primary care and has committed significant investment, through innovation funding
and the commissioning of new services, to the testing, evaluation and embedding of
several new roles. The CCG is committed to exploring additional opportunities for role
development in primary care.
6.3.1 Clinical Pharmacists
There has been considerable interest over the last few years in the role of clinical
pharmacists within the general practice team. Pharmacists are able to support
patients to self-manage their well-being and long term conditions, through optimising
medicines, and enabling improved medicine related communication between general
practice, hospital and community pharmacy e.g. on admission and discharge and at
other interfaces of care. This therefore means that GPs can focus their skills where
they are most needed and frees up GP time.
The Primary Care Workforce Commission recommended that ‘there should be greater
involvement of clinical pharmacists, including prescribing pharmacists, in the
management of people on long-term medication and people in care homes. This role
is best carried out in the GP practice in order to allow full access to the patient record
and to maximise interaction between the pharmacist and other clinical staff in the
practice.’ NHS England is testing a general practice clinical pharmacist programme
and, through the General Practice Forward View, has committed to a further roll out of
this scheme.
In 2014, Salford CCG funded an innovation scheme which provided clinical
pharmacists to three neighbourhoods. These posts evaluated favourably and were
shown to improve medicines safety, long term condition reviews and medicines
reconciliation at transfer of care as well as a reduction in waste and financial savings.
40
Following this successful pilot, the Salford CCG has approved a business case to the
value of £1,077,425 to commission a clinical pharmacy service to ensure every
practice has clinical pharmacist input on a regular basis. The key outcome of this new
service will be improved care and health outcomes for patients. In addition to this, it is
expected that this new service will release savings in the primary care prescribing
budget as well as reduce the number of medicine related non-elective admissions.
A lead provider has been appointed for the clinical pharmacists and the service is
currently being mobilised. The pharmacists will be based within general practice and
seen as a member of the primary care team. It is proposed that the teams are
formulated on a neighbourhood basis with a team leader supporting several
pharmacists.
6.3.2 Physician Associates
A physician associate is a new healthcare professional who, while not a doctor, works
to the medical model, with the attitudes, skills and knowledge base to deliver holistic
care and treatment within the general practice team under defined levels of
supervision. Physician associates provide generalist clinical care in general practice,
typically seeing people with acute minor illness. They have two years post-graduate
training, following a minimum of a 2:1 science degree. This training follows the model
of a medical qualification. Working under the supervision of a GP, physician
associates can make a significant contribution to practice workload.
Across the North West, HEE is leading the delivery of a pilot physician associate
education and training programme to develop these roles in secondary and primary
care. Salford CCG recognised this pilot as an opportunity to test and evaluate the
contribution of this new worker to the general practice team and has provided
£100,000 additional funding over two years to sponsor 10 trainee physician associates
to work in practices across Salford, coordinated by Salix Health Ltd. The trainees
commenced their education programme in January 2016 with their first primary care
placement starting in June 2016.
The CCG recognises that more studies are needed to assess how effective and cost
effective these roles are in the long term and will work closely with HEE to undertake a
robust evaluation of the contribution and impact of these roles in general practice.
6.3.3 Paramedics
Paramedics are autonomous practitioners who are registered with and regulated by
the Health and Care Professions Council. The Paramedic Career Framework (2015)
recognises that many paramedics are now moving away from traditional ambulance
41
service roles to work in primary and critical care, including out of hours services,
general practice, walk in centres and emergency departments. Paramedics are
experienced in pre-hospital care and are able to assess, diagnose, treat or signpost
patients. Paramedics have many clinical skills which are transferable into primary care
and have well developed communication skills including supporting patients to selfmanage their condition, where appropriate.
A number of community and primary care paramedic services have developed across
the United Kingdom. Within general practice, there are a number of options for
utilising paramedics as part of the primary care team. This may include running
clinical sessions, including pre-booked and urgent appointments, telephone triage and
home visits. The Primary Care Workforce Commission highlighted that ‘the potential
for paramedics to substitute for GPs in the assessment of urgent requests for home
visits merits further evaluation’.
Salford CCG is currently exploring options to utilise advanced practice paramedics in
one neighbourhood, as part of an acute home visiting service, to evaluate how this role
may improve access and patient care. This builds upon the success of utilising trainee
advanced practitioner paramedics within general practice, as part of the advanced
practice programme described above. The CCG recognises that an agreed
competency framework would need to be in place when introducing this role and that
defined protocols and supervision arrangements would also be required to ensure that
patient safety, quality and effectiveness are not compromised. Through the innovation
process, the CCG would carry out a robust evaluation of this role to determine impact
and benefit, prior to further roll out of the role.
6.3.4 Mental health workers
Mental health problems are widespread and mental health and physical health are
often linked. Many people presenting to general practice have primary mental health
needs or secondary mental health problems associated with their physical conditions.
As well as impacting on physical health outcomes, individuals with mental health
problems are less likely to engage in school or employment, leading to an impact on
wider public health services and resources.
Nine out of ten adults with mental health problems are treated in primary care,
although the primary care workforce may not always feel it has the appropriate level of
knowledge and skills to care for these people effectively. Resources for primary care
practitioners have increased through the development of IAPT (Improving Access to
Psychological Therapies) services, and in some areas nationally, the attachment of
primary care mental health workers to practices.
42
The General Practice Forward View has set an ambitious target to ensure there are an
extra 3,000 mental health workers in primary care by 2020, providing an average of a
full-time therapist for every 2-3 typical sized practices. In addition to this new resource,
the primary care workforce needs to be trained to ensure they are fully supported to
lead the delivery of multi-disciplinary mental health support in primary care.
General practices need links to mental health advice for the wide range of
psychological problems seen in both adults and children in primary care. In Salford,
there are established pathways of care for people requiring IAPT services and for
those with higher level mental health needs. The development of the integrated care
system in Salford provides opportunities to join up general practice, community
services and mental health services to provide new models of care delivery for
patients with low level mental health needs, through an integrated approach to
physical and mental health.
Salford CCG will work with partners to explore where new roles, new ways of working
and learning and development within the primary care workforce could improve care
pathways and quality of care for all individuals with mental health needs.
6.3.5 Physiotherapists
Musculoskeletal (MSK) conditions make up to 30 per cent of a GP’s caseload, rising to
50 per cent for patients over 75. There is increasing evidence of the role that
physiotherapists can take as part of primary care teams to support the management of
MSK problems.
Physiotherapists are autonomous practitioners able to assess, diagnose, manage and
discharge patients. Increasing numbers of physiotherapists are independent
prescribers and are able to administer injections or prescribe drugs as part of a
treatment plan. However, rapid referral to physiotherapy reduces levels of medication
and therefore having access to physiotherapy as part of the primary care team can
help to reduce levels of unnecessary prescribing.
As autonomous practitioners, physiotherapists can be accessed through self-referral
schemes, reducing the demand on GPs. This streamlines pathways of care and saves
time and money. Self-referral schemes in physiotherapy have been well evaluated
and have been shown to reduce DNAs, increase access, reduce administration costs
and increase patient satisfaction. One evaluation found that 85% of MSK patients
seen by a physiotherapist in primary care did not need to see a GP.
Salford CCG is keen to identify approaches to enabling patients with MSK problems to
access physiotherapy in a more timely and effective way at a location which is easily
accessible to them. Self-referral to physiotherapy is one area which is currently being
43
explored and as part of this, the CCG will consider where these services may be
located. Increased collaboration across primary care providers, as part of the
development of Salford Primary Care Together, may offer opportunities to co-locate
physiotherapists in practices or for primary care providers to employ them directly. In
addition to this, the integrated care system brings opportunities to develop new
pathways of care for patients with MSK problems and the CCG will work
collaboratively with secondary care providers to identify where the development of
physiotherapy roles may enhance primary care MSK provision.
6.3.6 Medical Assistants
Excessive administration in general practice is a major problem and many GPs cite
that non-clinical workload is a major factor in them leaving primary care roles. It has
been estimated that GPs spend 11% of their time on administrative duties, which could
be delegated to other parts of the workforce to enable GPs, and other clinical staff, to
focus more time on direct patient care.
The Medical Assistant role has been used in American and Australian primary care to
provide appropriate skill mix solutions to the demands on GPs. Medical Assistants are
trained to perform both clinical and non-clinical duties to support GPs. ‘The future of
primary care – creating teams for tomorrow’ report identified Medical Assistants as a
key area to pilot and evaluate its impact in primary care.
A recent workshop facilitated by HEE to discuss the role of Medical Assistants in
primary care across the North West revealed that some practices are already
developing roles which have a clinical and non-clinical element e.g. reception and
phlebotomy, and that many healthcare assistants undertake a variety of tasks which
cut across both areas. However, it was recognised that education and training to
support these roles, within a defined career framework, was not standardised and this
should be explored further, specifically to understand the core competencies needed
for this type of worker.
Salford CCG will continue to work with HEE and primary care providers explore
opportunities which this type of role could bring to primary care.
6.4
New ways of working
Introducing new roles into the general practice team will provide additional capacity in
primary care. In addition to this, there are several options which will reduce demands
on GPs and other clinical staff through new ways of working. Salford CCG would wish
to identify and explore options for new ways of working with primary care providers
and other stakeholders.
44
6.4.1 Productive General Practice
One of the key recommendations of the General Practice Development Plan was the
development of a framework to help and support practices to identify and implement
quality improvements. The Productive General Practice (PGP) programme, developed
by the NHS Institute for Innovation and Improvement, provides a systematic approach
to support practices in their drive to improve productivity, by creating improvement
capability. The programme enables the whole practice team to review their current
working practices, identify where improvements could be made and agree a plan for
improvement.
Salford CCG has commissioned Shaping Health International to deliver PGP across
practices in Salford. There are currently 22 practices, within 3 cohorts, engaged in the
PGP programme. The CCG recognises that the PGP programme will provide practices
with information relating to how they are currently utilising their workforce and will
support these practices to consider how new ways of working may lead to
improvement and increased productivity. There is a particular alignment between the
PGP programme and the approach being developed to identify future staffing models,
as described in an earlier section and therefore early links have been established
across the two programmes of work.
6.4.2 Asset-based care and care navigation
Socio-economic factors account for 50% of the determinants of health and social
isolation is one of the biggest health risks. It is known that GPs spend a fifth of their
consultation time on non-health problems. As demand on general practice continues to
grow, more interest is being taken in an asset based approach to health and wellbeing. The aim of asset-based practice is to promote and strengthen the factors that
support good health and wellbeing, protect against poor health and foster communities
and networks that sustain health. An asset based approach identifies the skills and
capabilities within local residents and communities and connects these assets into
more formal groups to build strong relationships and reciprocal social networks. The
ultimate aim is to mobilise local people to act on the things they care about and want
to change.
Salford has a strong sense of community cohesion and a well-developed voluntary,
community and social enterprise sector, ‘Salford Community and Voluntary Services’.
Salford City Council has mapped over 7,000 community assets available to individuals
and has developed a ‘Way2Well-being’ portal. However, general practice is not yet
sufficiently linked into these community assets to take full effect of them. Salford CCG
is currently supporting an innovation pilot in one neighbourhood to develop a ‘Health to
Wellbeing’ GP Network. The aim of this Network is to improve the health and well-
45
being of the local population and reduce pressures on the primary care system by
signposting the population to more appropriate services across the city.
‘Care navigators’ or ‘community champions’ are people who are trained to assist
patients and member of the public to identify appropriate support services without
needing to see a GP. There are different approaches to developing care navigators
within general practice. One option is to recruit additional people to work in the
practice to specifically undertake a care navigator role. Another option is to up skill the
current workforce e.g. reception staff to develop a wider care navigation function
across the team. For those individuals with higher needs, a shared point of access
can streamline the process to connect people with the services they need.
HEE (North West) is currently developing a training package to support an asset
based approach within primary care. This will offer different levels of development for
the primary care workforce to support asset based care, care navigation, social
prescribing and well-being coaching. Salford CCG will explore how this development
may be of value to the primary care workforce across Salford.
6.4.3 Empowering patients and the public
New care models and the priorities of the Five Year Forward View are achievable only
by fundamentally changing the relationship that the NHS and social care have with
patients, people and communities. Patients and the public require empowering to
enable them to self-care and to manage their healthcare needs, where appropriate.
Salford’s locality plan ‘Start Well, Live Well, Age Well’ sets out a need to use
behavioural approaches, including health coaching, to achieve its transformation
priority to upgrade population health, prevention and self-care. Health coaching helps
patients to acquire the knowledge, skills, tools and confidence to become active
participants in their care, so they can reach their self-identified health goals. Rather
than just an acknowledgment of the patient's ideas, concerns and expectations,
coaching explores patients' personal health beliefs and empowers them to select
health goals pertinent to their life.
Health coaching can have positive impacts on outcomes for patients, especially those
with long term conditions, as well as reducing demand on general practice. However,
the primary care workforce needs training and development to enable them to work
with their patients in this way to move from a directive approach to a more equal,
patient-focused, collaborative one. Salford CCG will work with primary care providers
to establish the most effective way to enable the workforce to feel confident in utilising
health coaching.
46
7.0 Implementation of strategy
Salford CCG recognises that workforce development is a responsibility for employers
and, as such, the implementation of many strands of this strategy will fall within the
remit of primary care providers and the emerging out of hospital entity, Salford Primary
Care Together. However, through the Community Based Care programme, the CCG
will continue to support and enable primary care workforce development through:






Testing and evaluating new roles and new ways of working through access to
innovation funding
Non recurrent funding to pump prime workforce development projects and
initiatives
Commissioning new roles where evaluation demonstrates evidence of positive
impact on primary care delivery
Working with HEE to pilot new roles and new ways of working in primary care
Building close relationships with other partners across the integrated care
system and wider locality to ensure primary care workforce development is a
key enabler for wider service transformation
Supporting providers to consider alternative methods of employment to improve
recruitment, retention, learning and development
The development of a federated model for general practice within Salford offers many
opportunities to realise the CCG’s vision outlined within this strategy and to ensure the
development of a primary care workforce fit for the future. The CCG will support the
development of federated working to enable providers to utilise their workforce
differently and test and embed new roles.
The Workforce Development Group as a sub-group of the Community Based Care
Commissioning Group (CBCG) will be the forum for the development of proposals for
non-recurrent resources to support primary care workforce development. Investment
to date in workforce development initiatives totals just under £3 million over a three
year period. The CBCG will continue to act as the sponsoring strategy group to
progress any further proposals for funding though the CCG Governance structures.
7.1
Delivery plan
7.1.1 Year 1
NHS England has mandated that, in 2016/17, every local system must develop and
implement a local plan to address the sustainability and quality of general practice,
including workforce and workload issues (‘Delivering the Forward View: NHS Planning
Guidance, 2016/17 – 2020/21).
47
‘Development of the General Practice Workforce’ is one of the deliverables in Salford
CCG’s 2016/17 business plan for the Community Based Care programme. As such,
this sets out the delivery plan for the first year of the Primary Care Workforce
Development Strategy. This is summarised in Table 1.
Table 1: Year 1 delivery plan
1.
2.
3.
4.
5.
6.
7.
8.
9.
Action
Establish baseline workforce data across all
practices
Implement pilot for primary care staffing model
across one neighbourhood
Evaluate pilot of primary care staffing model
and agree next steps
Develop and implement primary care learning
and development programme
Evaluate year one of advanced practitioner
programme
Enable systematic utilisation of apprenticeship
framework to increase the number of
apprenticeships within primary care
Commission and evaluate a primary care
leadership development programme
Implement a pilot within one neighbourhood to
explore the role of paramedics in primary care
Mobilisation of new practice pharmacy services
Timescale
March 2017
May 2016
September 2016
September 2016
October 2016
March 2017
March 2017
December 2016
December 2016
7.1.2 Year 2-3
A number of priority action areas for years 2 and 3 have been identified through
discussion with the CCG Primary Care Workforce Development Group and the
Medical Director of Salford Primary Care Together. These are outlined below. The
detail of how these areas will be delivered from 2017/18 onwards will be subject to
further discussion with practices and neighbourhoods as part of the implementation of
the business plan for Salford Primary Care Together.
Table 2: Year 2-3 delivery plan
1.
Priority areas
Roll out of primary care staffing model
2.
Development of city wide education hub
48
3.
9.
Creation of bespoke learning and development programme for all staff
accessed via a variety of media
Development of standardised competency framework for all staff groups
commencing with healthcare assistants
Profiling of skills within primary care administrative workforce to identify skills
gaps and develop options and proposals for new roles or new ways of
working
Support more practices to become training practices for GP training and
wider multi-professional students.
Explore options for development of roles for Allied Health Professionals in
primary care, commencing with physiotherapy roles.
Work with Academic partners to explore whether the research capability
building outlined within the Research & Innovation Strategy can support
recruitment and retention of GP’s into Salford practices.
Evaluation of practice pharmacist service
10.
Evaluation of impact of advanced practice roles in primary care.
4.
5.
6.
7.
8.
7.2
Risks
The following risks have been identified in relation to delivery of this strategy.
Table 3: Risks
Risk
Lack of engagement of
practices
Limited capacity in primary
care providers to deliver
workforce development
Public and patient resistance
to workforce development
Lack of funding for workforce
innovation and development
Mitigation
GP Lead (Workforce development)
Neighbourhood Leads (GP leads,
practice manager leads, practice
nurse leads)
Salford Primary Care
Together
Financial investment
Significant investment in Primary
Care through Salford Standard to
enable workforce development
Patient and public engagement
through PPGs
Innovation funding
Partnership working with
HEE
49
Development of a primary
care federated model that
does not support workforce
development
Primary care workforce
development seen in
isolation from wider ICS and
locality workforce
Limited ability to recruit to
substantive or new roles or
training posts.
Business case for federated working
with early opportunities for workforce
development identified
ICO workforce group
Locality workforce transformation
strategy and delivery plan
ETP to expose healthcare students to
primary care
Initiatives to promote Salford as a
place to train and work
50
Appendix 1: General Practice Workforce Headlines
The data source for the information below is based on practice submissions to the
Health Education England (North West) GP data collection tool in March 2016. Only
63% of Salford practices submitted to this tool, so the data set is not complete.
Therefore this analysis only provides an indicative picture.
Age and gender profile of the Primary Care workforce
all staff
male headcount
male staff
North West
Greater Manchester
50%
female headcount
13%
NHS Salford CCG
31%
30%
10%
2%
30%
24%
4%
27%
21%
male FTEs
40%
87%
female FTEs
15%
85%
30%
female staff
20%
22%
4%
22%
30%
23%
22%
10%
0%
16-34
35-44
45-54
55-64
65+
Profile of workforce
% FTEs of total General Practice workforce by role type
NHS Salford CCG
% FTEs by role type
NHS Salford CCG
Greater Manchester
North West
England (indicative as based on different
data)
North West
Greater Manchester
 Admin
 DPC
 GPs
 GPs (R&R)
 Nurses
55%
57%
57%
52%
12%
7%
7%
7%
19%
23%
23%
24%
2%
1%
1%
4%
13%
11%
13%
13%
51
Staff ratios per head of population
GPs per 100,000 weighted Population
l
l
l
l
l
NHS Salford CCG
Greater Manchester
North West
England
North West CCGs
40
45
50
55
65
GPs (excluding R&R) per 100,000 weighted Population
The analysis is based on national data provided to
HSCIC (General and Personal Medical Services in
England 2005-2015, Provisional Experimental
Statistics)
40
45
50
The data shows the spread and range in the rates
for each role type across the North West, along with
the respective regional and national averages.
55
60
Nurses per 100,000 weighted Population
-
Rates for NHS Salford CCG
60
5
10
15
20
25
30
35
40
FTEs per 100,000 weighted population
GPs
48
GPs (exc Registrars and Retainers)
45
Nurses
24
Direct Patient Care
19
Admin
110
Direct Patient Care Staff per 100,000 weighted Population
-
5
10
15
20
25
30
Admin (non-clinical) staff per 100,000 weighted Population
90
95
100
105
110
115
120
125
130
Note: Direct Patient Care includes all other staff (except GPs and nurses) with patient
care responsibilities. This includes healthcare assistants, physiotherapists,
pharmacists and others.
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135
Appendix 2: Feedback from patient and public engagement
To ascertain how patients and the general public would respond to plans to develop
new roles and new ways of working within general practice, a survey was sent to the
CCG Citizen and Patient Panel.
43 responses were received. These responses are summarised below. It appears
that the public are generally supportive of the plans to extend the workforce within
primary care. However, further assurances would be required around education,
training, competencies and confidentiality before the introduction of some of these new
roles.
1. Do you have any experience of seeing other clinical people in general
practice, apart from GPs or practice nurses?
Response Response
Percent
Total
1
Yes
44.19%
19
2
No
55.81%
24
Comments:
Respondents reported that they had been seen by a number of other healthcare
workers including a counsellor, phlebotomist, midwife and podiatrist.
2. Would you be happy to see a physiotherapist if you were suffering from a
back or neck problem, without seeing the GP first?
Response Response
Percent
Total
1 Yes
97.67%
42
2 No
2.33%
1
Comments:
‘But I would have to be confident in their skills and abilities to diagnose any
problems’
‘It is impossible for one person (i.e. the GP) to know everything about everything.
So I think it is an excellent idea to have added roles such as a physiotherapist’
‘Of course, this makes much sense as it saves time and money, as more than likely
a GP will refer a patient to a physiotherapist in any case’
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3. Would you be happy speaking to a clinical pharmacist in the practice about
any medication you are taking?
Response Response
Percent
Total
1
Yes
100.00%
43
2
No
0.00%
0
Comments:
‘Pharmacists should be used more in my opinion!’
‘There is a Pharmacist attached to practice whom is valuable’
‘This is offered by the pharmacy that prescribes my medication so not sure there is a
need for further unless it were co-ordinated’
4. Would you be happy if a paramedic, working as part of a general practice
team, carried out a home visit for you instead of a GP?
Response Response
Percent
Total
1
Yes
72.09%
31
2
No
27.91%
12
Comments:
‘I put no because if it was an emergency I would be happy for a paramedic to come.
It if I was ill and needed a diagnosis and treatment I would want to see a GP’
‘Provided they had access to the GP in the practice should they need to refer. I think
the only thing would be their access to my medical history in order to make a proper
diagnosis’
‘Though I have not been in need of one thus far I am sure they would be sufficiently
skilled enough to carry out an assessment’
‘This would depend who it was and who had access to my medical records?’
5. Would you be happy speaking to someone other than your GP or nurse
about any non-medical or social problems you have?
Response Response
Percent
Total
1
Yes
88.37%
38
2
No
11.63%
5
Comments:
‘What sort of non-medical problems would I talk to a doctor or nurse about anyway?
Would the "someone" be a professional person?’
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‘I think non-medical and social problems should be referred elsewhere to keep GP
surgeries focuses on health care’
6. To what extent do you agree with the plan to develop new roles?
Response Response
Percent
Total
1
Strongly agree
44.19%
19
2
Agree
53.49%
23
3
Disagree
2.33%
1
4
Strongly disagree
0.00%
0
Comments:
‘The changes should not be made in order to block the way to the GP, but I agree
something has to be done to relieve GPs of some of their burden of work’
‘I agree but you need the right people - qualified and credible people’
‘Extending the services can only be good for patients, and help to focus the staff and
skills in appropriate areas of need’
7. Do you have any concerns regarding developing new roles within primary
care?
Response Response
Percent
Total
1
Yes
6.98%
3
2
Yes, to some extent
37.21%
16
3
No
55.81%
24
Comments:
‘Roles have to be clearly identified and training given’
‘The focus should be on ensuring the correct skill mix not on saving money’
‘Right person for the job, confidentiality must be assured, adequate qualifications and
opportunities to remain as up to date within the role as possible. It should not create
a watered down service but meet people's needs’
55