Development of the Investment Plan October 2013 Update

1. Development of the Investment PlanOctober 2013 Update CONTENTS Strategic direction Recent findings Training changes in 2014/15 Financial impact Key risks UPDATE ON PROCESS Initial submission 1.9.13 Financial Model issued Second submission 4.10.13

2. Strategic Direction: Transformation Themes that cut across Spending Programmes Staff able to function in primary and community care settings New roles recognised alongside more familiar roles More integrated and team training with patient experience focus Full usage of flexible training routes so can be more responsive Build confidence and competence to work within high tech service delivery alongside patients as experts in their own care

3. Investment Plan: Our Strategic Direction

4. Our Most Recent Findings: What Trusts have been telling us (in relation to our Investment Plan) Confirmed overall strategic direction Medical workforce • gaps now at consultant level in Psychiatry, A&E, GP, Anaesthetics & Medicine • gaps now at specialty training level ( Acute & Emergency Medicine and medical) • high locum spend • extended training lengths (Paediatrics, Obstetrics and Gynaecology) • Non-medical workforce • seeking to increase advanced Nurse Practitioners but numbers not firm • gaps now in some areas in midwives, health visitors and nurses • skills gaps exist within specific services • particular challenges in providing physical and mental health care simultaneously and patients that are older, more frail and more dependant • pharmacists and healthcare scientists areas of risk not always fully recognised • Support staff – plans indicate intention to reduce number of clinical support staff despite narrative and dialogue to the contrary Advanced Practice and Post Registration specialist training - priority in Acute Medicine, Emergency Medicine, Paediatrics, Surgeryand Anaesthesia • * a more detailed feedback report is available from Jonathon Brown

5. Investment Plan: Training Changes in 2014/15 - Work in Progress

6. Specifics Range of course lengths and entry points into nursing to increase flexibility with aim to get all nurses more adaptable and flexible so first post can be anywhere Consideration of demand for return to practice + secondments to training New models of induction into first roles in primary and community care Run through training from radiography qualification into sonography Change to degree level ODP training (with paramedics to come) Better idea of what schools require from health input to link with increased IAPT activity (rather than just school nursing) More detailed work with primary care on competences for practice nurses and support staff and associated training available to fulfil these requirements Groups looking at range of HCS and pharmacy developments required / possible

7. Investment Plan Key Risks – as at October 2013 Financial Costs: tuition fees (BMP) and pay and prices Total Funding: 14/15 Allocation: for HEE How the cake is cut - • impact of activity-based Financial Model on ability to fund ‘new roles’ and reallocate resources • Postgraduate tariff • Impact of national formula for education support • Impact of tariff transition on HEYH • Leadership Ability to implement the plans (recruitment, take up of new roles, etc.) Medium term cumulative impact of GP expansion and national training model changes Tuition fee support to medical students, including the intercalated year Service and outcomes Posts reductions, transformation challenges Service delivery does not change and new posts not created to take up advanced and associate practitioners and other new roles