Workforce: a key enabler to North Central London delivery

Transcription

1 Workforce: a key enabler to North Central London delivery London Clinical Senate Forum 11 th October 2018 Dr Josephine Sauvage FRCGP Chair Islington CCG Clinical Lead North London Partners Clinical Lead for Workforce development NLP

2 Strategic risk management: Workforce 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

3 Who we are: North London Partners We are a collaboration between: 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 3

4 Ambitions of the STP Improve the health and wellbeing of the local population Ambition for the STP is built on existing CCGs, Local Authorities and Providers values and strategy Reduce health inequalities Maximise out of hospital care and build resilient and well supported communities 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?

5 What are the biggest workforce challenges in NCL Health & Care? Recruitment Retention Talent Management Systems and enablers Secondary Care turnover 21% average in 17-18; 26% nurses & 29% SLTs left NCL from * Attracting people both to and retaining in NCL Health & Social Care Long-term training pipelines for clinical and professional staff NCL trusts are sovereign organisations (competitors) HCCH: shortfall by % nurses, 14% AHPs, fewer GPs for popn, social care vacancies <23.5% 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 11.5% of staff costs on temporary staffing; with breaches on pay rates 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 Workforce age people at risk of retiring or leaving their role Inability to offer portfolio careers and rotations Need for workforce modelling and forecasting Skills gaps lead to increased demand for international recruitment 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

6 Our response: Workforce Strategic Intent Our aim is to: 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 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. Our priorities for are: Portability Urgent & emergency care preparation Place-based care: Social & Primary care/community Temporary staffing Workforce Analytics

7 Enablers Our response: Programme Portability (including passports, MAST) NCL employment licence MAST NCL continuation UEC preparation winter 2019 NCL Physician Associates Placed based care Registered managers 2nd cohort of capital nurse (care home leadership) Temporary staffing Shared Bank New employment models in Primary Care Common Recruitment approach Common benefits realisation NCL CAMHS Workforce Development CPEN access for home care staff Sector wide rotation programme GP trainee, medical assistant & pharmacist recruitment Nurse associate pilots Employment models Temporary staffing Key: System integration Key: Workforce integration Network funding & support for QI capability; Allied Health Professionals Network Workforce modelling; Financial analysis; L&D resource utilisation; collaborative recruitment

8 Enablers SROs Clinical leads Clinical workstreams Clinical workstreams and senior leadership in North London Partners NCL Health and Care Cabinet: Richard Jennings and Jo Sauvage STP Clinical Leads and Co-Chairs NCL Programme Board and Advisory Board Input and membership of clinical working groups from across NCL CCGs, Providers and LAs North London Councils Adult Social Care group Health and Children and Prevention Planned care care closer to Mental Health Maternity young people home Cancer Urgent and Emergency Care Social Care Dr Karen Sennett (Islington) Dr Tom Aslan (Camden) Dr Richard Jennings, (Whittington) Dr Debbie Frost (Barnet) Dr Katie Coleman, (Islington) Borough based leads for each CCG Dr Vincent Kirchner (C&I) Dr Jonathan Bindman (BEH) Dr Alex Warner (Camden) Dr Oliver Anglin (Camden) Professor Donald Peebles Mai Buckley (Royal Free) Professor Geoff Bellingan (UCLH) Dr Clare Stephens (Barnet) Dr Shakil Alam (Haringey) Dr Chris Laing (UCLH) Dr Julie Billet (Camden and Islington) Prof. Marcel Levi (UCLH) Tony Hoolaghan (H&I) Paul Jenkins (TAVI) Charlotte Pomery (Haringey LA) Rachel Lissauer (Haringey) Kathy Pritchard- Jones UCLH 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 Sarah Mansuralli (Camden) Dawn Wakeling (Barnet) 8

9 Our Workforce governance NCL Health & Care Cabinet NCL STP Programme Board Local Workforce Action Board NCL Workforce Steering Group NCL Integrated Education Provider Delivery Board Workforce Task & Finish Groups Project forums & networks Community Education Provider Networks (CEPNs x 5) Provider Boards Partner Organisations CCG Governing Bodies LA Committees /Cabinets Pan London & other STP Collaboratives

10 The Care & Health Integrated Network Model (CHIN Networks) QISTs The Care & Health Integrated Network CEPNs Quality Improvement Support Teams apply QI as our approach to reduce unwarranted variation in patient care. The boroughbased teams sit within primary care but working across the system. They offer support to identify and tackle unwarranted variation and build QI capability. Practice-based pharmacist working across networked practices, proactively reviewing patients 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 Voluntary sector link worker/ navigator able to proactively social prescribe/ navigate Local authority including link to social care, housing, employment, education and vol sector 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. 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.

11 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.

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

13 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.