NHS Board NHS 24 Contact Email Iain Adams iain.adams@nhs24.scot.nhs.uk Title Category Background/ context Problem Unscheduled Care Changing the Frontline Delivery Model in NHS 24 Workforce The development of the unscheduled care workforce plan within NHS 24 is a collaborative process, aligning HR, service and financial planning in partnership. This integrated approach aims to proactively define the workforce requirements for a 12 month period, ensuring that all parties involved are fully engaged in the planning process. Part of the service improvement methodology is to identify key workforce issues that support future models of service delivery so that NHS 24 will ensure the highest quality of service for the Scottish public and patients. Some of the key challenges and problems that NHS 24 faces in relation to the unscheduled care workforce are: service change population demographics age demographics population diversity the impact of remote and rural living technology changes In addition, internally, the following challenges have to be taken into account: predicting call volumes and demand for service in the short, medium and long-term
building rotas which best meet the needs of the service resourcing special days such as public holidays and protected learning times (for GPs), exceptional periods such as festive and Easter predicting performance and identifying shortfalls - endeavouring to cover any gaps Against this backdrop, NHS 24 must identify efficiency savings of 3 per cent which is increasingly challenging to achieve and where cost pressures continue to grow as budgets level off. There is also limited flexibility to alter the overall staffing profile due to the current NHSScotland policy of no compulsory redundancies. Aim Action taken The first step was to identify a preferred workforce model to support the achievement of wider corporate goals and objectives. The goals and benefits of change, the context of how services will be delivered in future, and the options for future service delivery and the drivers and constraints were considered. These steps outlined the workforce required to meet the predicted service needs and all of the key issues, local and national, which impact on workforce design and deployment. The workforce model was costed so that the level of cash releasing efficiency savings could be estimated and recognised against the previous model. The unscheduled care service remains NHS 24's key focus and priority, delivering a safe and effective service to the people of Scotland. Based upon current modelling, the changes to the workforce for this service in recent years are detailed as follows:- A reduction in whole time equivalent nursing numbers from 212 to 192 (-20) and a headcount reduction from 366 to 329 (-37). A reduction in team leader numbers from 90 to 69 (-21) and a headcount reduction from 89 to 77 (-12). This
Results reduction is due to the change in the model of management in local and remote centres. In addition, team leaders no longer manage Health Information Advisors, Breathing Space and the Scottish Emergency Dental Service as these staffing groups have their own management structures. The introduction of the senior call handler role, has also reduced the demand on the team leader role. The other significant workforce group is call handlers where there has been a whole time equivalent increase from 252 to 353 (+101) and a headcount increase from 450 to 563 (+113). The ratio of nurses to call handlers was 1 : 1 and the current position is now 0.7 : 1. In recent years, the mitigating effect of the introduction of protocol based call handler advise and discharge processes need to be taken into account these include exclusion of nurse interventions in, e.g. sore throat (over 5s), medication enquiries, bony injuries, death notification, minor ailments, suspected stroke, urinary tract infections, burns scalds and bites, earache and sunburn. The percentage of calls closed by call handlers has increased from 13.7 per cent to 26 per cent, an increase of 12.3 per cent. In recent years, there have been a number of 'new' roles introduced that would have reduced the need for trained nurses including the introduction of pharmacists, physiotherapists, dental nurses, breathing space advisors, mental health nurses and cognitive behavioural therapy (CBT) counsellors. Whilst the above have been introduced at varying stages, there is a clear justification in the reduced staffing ratios due to reduced nursing workload. The move towards a higher proportion of the service being delivered by call handlers during the 2013-14 financial year was delivered. The move to this model of delivery was based on the
experience gained over many years and consideration by management of the best, most efficient and appropriate way to deliver the service in future years. Patient experience Staff experience Efficiency savings and productive gains Patient service levels are aligned to key performance indicators (KPIs) in terms of the desired performance for time taken to answer calls and to deal with the needs of the patient within appropriate timeframes based on clinical priority. The performance targets are factored in to the workforce plan to deliver a highly responsive and effective service: Access Service Level 90 per cent of all calls answered within 30 seconds Clinical Calls 100 per cent of calls commenced consultation in three hours There has been a positive impact on staff experience with opportunities for staff to take on different roles and gain new experience as a result of the restructure of frontline services. During the 2013-14 financial year, NHS 24 was able to recognise a recurring cash releasing efficiency saving of 1.955 million. Sustainability Lessons learned NHS 24 continues to look at frontline delivery models to ensure that these support the clinical presentation of the calls received to the service on an on-going basis. The frontline workforce is modelled against changes in demand and takes account of the annual workforce and financial planning exercises. It is subject to scrutiny and review throughout the year. The full impact of the presentation of calls has to be taken into account and the impact of this on the culture of the organisation. Whilst time was spent with staff when the new models were being put into place, there is always scope for further discussions to take place with staff which would have been better for staff engagement. The last year has taught NHS 24 that the model introduced was quite well fitted to changing demand and NHS 24 has continued
to meet its KPIs. Much of the work used to introduce the new frontline delivery model was able to be utilised again during the planning for the introduction of the 111 free phone number.