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Future proofing

A 2016 survey by NHS Providers found that only one in four trust leadersStaff identity badge graphic (27%) was confident of having the right staff numbers, quality and skill mix to deliver high quality healthcare for patients and service users. Fewer still (22%) were confident about having the right staffing levels six months later.

And the top leadership itself is part of an unfolding recruitment crisis with the average tenure of a trust chief executive reported as 30 months and fewer senior managers wanting to take up the challenge.

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The single specialty networked model of care has some intrinsic advantages for overcoming some of the challenges to a sustainable workforce, but it is far from a panacea. A key advantage is its ability to test on one or two sites different ways of working without disrupting the rest of the network.

Among the solutions that will be needed are:

  • addressing workforce shortages.
  • shifts in skill mix.
  • retraining/repurposing the current workforce.
  • addressing any inequalities on spending on training across the workforce.

Advantages of the specialty networked model include:

  • a wider cohort to draw on, learn from, develop and grow.
  • more pulling power of a specialty provider’s reputation (for potential staff who want to work in that specialty).
  • more opportunities for local autonomy and leadership development.
  • ability to test innovations like new roles, without disruption to the rest of the network.
  • staff may be keen to work across different sites.

Staff working together photo

Moving to this type of model will not solve all problems. If the unit is in a location that is difficult to reach and without many facilities, it may still not attract staff even if taken over by a specialty provider. If so, it may be necessary to consider whether the unit is viable, whoever runs it.

As we have seen in so many contexts within this toolkit, good leadership is crucial, both centrally and locally. And staff are more likely to be attracted to a facility where they can learn, develop and increase their competencies.

Organisations more often turn to a specialty provider when a service is either failing or in danger of doing so. It can be tempting to think that if a specialty provider can get the service back on its feet, the problem is solved. But like any service, today’s solution may be tomorrow’s problem and networks have to keep pace. What they can offer is the opportunity to embed best practice at a new site from day one and to test different workforce solutions as the network develops. Commissioners and the host trusts expect to see the service improve and do things differently, not to just patch up the current model.

A significant problem for hospitals is today’s reliance on consultant clinicians, around whom the care modelStaff graphic traditionally revolves. There are not always enough of them to sustain the services needed. The NHS is increasingly looking to develop service models that do not entirely rely on consultants delivering the care.

The Heart of England Foundation Trust is replacing its largely medical workforce model, which relies heavily on locum and agency workers, with consultant-led teams including advanced clinical practitioners (ACPs). They are experienced non-medical clinicians such as pharmacists and allied health professionals who are trained to work as senior clinicians and will be able to substitute for doctors.

Over the next five years Heart of England plans to train up to 250 new ACPs and fund some of this by withdrawing up to 120 locum and middle-grade medical posts. The trust believes that this investment will deliver a flexible clinician-led workforce (consisting principally of permanent doctors and ACPs) to deliver care that is more consistent, timelier and safer for patients.

The Buurtzorg Model, Netherlands, sees skilled nurses provide comprehensive community care to vulnerable older people at home. In the past, care was provided by a constellation of different staff, many of them unskilled staff.

Iora Health, USA, provides comprehensive primary and community care to complex older patients with a very small number of GPs supported by health coaches, nurses and social workers working to help patients take better control of their health.

“Advanced practice was delayed by the organisation as there was fear of any complications which could occur with a nurse performing the task. If she’s been doing over 20 of these injections a day for years, why does she need a doctor supervising her?”