“ Integrated Planning ”

1. “Integrated Planning” Mike Burgess Assistant Director Workforce Strategy Network Leadership Groups

2. The DH model (complex and evolving)

3. The North West Model LETB Integrated Workforce Plans Providers Professional Networks Workforce Strategy Inform and Drive Education Commissioning Plan £ MPET QIPP/System Commissioning Plans Workforce Demand and Supply Analysis

4. What needs to be Integrated? • Integrated across medical workforce and non-medical workforce: The cause, effect and impact this creates of changing the size and shape of either workforce. • Integrated with finance, quality, performance and workforce – affordable, safe, quality and delivers NCB and CCG requirements of a workforce, service and quality • Integrated with education management: LETBs, DH, AHSNs, Clinical Networks, PABs, HEE, CfWI, Universities – delivers skills and competencies • Integrated at a local level, cluster, region and national – linked to national shortage specialties • Integrated with the Education Outcomes Framework • Integrated understanding of the demand side (PESTLE, activity and demand) • Integrated understanding of the supply side (training and the workforce) • Integrated along specialism and with GPs / Primary Care and the complexity this creates • Integrated blend of quantitative information and qualitative intelligence

5. What does success look like? Time frames and governance • Agreed time-scales: Operational 1 year, Strategic 5 year, Scenario 10 years + • Inclusions and exclusions in first stages and the pending urgency of medical workforce planning • Coverage of providers in the LETB (NHS, primary care, AQP, LA) • Span and depth of levels of qualitative and quantitative information • Agreed sharing protocols for plans • Education commissioning outputs • Local and LETB workforce development plans Workforce Assurance and Patient Safety • Plans signed off CE, Director of Nursing and Medical Director • Workforce and patient safety issues and action plans • Workforce assurance framework for LETB plan

6. What does success look like? Developed in Synergy • Processed developed in synergy with the Modernisation Hub to capture the demand for assistant, advanced and new roles • Developed with the Network Leadership Groups • Linked with North West Health Care Science network to capture the essence • Linked with North West Allied Health Professional network • Linked with the North West Deanery and Mersey Deanery • Utilising intelligence from the Centre for Workforce Intelligence (CFWI) • Documents available in the workforce planning draw of the eWIN workforce toolbox • Linked with Education Commissioners / Education Management • In line with North of England SHA cluster processes Plans that deliver X outcome and Y outcomes over the planning period

7. Integrated Planning Framework for 2012 Education and Learning Plan Grow and Develop own via CPD, Succession Planning, Competencies and Skills Current Reality Understand Current Workforce Demographics Ambitions Expectations Ability to change Operations Understand Financial Envelopes Quality indicators Patient Safety Performance Strategic Vision Labour Demographics Recruitment Pools Health indices Talent Leadership Supply chains Apprenticeships / Cadets Current Workforce Future Workforce Future Modelling Attrition Wastage Churn Participation CPD Development The 5 R’s Alignment to activity and finance Changing Roles New roles Enhanced Pathways Competencies Skills Curricula RCN Input Education Outcomes Framework Contingencies Cause, effect and impact on Medical and Dental Filling shortage roles and posts Integrated approaches Stakeholders and Capture Networks Plan Strategy Hot issues Actions Commissions Report Outputs

8. Support during transition to transformation Support from the NHS NW team through transition • eWIN tool box http://www.ewin.northwest.nhs.uk/ • Email reply service • Telephone reply service • Occupation code manual drive to align with NHS Information Centre • Workforce assurance links for best practice • Workforce planning best practice and guides on eWIN • Trust deep dives around business / workforce planning and assurance

9. Scenario 1 - Trauma Trust A is appointed as the Trauma Centre for the area. Trust A has a longstanding reputation for providing specialist elective orthopaedic training and the trainees who have worked in these senior training posts (including specialist fellowship posts) have provided out of hours cover for trauma patients. The School of Surgery are concerned that the T&O trainees are responsible for out of hours care in Trust A, without adequate supervision for the changing nature of the service and as Trust B has started to expand specialist elective orthopaedics services want to move the training contract to Trust B. This is likely to also impact on other specialist groups, including physiotherapy, rehabilitation and ortho-geriatrics training .  When workforce plans are submitted both Trusts assume that they will be able to include the trainee numbers in their service model. The School of Surgery decide that Trust A has not been offering adequate training and move the trainees to Trust B. Medical students in Trust A complain to the Medical School that they are no longer getting good teaching in T&O in Trust A.

10. Scenario 2 – Surgical The Centre for Workforce Intelligence has determined that there should be a decrease in the number of medical trainees entering surgical training. The School of surgery undertake a review of all the training sites and decide that Trust C should no longer be responsible for providing core surgical training. The Foundation School respond to the requirement in the SLA from DH to reduce the surgical posts and increase the psychiatry posts. They move two of the three F2 surgical posts and one F1 surgical post. The medical trainees report increased workload to the GMC trainee survey, reporting that they are called increasingly frequently to the surgical wards where they have little support from the senior nurses in undertaking tasks such as renewing iv access. The GMC asks the Dean to undertake a ‘serious concerns’ visit. The Deanery concludes that the additional activity related to surgical wards is compromising the experience for trainees and give an undertaking to the GMC that it will cease

11. Scenario 3 - Dermatology In the North West the number of doctors training for a CCT in dermatology is roughly equivalent to the predicted number of consultant vacancies; however across the country there are unfilled consultant vacancies. Trainees are therefore able to choose where they work as consultants. Most have stayed in the North West. The Dermatology SAC submit, and have approved, special interest training in paediatric dermatology and surgical dermatology. Trust D houses the regional paediatric unit and would provide ideal training; however it is unwilling to provide the funding for the fellowship post. Trust E is responsible for most of the surgery associated with dermatology and Trust F is responsible for providing plastic surgery training. Trust E and F are unwilling to cooperate to fund a fellowship post and the local commissioning consortia are unwilling to fund. Soon three trainees a year request out of programme to go to London, two of whom marry and leave the programme.

12. Scenario 4 - Dementia The CCG has identified the need to expand the number of primary care services for dementia including increasing the capacity of memory clinics, providing early and crisis intervention to prevent admission to hospital and to ensure there are alternatives therapies available to eliminate the use of antipsychotic drugs. This will involve consultant led primary care and community services and in-reach services to patients at home or in designated care/nursing homes. This will require the movement of resources and staff from secondary care and the need for 100 new workers to support the service training in delivering integrated dementia care and to support existing staff in this. The NLG is asked to consider the future scenario where staff will need to be trained in working differently, transferring from secondary care, providing a range of skills currently provided by Older Peoples Psychiatrist, Clinical Psychologists, nurses (Adult and Mental Health) physiotherapy, Occupational Therapy, diagnostic (including pathology and radiography) and others.

13. Scenario 5 - Pharmacy There is an increasing demand on Community Pharmacists to deliver High Street Testing and have a behavioural intervention role giving advice to the public on a range of lifestyle choices, including losing weight, smoking cessation and stress reduction. In the attempt to meet demand recruitment and pay to community pharmacists is escalating resulting in increased vacancies in hospital pharmacies. How might the NLG mitigate the impact of this.