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Scaling up networked care

Do workforce challenges act as a barrier or as a catalyst for network expansion?

Employing and training the right people is critical to ensuring good quality outcomes; and having the right people in place is critical to expansion.

NHS employers face increasing recruitment and retention challenges but there are differing views on the impact of workforce when expanding a network.

Nursing workforce in particular has seen a sharp decline in registrations. This has already resulted in more agency staff being used by providers, which can have unintended financial and quality consequences.

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Pressures resulting from workforce shortages and the potential impact of leaving the European Union (EU) were raised as both a risk and an opportunity in expanding networked care. There was speculation that the impact could be challenging for expansion if NHS EU nationals repatriate. In contrast, these challenges could also drive providers to network more, in order to make the most of the available workforce, such as sharing staff in posts that are difficult to recruit to.

A particular challenge when expanding geographically is recruiting specialists in different areas of the country. This is considered an issue by both providers and regulators, particularly where travel times and remoteness are factors. 

Some felt this might be too big an obstacle to expanding geographically. Other providers and commercial organisations facing the same challenge did not see it as insurmountable. Training other provider staff to follow standardised pathways has worked for some network providers and can help with network expansion.

Network growth may incentivise innovative solutions to workforce challenges. For instance some staff could be given tasks which might alleviate pressure points in other staff groups (see case study on DART programme below). Given that medical and nursing vacancies were highlighted as a key challenge, this was considered a way in which networked care might address difficult workforce issues.

case studies icon Case study: managing capacity challenges

Domestic Abuse, Recovering Together (DART), is a programme rolled out by the National Society for the Prevention of Cruelty to Children (NSPCC) to different organisations where children and their mothers can talk to each other about domestic abuse, learn to communicate and rebuild their relationship.

The issue: DART requires four members to run each session. One local authority said: “It’s taken four members of staff out of doing their 1-to-1 work for a whole day every week for 10 weeks. So there was a big financial commitment, not only for resources and co-ordinating how people were going to get there, but worker time as well.”

What NSPCC learnt: We needed to think of ways to address staffing capacity without compromising the way DART works.

What NSPCC is doing: We’re developing new ways for DART to be delivered that stay true to the model. One option is running the programme with two volunteers and two trained practitioners. The staff would be the leaders and the volunteers would be supporting co-facilitators. This option would need careful cost-benefit analysis but it could work well for the organisations with established volunteer support. The use of volunteers could have an added benefit for the local community, helping members of the public learn how to identify and address the signs of domestic abuse and signpost routes to support. We’re also developing a ‘train the trainer’ model so organisations can train their own staff, reducing their reliance on us and making the service sustainable.


  • Workforce challenges can be an opportunity for networked care growth as they drive the need to use workforce more efficiently.
  • Extending staff roles and providing training to transferred staff might facilitate network expansion in offering potential solutions to recruitment challenges.
  • Expansion into new areas could offer recruitment opportunities for a networked care provider, but they would need to recognise that workforce attrition may destabilise a health system.