‘Workforce: a key enabler to North Central London delivery’

London Clinical Senate Forum

11th October 2018

Dr Josephine Sauvage FRCGP Chair Islington CCG Clinical Lead North London Partners Clinical Lead for Workforce development NLP

• One of the key risks to delivering the plans set out is relating to workforce: regarding the risk that plans do not enable the health and care sector to work in new ways effectively

• This presentation sets out at high level how the programme is working to manage this risk and the priorities for 2018/19.

• Service transformation plans across health & social care continue to evolve. Workforce plans for system integration need to complement local organisational plans:

• Difficult to model

• Unpredictable

• Take account of workforce development and planning

Strategic risk management: Workforce

3

5 CCGs & Local Authorities 11 Provider Trusts Other Partners

• Camden CCG • Barnet CCG • Islington CCG • Haringey CCG • Enfield CCG Local Authorities • Camden • Barnet • Islington • Haringey • Enfield

• Barnet, Enfield and Haringey Mental Health NHS Trust

• Camden and Islington NHS FT • Central London Community Healthcare

NHS Trust • Central and North West London NHS

FT • Moorfields Eye Hospital NHS FT • North Middlesex University Hospital

NHS Trust • Royal Free London NHS FT • Royal National Orthopaedic Hospital

NHS Trust • Tavistock and Portman NHS FT • University College London Hospitals

NHS FT • Whittington Health NHS Trust

• c220 – GP practices • 497- Active social care

sites- (including 273 registered care homes)

• 214- Registered domiciliary care providers

• London Ambulance Service

• NHS 111

We are a collaboration between:

Who we are: North London Partners

Ambition for the STP is built on existing CCGs, Local

Authorities and Providers values and strategy

Improve the

health and

wellbeing of the

local population

Reduce health

inequalities

Maximise out of

hospital care and

build resilient and

well supported

communities

Ambitions of the STP

‘A partnership of the NHS and local authorities, working together with the public and patients where it’s the most efficient and effective way to deliver improvements’

WHAT DOES THIS MEAN FOR OUR VISION FOR OUR WORKFORCE?

HCCH: shortfall by 2020 22% nurses, 14% AHPs,

fewer GPs for popn, social care vacancies <23.5%

Recruitment Retention Talent Management

Systems and enablers

Secondary Care turnover 21% average in 17-18;

26% nurses & 29% SLTs left NCL from 2010-15*

11.5% of staff costs on temporary staffing; with

breaches on pay rates

Long-term training pipelines for clinical and

professional staff

NCL trusts are sovereign organisations (competitors)

Attracting people both to and retaining in

NCL Health & Social Care

Key skills gaps and high vacancy rates

(1 in 11 across NHS nationally)**

Some informal but not systemwide ability to

share staff, across pathways, organisations

Employment systems: ERS in 2° means only some

ability to track NCL staff

20% of nurses leave in their first 18 months of

employment

Repeated induction and mandatory training

Digital systems don’t enable timely information

or intelligence

Workforce mobility increasing & desire for

flexible working

Skills gaps lead to increased demand

for international recruitment

Workforce age people at risk of retiring or

leaving their role

Inability to offer portfolio careers and rotations

Need for workforce modelling and forecasting

Inconsistency in T&Cs for 2°, 1° and social care

Health and social care do not enable inter-sector

passporting

Social and economic factors – London travel &

housing costs

* 26% of adult nurses and 29% of speech and language therapists left the NHS entirely between 2010 and 2015, NLC STP ** ‘NHS vacancies a 'national emergency’ – BBC 11 September 2018

What are the biggest workforce challenges in NCL Health & Care?

Our objectives are to:

• Improve patient experience and outcomes through improved staff experience and engagement

• Define and adopt new ways of working, enabling working across health and care settings • Maximise workforce efficiency and productivity • Create a reputation where NCL is recognised as a great place to work aiding recruitment and

retention • Promote and provide an excellent learning environment • Develop, implement and embed a systematic approach to leadership development & quality

improvement.

‘To attract people to live and to work in North London so we have the best possible workforce to deliver high quality services to our community.’

Our aim is to:

Portability

Our priorities for 2018-19 are:

Urgent & emergency care preparation

Place-based care: Social & Primary care/Community

Temporary staffing

Workforce Analytics

Our response: Workforce Strategic Intent

7

Portability (including passports,

MAST)

NCL employment licence

MAST NCL continuation

New employment models in Primary

Care

Common Recruitment

approach

Common benefits realisation

UEC preparation winter 2019

NCL Physician Associates

NCL CAMHS Workforce

Development

CPEN access for home care staff

Placed based care

Registered managers

2nd cohort of capital nurse (care home

leadership)

Sector wide rotation programme

GP trainee, medical assistant & pharmacist

recruitment

Nurse associate pilots

Employment models

Temporary staffing

Shared Bank

Temporary staffing

Workforce modelling; Financial analysis; L&D resource utilisation; collaborative recruitment

Network funding & support for QI capability; Allied Health Professionals’ Network

Enab

lers

Key: Workforce integration

Key: System integration

Our response: Programme 2018-19

8

Prevention Planned care Mental Health Maternity Urgent and Emergency

Care

Health and care closer to

home

Children and young people

Cancer

Dr Julie Billet (Camden and

Islington)

Prof. Marcel Levi

(UCLH)

Paul Jenkins (TAVI)

Rachel Lissauer

(Haringey)

Sarah Mansuralli (Camden)

Tony Hoolaghan

(H&I)

Charlotte Pomery

(Haringey LA)

Kathy Pritchard-

Jones UCLH

Dr Clare Stephens (Barnet)

Clin

ical

wo

rkst

ream

s SR

Os

Dr Karen Sennett

(Islington)

Dr Richard Jennings,

(Whittington)

Dr Vincent Kirchner

(C&I)

Professor Donald Peebles

Dr Shakil Alam (Haringey)

Dr Katie Coleman, (Islington)

Dr Oliver Anglin

(Camden)

Professor Geoff

Bellingan (UCLH)

Clin

ical

lead

s

Dr Tom Aslan (Camden)

Dr Jonathan Bindman

(BEH)

Dr Alex Warner

(Camden)

Mai Buckley (Royal Free)

Dr Chris Laing (UCLH)

Input and membership of clinical working groups from across NCL CCGs, Providers and LAs

Clinical workstreams and senior leadership in North London Partners

NCL Programme Board and Advisory Board

Dr Debbie Frost (Barnet)

Borough based leads

for each CCG

Social Care

Dawn Wakeling (Barnet)

North London Councils Adult

Social Care group

NCL Health and Care Cabinet: Richard Jennings and Jo Sauvage STP Clinical Leads and Co-Chairs

Workforce: SRO - Siobhan Harrington (Whittington)

Digital: Clinical lead – Dr Cathy Kelly (UCLH), SRO – David Sloman (Royal Free)

Estates: SRO – Simon Goodwin (NCL CCGs)

Communications and Engagement

Enab

lers

Our Workforce governance

NCL Health & Care Cabinet NCL STP Programme Board

NCL Workforce Steering Group

Project forums & networks

Workforce Task & Finish Groups

Local Workforce Action Board

NCL Integrated Education Provider Delivery Board

Community Education Provider Networks

(CEPNs x 5)

Partner Organisations

Provider Boards

CCG Governing Bodies

LA Committees/Cabinets

Pan London& other STP

Collaboratives

The Care & Health Integrated Network Model (CHIN Networks)

Practice-based pharmacist –working across networked practices, proactively reviewing patients

Community services e.g. primary care, or specialist nurses, physio, working as part of the network to improve population health outcomes

Mental health input via a link worker or primary care MH support through clinics within the network. Proactive

population support .

Voluntary sector link worker/ navigator able to proactively social prescribe/ navigate

Acute -consultant/ specialist advice and guidance to GPs/ network partners in managing patients in primary care and avoiding unnecessary referrals

General Practice

team (GPs, practice

nurses, health care assistants across a

network) and Quality

Improvement Support

Team

Local authority –including link to social care, housing, employment, education and volsector

Quality Improvement Support Teams apply QI as our approach to reduce unwarranted variation in patient care. The borough-based teams sit within primary care but working across the system. They offer support to identify and tackle unwarranted variation and build QI capability.

Community Education Provider Networks

in each borough work with stakeholder

partners to develop collaborative

networks of service and education

providers, working across a geographic

footprint, with a shared purpose to

create the right workforce to

support the delivery of population health

outcomes.

The Care & Health Integrated Network QISTs CEPNs

Some key risks to delivery • Attracting and retaining workforce to London so that they stay (evidence suggests

retention in first 18 months means staff stay 5 years+)

• Health care challenges in general practice, nursing and allied health professionals

• Building local recruitment pathways to employ north Londoners in our services*

• Social Care workforce faces significant recruitment and retention challenges and is the focus of the North London ASC Programme

• Social care nurses and registered managers: we need a focus on developing and supporting these groups, especially in relation to leadership skills

• Salary competition in inner London – competitive rates needed to attract nursing workforce

• The salary gap between salaries in social care and for health care assistants is widening and presents a challenge to the social care workforce

• Key worker benefits needed including travel and housing

* The NCL adult social care sector estimated contribution to the local economy in 2016/17 was £1bn: a focus on this economic argument could bring efforts together to meet rising demand for services. 1 in 8 Londoners are estimated to be working in health or social care. Recruiting local people helps our local economy, improves health outcomes and should support retention.

RETAIN Older GPs’ experience & skills are needed by the system: • Co- produce new employment

models, enabling all staff to work more flexibly across organisational interfaces: • Portability & passporting • Review terms & conditions • Explore opportunities to

secondary care education • Improve opportunities for

flexible working and promote portfolio career options for GPs & other staff

• Encourage good employment practice eg national/ SW England approach to terms and conditions.

RECRUIT Critical, given the high requirement demographic and attrition rates: Focus on: • The GP workforce, through:

•GP Trainee Recruitment •The model of GP training •GP Trainer networks •Returning practitioners •Overseas recruitment

• Creating opportunities to attract others to professions in general practice eg work experience, business and administrative / health care apprenticeships & opportunities for existing health professionals.

• The GP Nurse workforce.

WIDEN OUR SKILL MIX Transformation in delivery of care needs new ways of working: • System commitment to

identify resources to support testing of new employment models and to collaborate

• Support GP Nurses to work at the top of their license, develop and maintain skills, create opportunities for leadership skills & mentoring

• Support and augment the development of new roles to work in general practice, eg physician & nursing assoc-iates & medical assistants.

Case study: General practice as the foundation of the NHS A North Central London Strategy for General Practice

In conclusion

• Workforce is a key enabler to a transformation in the way we deliver care

• We face real workforce challenges and the solutions need to be innovative using a combined approach

• Solutions need to be strategic and over-arching

• Street design co-produced by staff

• Need to address priorities: Care market/GP/middle grade and junior Drs/other professional groups

• Pay attention to staff wellbeing

• Bigger issues around where collaboration at a London level might be an opportunity to secure a workforce for London.