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1 Title of meeting Primary Care Commissioning Agenda item 8 Committee Date of meeting 9 th August 2018 Title of paper Update on the STP Primary Care Workforce Plan Director (name and title) Sadie Parker Author role (name and title) Action requested Approval Noting Purpose of paper: For information Kate Lewis Head of Strategic Planning (STP Primary and Community) Executive summary (200 word limit) This report provides an update on the development of the STP Primary Care workforce plan which is a key deliverable of the wider STP Primary and Community Care strategic work plan. It highlights recent developments on the GP Retention Plan, progress with initiatives, an update on the International GP Recruitment Programme, an update on nurse training and plans to progress new clinical roles. Recommendation to Governing Body/Committee Staff, patient, stakeholder engagement: Key Risks Clinical For noting. Finance and performance Impact assessment (environment and equalities) Reputation Legal Next update due September n/a Resilience and stability issues addressing current challenges whilst developing longer term strategy and delivery plan. Keeping up with pace of change supporting practices to adapt culturally and organisationally to develop internal resilience and ability to respond to population health need.

2 Resource required Resources identifying resources required with adequate levels of skills and expertise to drive the integration and strategic primary and community work plan across the footprint. Reference document NHS Constitution Conflicts of interest Directorate involvement (Name and title) Finance Quality Quality CHC Clinical Commissioning Primary Care Sadie Parker Director of Primary Care Communication and Corporate Affairs Governance GB/Committee approval/rejection of recommendation with dates Update on the STP Primary Care Workforce Plan 1.0 Introduction The STP Primary Care Workforce Plan is a key priority within the overall STP Primary and Community Care Strategy. The Workforce Plan sets out how we intend to address the challenges of an aging workforce (23% of GPs are aged over 54 compared with 22% nationally); the challenge of recruitment and retention (we are facing loss from the primary care workforce including both nurse and GP positions for various reasons including workload, income, pension changes and demography); and we know that if we do nothing by 2020 there will be a shortfall of 85 GPs across Norfolk and Waveney. In order to respond to the challenge, the STP Primary and Community Care work stream has established a new STP Primary and Community Care Workforce Working Group which is accountable to the STP Primary and Community Care Programme Board and reports in the Local Workforce and Advisory Board (LWAB), to progress and implement schemes identified within the workforce plan across the STP. 2.0 Progress to date Since the last update in June, NHS England has revised our International GP Recruitment allocation which is a key scheme within our plan aimed at increasing GP recruitment numbers. Our allocation has been reduced to 41 GPs (we were expecting 80) which has left us with a gap of 39 GPs to find through other schemes. In light of the gap we revised our GP retention trajectories and bid for local retention funds from the national pot of 7 million of new funding to support delivery of the commitment set out in the GP Forward View to ensure additional doctors working in general practice by 2020, with a specific focus on supporting GPs who are at risk of leaving or who have 2

3 already left practice. The Midlands and East region received 2.07m allocation of the 7m Local GP Retention Fund. The regional allocation has been split across 15 STPs using weighted populations as the basis for funding. We have been informed that we are being awarded 149k awarded on fair share basis with other STPs across the region. With regards to the trajectory the regional team have revised our plan to reflect numbers of newly qualified GPs expected to attract through the GP Fellowship scheme. This has left us with a variance of -6 against our target of 645 GPs by This gap will be met by further revisions to the plan due for submission to NHS E by 7 August GP Retention Plan Following the GP Retention Plan bid submission at the end of June, NHS E has requested further project detail behind each of the schemes to be worked up and reviewed at the NHS E GPFV Oversight Meeting on the 30 July. Schemes within our GP Retention Plan include: 3.1 Targeted Enhanced Recruitment Scheme (TERS) Our proposal is to tap into national funding opportunities such as the TERS, to offer salary supplement to attract GPs to work in the area. The TERS will help to recruit to training places that have been hard to recruit to for the past three years. Following application and successful recruitment to training places our dedicated Coordinator will provide pastoral support to the trainees, linking them in with peers/ career development support and supporting them to engage with practices in their area for future job prospects. Application for the scheme starts in February The suggestion is for some funding to add project management capacity to ensure a consistent approach across the STP and engagement with the training practices. 3.2 GP Careers Plus Our proposal is to applying learning from the GY&W pilot to roll out the GP Careers Plus Scheme across the Norfolk and Waveney STP, focusing on the pre-retirement pathway and flexible working for younger GPs. The initial areas of focus to target retiring GPs include Norwich and South Norfolk with a phased roll out over West and North Norfolk to cover all areas of the STP footprint. The scheme will continue to be centrally coordinated by GY&W in the first instance, moving to a more sustainable model when it is administered by a GP Provider Group. Funding includes contribution toward indemnity cover, engagement sessions and training budget. Funding to develop technology use to streamline scheme and increase scale. 3.3 GP Fellowships 3

4 Our proposal is for Norfolk and Waveney STP to host GP Fellowships, offering GPs the opportunity to develop skills outside of practice with support to pursue higher education and encouraging a mix of clinical and leadership skill development. We have been successful in a recent HEE bid for GP Fellows and we are currently working to detail placements including named supervisors and further detail of placement content. Applications for the Post-CCT Fellowships closed on Friday 1 June. HEE were seeking to recruit to 75 fellowship posts across Midlands and East however, 36 applications were received this round, with 11 expressing interest for East of England. HEE panel interviews took place at the end of June with successful candidates notified beginning of July. Candidates will be matched with their preferred area and recruited via the Norfolk and Waveney Training Hub; we are seeking clarification on numbers for our STP and region. We also understand that HEE have agreed in principle to run a second round of recruitment for the programme during September 2018 with fellowships commencing in January Careers Start Our proposal aims to develop a framework for local induction and support to practice, implemented via the Careers Start framework. Working closely with the GP Provider Groups (Federations) the CCG will support development of a new employment model and job offer for newly qualified GPs, where the employment/ or 'hosting' will sit with the GP Provider Group, with clinical capacity shared amongst practices, offering a flexible (or 'port-folio') career approach. We will apply learning from the Sunderland Career Start initiative run by Sunderland GP Alliance. As this is a new initiative to our area we have sought expression of interest from GP providers working in collaboration to deliver a small scale, short-term pilot to trial and test the development of a framework to support a new employment model and job offer for newly qualified GPs. The intention with this scheme is that providers work together for immediate roll out and delivery by March 2019 as we recognise the time limited nature of the funding attached. 3.5 Joint Local Retention scheme targeting trainees in collaboration with Suffolk and NE Essex STP Working collaboratively across both STPs we have agreed to realign existing resources (IGPR resource) to provide connectivity with the medical schools, building relationships across the STP footprint to promote and engage with 4

5 trainees considering future jobs in primary care. We would utilise our Norfolk and Waveney IGPR Coordinator to provide pastoral support to new trainees, helping to embed doctors in work and home life. It will also be important to link new GPs/ Trainees up with our Training Hubs and we see this as a key forum for networking, education and support. 4.0 International GP Recruitment (IGPR) Update The IGPR team are now fully in post and working closely with NHS E and the Recruitment Agent abroad to identify potential candidates coming through the assessment process. Whilst the recruitment process has been slower than expected the IGPR Team have been able to test the system with the first Suffolk candidate who successfully passed the Stage 1B interview in July and has been invited back for the Stage 2 process. With work undertaken with the IGPR clinical leads to outline the most constructive questions to be asked at Stage 1B proving invaluable to the regional team interview panel. The IGPR team are now starting to work more closely with all the Heads of Primary Care and practices across the STP (as well as Workforce and other regional and local resources such as HEE etc.) with the view to being fully ready to respond to the 12 candidates currently advised as being in the initial Stage 1/1A application process to progress through the next stages towards potential relocation into the area. 5.0 Nurse development and training update As an STP we have been successful in bidding for Advanced Clinical Practice education placements and have been provided funding for 25 places at UEA for 2018/19. To fairly allocate places Norwich CCG will be leading correspondence with practices to scope out interest and to collect nominations. The intention is to supply a cohort for January 2019 start. On General Practice Preceptorship training, Cohort 1 (North Norfolk and Norwich) will complete by September There are a further 9 students who will commence preceptorship training in November. Cohort 2 (South Norfolk & GYW) commenced in July 2018 with a total of 8 students, preceptorship will commence in February. Funding for cohort 3 (West) has been secured and Norwich CCG who are the project leads are taking this forward. 6.0 Other roles update 5

6 6.1 Apprenticeships (Clinical & Non clinical) a scoping exercise being led by North and South Norfolk CCGs is currently taking place. A small range of HEI providers including the OU have liaised with the leads to link what is on offer. Project Leads are also meeting with Norwich City College to scope out a co-produced bespoke assistant practitioner role for primary care. A meeting has been held with the UEA to explore the Nursing Associate pathway into pre-registration training. This is also offered by the OU via the apprenticeship route. 6.2 Practice Manager Training North and South Norfolk CCGs as project leads are currently scoping various training opportunities on system wide leadership for senior managers which will be progressed through the Norfolk and Waveney Training Hub. 6.3 Paramedics in Practice currently linking into system wide conversations with the ambulance trust, out of hour provider and acutes to understand opportunities for collaboration on shared roles across organisational boundaries. Next meeting led by LWAB scheduled for 3 rd August Confirmed resources Great Yarmouth and Waveney CCG as STP Primary and Community Care work stream lead, provide an overall coordinating lead role to the GP Forward View Norfolk and Waveney STP Workforce Plan (Kate Lewis). This includes providing a single contact with regulator and HEE; driving forward the workplan; distributing information; coordinating bids; submitting returns; assurance reports etc. New STP Primary Care Workforce Coordinator role starting 6 August to support the implementation of the GP Careers Plus scheme and coordination of a joint STP Community Education Professional Network (CEPN)/ Training Hub (role hosted by GY&W CCG funded by HEE GP Careers Plus and CEPN) International GP Recruitment Programme Manager (band 8b) joint post across Norfolk and Suffolk in post anticipated support for GP retention in place of IGPR in the interim. IGPR Coordinators (one for Norfolk, one for Suffolk) providing pastoral support to international GPs and their families focus on GP retention in the interim started 9 July. STP Primary Care Workforce Project Manager (band 7) now agreed by the five CCGs and part funded by the GP Retention fund. This role is currently out to advert. 6

7 Identified risks 1. Newly qualified GPs are not retained Risk description: There is a risk that despite best efforts, newly qualified GPs do not want to stay in Norfolk and Waveney and that following an initial period of incentive, support etc. the GPs leave practice and move out of area. Mitigating action: As described, efforts to actively promote Norfolk and Waveney as a place to live and work are joined up via the LWAB and other organisations, promoted by the realigned pastoral support from IGPR. Promotion will include the TERS, Careers Start and GP Fellowships - opportunities to link in with GP Provider Groups to understand networking, support from experienced GP colleagues and peer support mechanisms etc. 2. GPs mid-career or pre-retirement opt out Risk description: There are risks that as a wider system, despite resilience and stability mitigation, improvements are not felt on the front line and the numbers of GPs midcareer or pre-retirement decide to opt out of practice due to workload pressures. Mitigation action: Develop early warning system working with LMC/ GP appraisers to identify which GP require pro-active support and package (in the form of GP careers plus). Work with the GP Provider Groups to develop at scale working and networking to implement 10 High Impact Actions and resilience schemes to transform primary care delivery. Linking in to wider STP Primary and Community Care work plan. 3. Primary Care at Scale - organisational maturity Risk description: There is a risk that the emerging GP Provider Groups are not able to maintain the necessary pace and scale of organisational development to be able to support the delivery of workforce initiatives such as Career Start. Mitigating action: Early engagement with GP Provider Groups to identify test sites for Careers Plus and apply learning from schemes where this has been implemented elsewhere. 4. Delays to International GP Recruitment Gap created due to delays to IGPR scheme unable to meet patient need as a result of gap. Mitigating action: Developing wider Primary Care workforce strategy with focus on developing other clinical roles to support resilience in primary care. 5. Delays to recruitment - General Practice Nurse Lead - match funding of 15k to recruit General Practice Nurse Lead (band 6/7) to support nurse training and development projects within the Workforce Plan job description under development. Mitigating action: Lead STP nurse to work with project leads (Norwich) and to go through CCG Chief Nurses as appropriate until recruitment complete. 7

8 6. Organisational capacity to deliver against plan STP Strategic Lead going on maternity leave which will leave a gap in coordination of the Primary Care Workforce Plan. Mitigation action: recruitment of Project Manager to create capacity on the delivery of GP retention initiatives. Primary Care team currently considering options for maternity cover. 8

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