Workforce Planning & Redesign

WORKFORCE PLAN 2017-2020 Author Service Lead and Queries Executive Lead Pauline Rae Gerry Lawrie Dr Annie Ingram Workforce Planning & Redesign 1 P a g e

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Foreword NHS Grampian remains in a period of significant change with the introduction of Health and Social Care Partnerships in April 2016, the publication of the Grampian Clinical Strategy during October 2016, followed by the national Health and Social Care Delivery Plan 2016. These changes in service delivery and strategy, together with the significant workforce challenges that health and social care face, continue to be the drivers for transformation of health care services, undertaken in collaboration with our partner organisations, to deliver our ambitions and values. Transformation of the approach of services, with a greater emphasis on prevention and anticipation; accessible and flexible services, centred on the needs of the individual; improving community empowerment and improving outcomes are the key drivers for continued collaboration. The emphasis on the impact that the workforce has in enabling change and transformation, with the staff at the heart of making that change happen, in a context where supply continues to challenge services is likely to require innovative ways to improve health care outcomes for patients and their families, using different models and approaches. It is in this context, that this Workforce Plan has been developed. The Plan recognises the different staff groups within the NHS and within partner organisations, acknowledging that high quality services are delivered by hard working people, responding to the changing demand, evolving delivery models and rising public expectation in an ever-changing environment. 3 P a g e

Table of Contents Index of Tables and Charts... 5 1 Introduction... 6 1.2 Purpose of the plan... 6 1.3 Scope of the plan... 6 1.4 Ownership of the plan... 7 2 National and Local Strategy... 7 2.1 Health and Social Care Delivery Plan... 7 2.2 National Health and Social Care Workforce Plan... 8 2.3 National Clinical Strategy... 8 2.3 Workforce 2020 Vision... 9 2.4 Audit Scotland... 10 2.5 Shared Services... 10 3 Risks and Challenges... 12 3.1 Finance... 12 3.2 Supplementary Staffing... 12 3.3 Doctors in Training... 13 3.4 Improving Junior Doctors Working Lives... 14 3.5 Collaboration with NHS Education for Scotland... 15 3.6 BREXIT... 15 3.7 Job Planning... 15 3.8 Age Profile... 16 4 Transformation of the workforce... 17 4.1 Physician Associates... 17 4.2 Clinical Development Fellows... 17 4.3 Advanced Clinical Practice... 18 4.4 Health Care Support Workers... 18 4.5 Apprenticeship Programme... 19 4.6 Making Transformation Happen... 19 5 Recruiting, Retaining and Developing the Workforce... 20 5.1.1 Workforce Supply... 20 5.1.2 Recruitment 2020... 20 5.1.3 The use of Social Media... 21 5.2 Medical Workforce Planning for Secondary Care... 22 5.3 Medical Education... 22 5.4 Workforce Utilisation... 23 5.5 erostering for Doctors in Training... 23 5.6 Bank Review... 24 5.7 Nursing and Midwifery Workload and Workforce Tools... 25 6 Summary of Actions... 25 6.1 Summary... 25 6.2 Actions... 26 Appendix 1... 27 Appendix 2... 41 4 P a g e

Index of Tables and Charts Chart 1: NHS Grampian wte and % Split by Job Family 31st March 2017... 27 Chart 2: Split between Whole-Time and Part-Time by Job Family 31 March 2017... 28 Table 1: Headcount and WTE (Whole Time Equivalent) as at 31 March 2017... 28 Chart 3: NHS Grampian Age Profile by Three Main Clinical Job Families 31 March 2017... 29 Chart 4: Age Range by Headcount 31 March 2017... 30 Chart 5: NHS Grampian Age Range as at 31 March 2017... 31 Chart 6: NHS Grampian Gender Split... 31 Chart 7: NHS Grampian Sickness Absence Rates, Monthly ISD, April 2016 - March 2017... 32 Chart 8: NHS Grampian Sickness Absences (SWISS) 1 April 2016-31 April 2017... 33 Table 2: Job Planning Completion as at 31 March 2017... 33 Table 3: Aggregated Starters and Leavers 1 April 2016-31 March 2017... 34 Chart 9: Employment Rates 2004-2016... 35 Table 4: shows that the north-east of Scotland unemployment figures fluctuate in line with the variations of the Oil & Gas Sector.... 36 Chart 10: North-east of Scotland unemployment... 36 5 P a g e

Introduction This plan for NHS Grampian describes the future workforce required to ensure delivery of quality services within the agreed values of Caring, Listening and Improving. 1.2 Purpose of the plan The aims of this plan are to describe: the overall direction of travel for the workforce; the context and drivers for change; the type and level of changes required; the new roles and skills requiring investment; the new ways of working with our colleagues; the workforce risks; and the key actions to implement change. 1.3 Scope of the plan NHS Grampian provides clinical, corporate and support services for the people of Grampian and through Service Level Agreements (SLA) for other NHS Boards, including NHS Orkney and NHS Shetland. These services are included within the Board and Sector Workforce Plans to ensure comprehensive planning across the organisation. The Health and Social Care Partnerships (HSCPs) in Aberdeen City, Aberdeenshire and Moray assumed responsibility for strategic commissioning and delivery of a number of services on the 1 April 2016. NHS staff who work in the Health and Social Care Partnerships remain NHS Grampian employees, and therefore, are included in this Plan ensuring that workforce issues and information are included for the entire NHS Grampian workforce. Effective workforce planning supports strong financial governance, financial planning and ensures the capacity and capability of the workforce are developed to support service development plans. All staff referenced within this plan are covered under the following national job families: Administrative Services. Allied Health Professional. Dental Support. Healthcare Sciences. Medical and Dental. Medical Support, which includes Operating Department Practitioners and Assistants, Physician s Assistants and Theatre Services. Nursing and Midwifery. 6 P a g e

Other Therapeutic, which includes Psychology, Genetic Counselling, Optometry, Pharmacy and Play Specialists. Personal and Social Care. Support Services. 1.4 Ownership of the plan This Plan has been informed by local Workforce Plans, developed in partnership, within each Sector and Health and Social Care Partnerships 1. These local Workforce Plans provide a more detailed approach to workforce issues, direction of travel, challenges and risks for each area. NHS Grampian works closely with other NHS Boards in the North of Scotland through regional working, SLA arrangements and managed clinical networks. NHS Grampian is fully engaged with other partner organisations such as the University of Aberdeen, the Robert Gordon University, the North East of Scotland College (NESCOL) and the three local authorities in Aberdeen City, Aberdeenshire and Moray. 2.1 Health and Social Care Delivery Plan National and Local Strategy The Health and Social Care Delivery Plan 2, published in December 2016, sets out the key aims and actions for the NHS going forward, including Health and Social Care Integration, public health and Board reform. The aims of the Delivery Plan are to further enhance health and social care services, so the people of Scotland can live longer, healthier lives at home or in a homely setting, supported by a health and social care system that: Focuses on prevention, anticipation and supported self-management; Has day-case treatment the norm, where hospital treatment is required and cannot be provided in a community setting; Focuses on care being provided to the highest standards of quality and safety, whatever the setting, with the person at the centre of all decisions; and Ensures people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission. NHS Grampian through delivery of the local Clinical Strategy, and regionally, through the development of the Regional Delivery Plan is working towards delivery of the aims of the Health and Social Care Delivery Plan, appropriate to our local needs and regional aspirations, ensuring that health and care are integrated, are of a high quality, developed innovatively, with individual at the centre. 1 Health and Social Care Partnerships (HSCP) are the organisations and the Integrated Joint Boards (IJBs) are the Boards that oversee the strategic direction and governance of these partnerships. 2 (2016) Health and Social care Delivery Plan December 2016, Edinburgh. www.gov.scot.uk. 7 P a g e

NHS Grampian will continue work towards the aims of the Health and Social Care Delivery Plan. This will be undertaken with a regional approach, as part of the Regional Delivery Plan. Work will continue in relation Health and Social Care Integration and continued development of patient centred care. 2.2 National Health and Social Care Workforce Plan The Health and Social Care Delivery Plan signalled the need for a National Workforce Plan, which will be published in three parts. Part 1 was published in June 2017 3 and focuses on NHS Scotland workforce planning. Part 2 will be published in the autumn of 2017, with part 3 being published following the conclusion of the General Medical Services contract negotiations in late 2017. A National Workforce Planning Group will meet in the coming months to review the recommendations and proposals for future work. The Group will seek to improve consistency and use of workload tools across Scotland. NHS Grampian will reflect on the recent NHS Scotland workforce planning publication and participate in all National discussions, taking necessary action in relation to workforce planning development. NHS Grampian will continue to use and report on the use of the workload tools for Nursing, Midwifery and Allied Health Professionals. 2.3 National Clinical Strategy In 2015, the National Clinical Strategy for Scotland 4 was published. In October 2016, NHS Grampian published the local Clinical Strategy, which identifies how clinical services need to change to be sustainable and fit for the future. The Grampian Clinical Strategy places the workforce at the heart of enabling transformation and highlights the importance of creating the right environment for change, including focussing on the health and wellbeing of the workforce. 3 (2016) National Health and Social Care Workforce Plan - Part 1: a framework for improving workforce planning across NHS Scotland June 2016. Scottish Government, Edinburgh. www.gov.scot 4 (2015) NHS Scotland National Clinical Strategy for Scotland February 2015, Scottish Government, Edinburgh. www.gov.scot 8 P a g e

All three Health and Social Care Partnerships (HSCPs) also have strategic plans, which identify different priorities, based on client need and service demand, within the context of their localities. It is vital that the Grampian Clinical Strategy, and the supporting Workforce Plans, focus on the agreed NHS Grampian priorities and those of the Health and Social Care Partnerships. Across all strategic plans the focus on individual patient pathways and person centred care is a priority. Efficient and effective strategic and operational relationships will enable the needs of individuals to be met across all services and collaborative working to achieve this vision will be ongoing. NHS Grampian will continue to focus on the National Clinical Strategy and the priorities for the Grampian Clinical Strategy. NHS Grampian will focus on prevention, support, self management for patients, the continued high standards of quality and safety and patient centred care. NHS Grampian will continue the transformation required through the continued support and well being of its workforce. 2.3 Workforce 2020 Vision The 2020 Workforce vision, developed in 2012, envisioned that by 2020 NHS Grampian would: employ a leaner, more flexible, multi-skilled, workforce, who will enable and empower people to take responsibility for their own health, the workforce will be organised in an integrated way, focussing on the needs of the individual rather than the desires of the professional. Whilst managing growth and demand, healthcare professionals will be more accessible to the public and to each other. There will be a sense of responsibility across the organisation that will focus on: Results & value for patients; Enablement, anticipation & rehabilitation; Safety & Quality; and Those who need it most. 5 The Board has recognised that this vision needs to be refreshed during 2017-18. 5 (2013). Workforce 2020. NHS Grampian: Aberdeen 9 P a g e

2.4 Audit Scotland The recent publication of the Audit Scotland 6 report in relation to the Clinical Workforce in Secondary Care identified five key messages: The number of staff and level of spend on the workforce have increased, alongside increases in agency spend. Workforce planning requires improvement. Workforce planning processes require improvement to tackle major reform, in particular, the shift to more community and home based services. The age profile of the workforce is increasing and an aging workforce has implications for service delivery. Increasing demand for health and social care, will impact on the current workforce and the existing workforce need to change to meet these changing demands, but planning for this is not clear. Publication of a single workforce plan to cover health and social care is required. NHS Grampian is reviewing the Audit Scotland Report and taking action to address these in a local and regional context. 2.5 Shared Services NHS Grampian is actively participating in the shared services agenda, working towards reducing geographical and organisational barriers to the delivery of support services and functions, including. Finance, Payroll, Workforce, Catering, Decontamination, Linen and Laundry and Logistics. The Once for Scotland agenda promotes, where appropriate, that services should be managed on a Scotland-wide basis and should be delivered in a consistent way, unless a compelling reason exists for variation 7. NHS Grampian fully recognises the potential benefits of working to the shared services agenda and has undertaken significant steps towards the development and provision of regionalised services, particularly in relation to corporate services. NHS Grampian continues to provide payroll services for NHS Shetland and NHS Orkney and working with colleagues from NHS Tayside, to demonstrate how a collaborative approach for the delivery of Payroll, Car Leasing, Expenses and Scottish Standard Time System (SSTS) services is delivered. NHS Highland has also begun to participate in this collaboration. This regional approach, is part of a wider pan-scotland approach to deliver consistent, standardised payroll services across Scotland within regional consortia. 6 (2017) NHS workforce planning: The clinical workforce in secondary care July, 2017, Audit Scotland, Edinburgh. www.auditscotland.gov.uk 7 The Scottish Government. NHS Scotland Shared Services accessed online; http://www.qihub.scot.nhs.uk/quality-and-efficiency/sharedservices.aspx 10 P a g e

In June 2016, NHS Grampian and NHS Orkney agreed to establish an integrated Workforce service, with a shared Director of Workforce. Integrated within the service are Recruitment, Payroll, Operational HR, Occupational Health Services and some elements of Workforce and Development. Health and Safety were part of the initial agreement, but a recent review will see this out of scope of the arrangements. NHS Grampian and NHS Shetland continue to collaborate in relation to Public Health Services, with the Director of Public Health for NHS Grampian taking responsibility for NHS Shetland. This presents an opportunity to identify Public Health shared services across the Boards and further connect acute care pathways which impact on Island patients. Within Estates and Facilities, NHS Grampian continues to work with North partners to share services and seek efficiencies. This includes appointment of a joint post in Logistics with NHS Highland. NHS Grampian will continue to drive the shared services agenda by joint regional working, integration of services and resources and working collaboratively with our partner Boards in the North Region. NHS Grampian will continue to actively participate in the shared services agenda and will continue with collaboration in relation to regional working and development of services. NHS Grampian will seek to make continued efficiencies, reducing variation in processes and continued development of standardisation of processes across the region. 11 P a g e

3.1 Finance Risks and Challenges The national context, within which NHS Grampian operates and provides services, influences the local strategy in which these services are planned and delivered. Across NHS Scotland, there is a drive for improved financial efficiency and savings. NHS Grampian is required to make financial savings of 5% ( 30m) during 2017/2018, and in each of the next three years. These financial challenges will mean implementing innovative changes to support the workforce, rather than financial solutions. More staff, undertaking traditional roles is not a viable solution given there are continued issues with workforce supply. NHS Grampian will continue to focus on the transformation of roles, skill mix, workforce planning and learning and development of the workforce to ensure sustainability and financial balance in the future. NHS Grampian will continue to work on the redesign of services to ensure that the workforce is utilised optimally. All staffing costs will continue to be scrutinised, whilst identifying the continued balance between demand and capacity. Work will continue to engage with services in relation to the transformation of roles and the options for skill mix, innovative change and to reduce supplementary staffing costs. 3.2 Supplementary Staffing The total Bank Spend for all job families across NHS Grampian over the last two financial years has increased from, 27.4M, April 2015 to March 2016, to 27.6M, April 2016 to March 2017. Nursing and Midwifery Bank over the last two financial years has increased from, 16.6M, April 2015 to March 2016, to 17.8M, April 2016 to March 2017. For the current year to date, April 2017 to June 2017, Nursing and Midwifery bank spend has increased by 4%, compared with the same period last year. Nursing and Midwifery Agency over the last two financial years has increased from 1.9M, April 2015 to March 2016, to 3.4M, April 2016 to March 2017, which represents an increase of 78.9% in Nursing and Midwifery Agency spend. Following a decision, within the current year, to cease off contract agency nurses within the Theatres between April 2017 and June 2017, the spend has decreased by over 22%, compared with the same period last year. Medical Agency Locum spend over the last two financial years has increased from, 15.9M, April 2015 to March 2016, to 18.9M, April 2016 to March 2017. This represents an increase of 19%. NHS Grampian and NHS Highland account for 75% of all locum spend in the North 12 P a g e

of Scotland Boards 8 and 35% of the overall Scottish spend, driven particularly by supply issues and the requirement to use off-contract locums to ensure safe staffing, which is driving up costs. Medical Agency Locum spend Year to date, has shown a decrease of 0.5% when compared with the same period last year. If this trend continues the end of year estimated expenditure will be 18.8M, which is comparable with spend last year. There has been significant Medical Agency Locum spend across NHS Grampian, with services highlighting they require a robust middle grade workforce to avoid locum costs and have indicated they would reduce Consultant locum spend by developing a more resilient middle grade workforce to undertake more out of hours work. It is hoped that the introduction of Clinical Development Fellows (CDFs) will help reduce gaps at middle grade and reduce Medical Agency Locum spend. NHS Grampian will limit the number of locum doctors, particularly those off-contract and continue with a robust scrutiny process, linked to a wider, more strategic review of the sustainability and resilience of secondary care services, which will work with service to understand how services need to change to be sustainable in the future. This will include working across the North with other partners. NHS Grampian will continue to scrutinise the use of supplementary staff, and in particular, the use of Medical Agency Locums and work with services to redesign services that are sustainable and resilient. NHS Grampian will continue work in relation to the introduction of Clinical Development Fellows (CDFs) to ensure a more resilient middle grade medical workforce. 3.3 Doctors in Training Resilience of Doctors in Training, particularly in Speciality Training is a common theme across NHS Scotland, including Grampian. There are gaps in some speciality rotas, with challenges in meeting the Working Time Regulations 9 and new Deal compliance. This has a direct impact on the training experience and the legality of rotas. A review of the number of rotas for Doctors in Training across Grampian is required, together with further development of a multi-disciplinary team approach. The development of Clinical Development Fellows, Physician Associates, Advanced Nurse Practitioners and Medical 8 North of Scotland Boards = NHS Grampian, Highland, Orkney, Shetland, Tayside and Western Isles. 9 The Working Time Regulations (1998) 13 P a g e

Support Nurses will support this approach, but there must be an emphasis on making NHS Grampian the training destination of choice for Doctors in Training. NHS Grampian is actively working to embed these new and developing roles into the workforce to support the medical workforce, Doctors in Training and the wider multidisciplinary team. NHS Grampian will continue to develop a multi-disciplinary approach to workforce planning and development. NHS Grampian will continue to develop transformational roles to support clinical teams such as Clinical Development Fellows, Physician Associates, Advanced Clinical Practitioners and Medical Support Nurses. 3.4 Improving Junior Doctors Working Lives NHS Grampian has been working as an early implementer Board in relation to Doctor and Dentists in Training (DDiT) shared services initiative. Aimed at improving the lives of junior doctors, though improved continuity of employment and minimisation of unnecessary bureaucracy. NHS Grampian has been working collaboratively with NHS Education for Scotland (NES) to test the lead employer model for DDITs. As of August 2017, NES became the employer of all General Practice Specialist Trainees (GPSTs) in the NHS Grampian GPST programme. It is intended that the approach will be rolled out for all DDIT programmes from August 2018, with each region identifying a lead employer and other Boards becoming placement Boards. NES will continue to be the employer for all GPSTs in Scotland and possibly other national programmes, but this is yet to be agreed. There is also national work aimed at improving junior doctors lives. The management chair of this work is the Director of Workforce for Grampian. NHS Grampian will continue to support the Doctor and Dentists in Training (DDiT) shared services initiative. NHS Grampian as early implementer Board will support the shared services initiative and report on learning and improvements from this work. NHS Grampian will report on the findings to inform the process for wider roll out to other NHS Boards from August 2018. 14 P a g e

3.5 Collaboration with NHS Education for Scotland NHS Grampian is working collaboratively with NHS Education for Scotland (NES) on a number of initiatives to improve communication and information sharing. NHS Grampian have volunteered to work with NES to share NHS Grampian elearning content, accessed through a more user friendly front end system, TURAS Learn. NHS Grampian will continue collaboration with NHS Education for Scotland and to make continued improvements in communication and information sharing. 3.6 BREXIT NHS Grampian has a significant number of employees from other European Union (EU) countries. The decision that the United Kingdom will leave the EU in March 2019, has created uncertainty over the status of EU workers employed in the UK and this has created a significant risk for some services in NHS Grampian. Scottish Government have recognised the commitment of EU workers, particularly within the NHS, but immigration is not a devolved matter and the impact will not be clear until the UK Government and the EU have concluded BREXIT negotiations. Work will be progressed in NHS Grampian to determine what these risks might be. The decision in relation to BREXIT has also created further uncertainty over the potential for a second Independence Referendum. This previously created risks in relation to both recruitment and retention of the workforce at all levels; and should the Scottish Government progress with this is likely to do so again. NHS Grampian will ensure that workforce planning for the implications of BREXIT continues to be progressed and will seek to influence thinking alongside the Scottish and UK Governments to minimise the loss of staff. NHS Grampian will continue to undertake workforce planning in relation to BREXIT and the implications of this across the organisation. Risks will continue to be identified and associated actions will progressed to minimise uncertainly for the existing and future workforce. 3.7 Job Planning NHS Grampian requires all Consultants and Specialty Doctors to have an agreed job plan. Job planning is a key mechanism through which responsibilities and objectives are agreed, monitored and delivered. Consultants are required to identify adequate time within the job plan for teaching and training, which is an important commitment for a teaching Board, and 15 P a g e

has a major impact on the training experiences for Doctors in Training and the attractiveness of the Board as an employer. Following publication of new guidance in August 2016, NHS Grampian has been developing refreshed job planning guidance. Linking Job Plans with Service Plans is vital to ensure improved service delivery, supported by inclusive processes, with meaningful consultant engagement throughout the year. This process will facilitate better informed individual job planning, maximising the effectiveness of the annual job planning meeting from the point of view of NHS Grampian, as the employer, and individual consultants. Plans should contribute significantly to the achievement of NHS Grampian s objectives and comply with the requirements of the Directors Letter (2016) 14 10 in relation to Consultant Job Planning. NHS Grampian will roll-out the refreshed approach to job planning. NHS Grampian will invest in ejob planning software and develop a roll-out programme. 3.8 Age Profile The age profile of NHS Grampian highlights a risk to the sustainability of the workforce, particularly in light of changes to pension age. To ensure a sustainable workforce, NHS Grampian must support employees to work longer, particularly in professions such as Nursing and Midwifery and Medicine where historically, some specialties could retire at age 55, without loss of pension benefits. NHS Grampian will continue to work on age profile modelling, supporting services to develop sustainable models of care, including reviewing working patterns to take account of the impact of an ageing workforce on the pattern of delivery of care. Work will be ongoing to understand the overall workforce and identify how NHS Grampian can retain the skills and experience of the older workforce, whilst providing safe and manageable roles. NHS Grampian will continue to undertake workforce age profiling and workforce planning to understand the implications of an aging workforce. NHS Grampian will develop an action plan to assist with mitigating the risks associated with an aging workforce. NHS Grampian will consider the employment needs of older people to ensure a sustainable and capable workforce. 10 DL (2016) 14, Consultant Job Planning Guidance, June 2016. Scottish Government, Edinburgh. 16 P a g e

4.1 Physician Associates Transformation of the workforce The Physician Associates workforce continues to grow and has extended to more specialties across NHS Grampian, with 19.9 wte working across Secondary and Primary Care, in 2017. In line with expansion and development of the Physician Associate workforce, the numbers of Physician Associates are projected to increase over the next 3 years. Work continues in collaboration with the University of Aberdeen to ensure there is a supply of Graduates from the MSc in Physician Associate Studies. NHS Grampian has developed an Internship Programme, which will provide training and a career structure for this emerging workforce. The Physician Associate role has been recognised in many Sector Workforce Action Plans as having the potential to provide valuable support alongside Doctors in Training and ensure there is support for the medical workforce and wider multidisciplinary teams, but delivering this at scale will be challenging. NHS Grampian will continue to develop the Physician Associate workforce. There will be continued collaboration with the University of Aberdeen in relation to the MSc in Physician Associate Studies Course and continued development of a career pathway for the emerging Physician Associate workforce. 4.2 Clinical Development Fellows The emergence of the Clinical Development Fellow (CDF) workforce was in response to the ongoing risks associated with unfilled training posts, which created rotas for Doctors in Training which were not resilient and had a significant impact on the training experience and further recruitment. The role was also seen as a response to the changing expectations of Doctors in Training, who seem to want to take a step back before committing to a training programme which will set their future career direction. The aim of the role is to ensure high quality, safe and patient-centred care is maintained; improve the resilience of Doctors in Training rotas to ensure high quality training; and support the recruitment and retention of high quality Doctors in Training. In 2017, NHS Grampian has recruited 18 Clinical Development Fellows who will commence in August 2017, with one post already filled for April 2018. It is anticipated that the Clinical Development Fellow workforce may increase during the remainder of 2017. NHS Grampian will continue with the development of the Clinical Development Fellow workforce. This workforce will continue to support unfilled training posts and support gaps in rotas for Doctors in Training. The continued development of this workforce will enable a 17 P a g e

more resilient medical workforce that will provide excellent training experiences for Doctors in Training and assist with workforce supply issues. 4.3 Advanced Clinical Practice Medical workforce supply challenges across NHS Grampian have supported Advanced Clinical Practitioners (ACPs) to demonstrate their capacity and competency to both substitute for, and supplement to, medical care delivery across the spectrum of healthcare. A major review of Nursing and Midwifery Advanced Clinical Practitioners roles in Grampian was undertaken during 2016 which scoped existing roles and practice to inform future strategy. Over the next five years, NHS Grampian will aim to maximise all Advanced Clinical Practitioners contribution to healthcare delivery, based on service needs. Advanced Nurse Practitioner roles will be a major focus of the Scottish Government educational fund initiative. It is anticipated that this fund will enable improved access to educational pathways and role development in areas where increased access to essential healthcare is required. Advanced clinical practice is a unique integration of nursing, midwifery, allied health professional and medical knowledge and skills, which has facilitated new ways of working and fostered better collaborative working. Advanced Clinical Practitioners are a sustainable solution to help meet the changing demands and challenges of the workforce. NHS Grampian will continue to develop the Advanced Clinical Practitioner workforce which will assist with continued workforce supply issues within the medical workforce, up skill and develop the existing workforce and will enable collaborative multi-disciplinary working. 4.4 Health Care Support Workers NHS Grampian continues to work in partnership with Moray College, North East Scotland College and Robert Gordon University to provide Health Care Support Workers (HCSWs) with a route to become Registered Nurses, via the HNC Care in Administrative Practice programme. 17 Nursing HCSWs have been offered a place with North East Scotland College and 1 HCSW will commence their studies for the HNC at Moray College in August 2017. NHS Grampian will offer continued support for HCSWs with access to SVQ qualifications. The model for how this will be provided and resourced will be revised as part of the overall Practice Education Review. 24 HCSWs are currently registered for an SVQ level 3 qualification using the healthcare support framework. The Perioperative Development Award has also seen success in developing Preoperative Assistant Practitioners. This two year programme requires those undertaking the course to gain an HNC in their first year, followed 18 P a g e

by the Professional Development award in the second year. 12 individuals will be entering year two which is due to commence in August 2017 and 9 applicants for the 2017 intake. NHS Grampian will continue to develop the Health Care Support Worker workforce and will encourage development of the workforce to become Registered Nurses. This will develop the existing workforce and assist with continued workforce supply issues for Registered Nurses in the future. 4.5 Apprenticeship Programme NHS Grampian currently employs Modern Apprentices (MA) and will continue to grow these roles in the future. Plans are to recruit to the North Graduate and Foundation Apprenticeship Programmes in 2017/2018. This programme is being utilised within NHS Grampian to recruit and develop the workforce, in line with a national drive to develop MAs within NHS in Scotland. NHS Grampian will continue with the Modern Apprentice Programme and will expand the programme in the future. With an aging workforce it is vital to expand and develop the workforce. 4.6 Making Transformation Happen During 2017/2018 and beyond, NHS Grampian will continue to identify opportunities to develop new roles or expand the areas in which recently developed roles are utilised; such as Advanced Clinical Practitioners, Physician Associates and specialised Band 4 HCSW roles. This will only be delivered through a collaborative approach with NHS Education Scotland, North East of Scotland College NESCOL, the University of Aberdeen and Robert Gordon University, as well as regional and national colleagues. NHS Grampian will reflect upon the Health and Social Care Delivery Plan, National Clinical Strategy, Grampian Clinical Services Strategy and the Audit Scotland Report, working with stakeholders, to identify the operational and service developments to achieve the visions and values outlined. Collaborative working will continue between Teams, Divisions and Directorates within NHS Grampian and Health and Social Care Partnerships to support services across boundaries. NHS Grampian will continue to extend its collaborative working, building on existing relationships with other NHS Boards and partner organisations. 19 P a g e

Stronger regional arrangements will drive planning in Grampian with partners across the North. Building on current managed clinical networks, the development of regional solutions to service sustainability will be a feature of the NHS in the North for the future. The regional Workforce Planning group has worked collaboratively for some time, but the emergence of regional corporate services and stronger clinical links, will see the requirement for regional planning to strengthen. Shared services will be delivered on a regional basis and lead the development of regional corporate services, rather than Board specific services. NHS Grampian will seek to lead aspects of this agenda and actively participate in others. There will be the continued support in relation to the engagement of staff through effective partnership working and upholding the Staff Governance Standards. NHS Grampian will continue to measure the experiences of staff through the use of local and national tools, such as imatter, to support and empower teams and improve their experiences at work. 5.1.1 Workforce Supply Recruiting, Retaining and Developing the Workforce NHS Grampian continues to undertake recruitment initiatives, including the implementation of the Return to Practice Programme. This programme will enable individuals to return to various specialties within Nursing and Midwifery, the continued development of the Clinical Development Fellow (CDFs) and Physician Associates (PAs) to bolster and support the Medical Workforce and attendance at various careers fairs across the United Kingdom. In November 2017, NHS Grampian will participate in an international recruitment process in Australia aimed at repatriating UK nurses and midwives. In addition, we will work with colleagues from across Scotland to progress an international approach to the recruitment of radiologists. NHS Grampian will continue recruitment initiatives to address workforce supply. There will be the continued development of new roles such as Clinical Development Fellow (CDFs) and Physician Associates (PAs). There will be development opportunities for Advanced Clinical Practitioners and Health Care Support Workers to assist with recruitment and retention of the workforce. 5.1.2 Recruitment 2020 During 2017, NHS Grampian will refresh the Recruitment Strategy 20:20 and new Recruitment priorities will be identified with key stakeholder involvement. In light of the continuing workforce supply challenges, work streams under Recruitment 2020 will continue to be a priority with attendance at medical and non medical recruitment events continues. NHS Grampian will continue to work with Nursing and Midwifery, Allied Health Professionals, 20 P a g e

Medical Staff and Senior Managers to progress a number of initiatives to attract staff to Grampian such as attendance at school careers events, work with the University of Aberdeen and Robert Gordon University, NESCOL, Moray College and the University of Highlands and Islands. NHS Grampian will refresh the Recruitment Strategy 20:20 and will continue to develop recruitment initiatives to attract individuals to live and work in Grampian. 5.1.3 The use of Social Media NHS Grampian has developed a number of initiatives in relation to social media and websites to address difficulties in workforce supply. A dedicated Nursing/Midwifery and Allied Health Professionals recruitment website has been developed to aid the attraction of new and return to practice staff to the organisation. NHS Grampian continues to support the Facebook page GPJobs Grampian to promote Grampian as a place to live and work, advertise vacancies and share experiences and stories from existing Medical Staff in Primary Care and their experience of living and working in Grampian. NHS Grampian has also actively used social media, including Facebook and LinkedIn to support recruitment for large scale campaigns or specific specialist roles. As of August 2017, there are 570 likes and followers of the page. On average, each update posted to the Facebook page reaches 14,000 individuals with the potential for onward sharing of the information or vacancy. Intelligence suggests the Facebook page and vacancies are viewed worldwide. In October 2016, www.nosdoc.co.uk was launched which further promotes NHS Grampian s medical vacancies in Primary Care. The website has information on latest vacancies, displays a live Facebook feed; provides information on things to do in Grampian such as travel, entertainment, sports, education and sightseeing. It has various promotional videos and information in relation to educational and learning events in Grampian, targeted for the Medical Workforce in Primary Care. It is hoped the website will be developed further in the coming months to include the Secondary Care medical workforce. NHS Grampian will continue to support recruitment initiatives and overall workforce supply across professions, Sectors and Divisions through the Recruitment 2020 strategy. There will be an ongoing NHS Grampian presence at recruitment events and ongoing campaigns to ensure momentum is maintained in the professions and roles targeted to date. NHS 21 P a g e

Grampian will work with services to identify professions and roles which require additional support for recruitment. NHS Grampian will work with partners to identify opportunities to identify sustainable accommodation for key workers to address cost of living and accommodation barriers to recruitment and market Grampian as a good place to live and work. 5.2 Medical Workforce Planning for Secondary Care In 2017, NHS Grampian published the Secondary Care Workforce Plan Volume 2 2016/2017 11.The combined volumes were the first medical workforce plan for medical staff, including all acute specialties across the organisation and is an important building block for a refreshed workforce plan for NHS Grampian. Understanding the medical workforce, the current challenges and risks in times of significant change is vital. Common themes highlighted within the Plan will inform sustainability and resilience plans being developed by services, ensuring that the risks and challenges are proactively being addressed. NHS Grampian will support the development of sustainability and resilience plans with services, ensuring that workforce planning for Medical Staff within Primary and Secondary Care continue to support and inform local, regional and national service and workforce planning. This will ensure that the implications of the future medical workforce in these specific contexts are understood, alongside the impact this is likely to have on other staff groups, and how these contexts are likely to influence workforce planning across the system. 5.3 Medical Education NHS Grampian is working to continually improve the training experience and quality of educational delivery for doctors in training across NHS Grampian, recognising that reputation and attractiveness as an employer will be enhanced by positive experiences and feedback from trainees. A range of ongoing educational opportunities are on offer, such as the annual medical education conference, membership of a GLINT (Grampian Learning Initiative for Trainers) peer group and attendance at locally delivered training events and seminars. In 2017, a programme has been developed for Staff as Educators comprising of 14 workshops, led by the University of Aberdeen. These will be delivered over the coming months in partnership with NHS Grampian staff. 11 Volume 1 was published in September 2016 and covered front door specialities. 22 P a g e

NHS Grampian will continue to support medical education and improve training experiences for Doctors in Training. Work will continue to ensure high quality training and positive training experiences and to ensure NHS Grampian is an attractive employer for doctors in training. 5.4 Workforce Utilisation NHS Grampian has developed many initiatives in relation to the effective utilisation of its workforce, in line with National and local strategies. These actions are to ensure that the workforce is in the right place, at the right time, with the right skills and competencies required for a robust workforce. As part of this vision, NHS Grampian has agreed to introduce and electronic rostering system, supported by a Clinical Resource Hub, which will support a centralised approach to rostering and Bank allocation for all Medical, Nursing and Midwifery, bank, rosters and Doctors rota monitoring to take place as an integrated team to support effective and efficient workforce utilisation. NHS Grampian will introduce an erostering system to support effective utilisation of staff. The initial roll-out will be focussed on nursing and midwifery staff, starting with the Nurse bank, and will include the establishment of a clinical resource hub, integrating rostering support and bank allocation. NHS Grampian will increase the Medical staff Bank to support improved internal utilisation of doctors. 5.5 erostering for Doctors in Training In 2015, the Scottish Government approached NHS Grampian to pilot an electronic rostering system for Doctors in Training, DRS Real Time (Doctors Rostering System RealTime). After a successful pilot phase, evaluation indicated benefits to both Doctors in Training and to the senior clinicians who are building and managing the rosters. Some of the benefits associated with DRS Real Time: more control of the rotas for Doctors in Training; right staff, in the right place at the right time; rosters built and managed to comply with the European Working Time Regulations and the New Deal requirements. 23 P a g e

NHS Grampian has over 90 live rotas on DRS Real time and continues to hold monthly Rota, Education and Compliance Group meetings. The purpose of this group is to identify High Risk Rotas and work to actively improve these rosters with services and improve the experience of Doctors in Training. It is hoped that as the system is fully embedded across NHS Grampian, there is a reduction in variation and the number of different rotas and educational experience improves further. NHS Grampian will complete the implementation of the new DRS Realtime system, supporting Clinical Leaders to achieve effective, safe rosters for Doctors in Training. NHS Grampian will undertake a strategic review of the number of rosters for Doctors in Training. 5.6 Bank Review In 2016, NHS Grampian commissioned a project team to progress the required service improvements resulting from the external Nurse Bank Review. The project team has worked with service users, through the nurse bank project group, to produce a project improvement delivery plan based on the recommendations made by the external review, whilst considering local and national guidance and bench marking. The delivery plan identified five key requirements that will improve clinical, financial and staff governance through delivering a greater level of standardisation, consistency and control. The key requirement for the delivery of this plan is the integration of all banks into an NHS Grampian nurse bank service. The electronic integration of this service is underway, with a projected start date of September 2017. The second phase of this project is the full integration and amalgamation of the four central bank offices to one site and under one management structure. The projected timeframe for the completion is December 2017. NHS Grampian will ensure that the Nurse Bank fully supports a sustainable, effective and capable nursing workforce. The Bank service will be integrated electronically, before amalgamating the separate bank offices into one service, ahead of the implementation of the roll-out of e-rostering and the establishment of the clinical resource hub 24 P a g e

5.7 Nursing and Midwifery Workload and Workforce Tools NHS Grampian continues to use and support the Nursing and Midwifery National Workload and Workforce Tools (NMWWT) where appropriate. NHS Grampian is currently following the national guidance when applying these tools, which aligns with the Healthcare Quality Strategy for NHS Scotland. It aims to build upon quality healthcare services ensuring all work is integrated and allied to the quality ambitions, resulting in measurable improvements within the local workforce. NHS Grampian will continue to utilise Nursing and Midwifery National Workload and Workforce Tools (NMWWT) to support the ongoing review of nursing resource, ensuring that the nursing workforce is the most appropriate workforce available. 6.1 Summary Summary of Actions The Board has highlighted a number of actions and commitments throughout this Plan to implement national and local strategies, by supporting, developing and enabling the workforce. NHS Grampian recognises that the workforce is key to the delivery of these strategies. NHS Grampian, as with other Boards across Scotland, is undergoing a period of significant change. Once for Scotland and the continued development of the Health and Social Care Integration and Shared Services means the way in which services have been delivered, will need to change. NHS Grampian recognises the existing and future workforce will need to be better aligned to deliver the change required. An integrated, seamless service is required to truly deliver patient centred care. NHS Grampian will continue to support this change; however, there will be significant challenges in doing so. There will be the complexities of emerging integrated services, workforce supply issues, an aging workforce and the financial constrains in which NHS Grampian is required to operate. The actions and commitments highlighted throughout this Plan are hoped to support the changes required, develop the workforce and mitigate the risks and challenges outlined. 25 P a g e

6.2 Actions NHS Grampian will continue to work towards the aims of the Health and Social Care Delivery Plan and will continue with a regional approach as part of the Regional Delivery Plan. There will be continued participation in the NHS Scotland workforce planning process and an active role in workforce planning development regionally. There will be a continued focus on the National Clinical Strategy and the Grampian Clinical Strategy, placing patients at the forefront of their care. Prevention, self management and services delivered closer to the patients home are pivotal in delivering this vision. The Board will continue to align the workforce and service to enable the changes required. NHS Grampian will be a more multi-skilled workforce, which will focus on the needs of the patients and who will work collaboratively with colleagues across all steps of the patient pathway. There will be active participation in relation to the shared services agenda and continued collaboration in relation to regional working. Redesign of services will continue to ensure the workforce is utilised optimally and there is a continued balance between demand and capacity. The Board will continue to have financial challenges in 2017/2018 and beyond, therefore supplementary staffing will continue to be robustly scrutinised. NHS Grampian will continue to prioritise adequate workforce supply, to limit the use of Bank and Agency staff by the introduction of transformational roles such as Physician Associates, Clinical Development Fellows and Advanced Clinical Practitioners. Robust utilisation and resilience of the workforce will continue to be a priority. There will be continued erostering for Nursing and Midwifery and Doctors in Training, alongside the establishment of a clinical resource hub. Part of this work will include a larger Medical staff Bank to support internal utilisation of Doctors and therefore reduce Agency Medical Locum spend. NHS Grampian will continue to expand the workforce in relation to Health Care Support Workers. This emerging workforce will assist with a continued workforce supply of Registered Nurses, develop the existing workforce and support an aging workforce. Workforce Supply will continue to be a priority with ongoing recruitment initiatives and the refresh of Recruitment 20:20. There will be ongoing work in relation to the use of social media and collaborative working with Schools, Colleges and Universities to promote Grampian as a place to live and work. Age profiling will continue and implications of an aging workforce will be a priority over 2017/2018 and beyond. Action plans will be developed to mitigate the risks for the workforce now and in the future. 26 P a g e

Workforce Data Appendix 1 1 Current Workforce Highlights The following is a summary of data compared to information presented in 2016-2017 and analysed to assess risk and develop action plans. 1.1 Staff in Post NHS Grampian employed 14,566 people 12,063.4 12 whole time equivalent (wte) staff as at 31 March 2017, which is shown by job families in Chart 1. Since March 2016, there has been an increase of 124 headcount and 96.4 wte across the entire workforce. Chart 1: NHS Grampian wte and % Split by Job Family 31st March 2017 MEDICAL SUPPORT, 54.3, 0% NURSING/MIDWIFE RY, 5254.2, 43% OTHER THERAPEUTIC, 336.7, 3% PERSONAL AND SOCIAL CARE, 71.1, 1% SENIOR MANAGERS, 35.5, 0.3% SUPPORT SERVICES, 1620.5, 13% MEDICAL AND DENTAL, 1299.6, 11% HEALTHCARE SCIENCES, 430.6, 4% DENTAL SUPPORT, 188.7, 2% ALLIED HEALTH PROFESSION, 940.8, 8% ADMINISTRATIVE SERVICES, 1831.3, 15% 12 The workforce figures throughout this section do not include Honorary Contracts or medical leadership and support roles such as GP appraisers, GP Sub Committee members, Clinical Leads, Medical Director, where most have a low WTE. 27 P a g e

1.2 Whole/Part Time Working Over the previous 4 years, there has been a shift from whole time towards part-time working across the workforce, although more staff still work whole time 62.5%. This has slightly reduced from 2016, when 62.9% staff worked whole time. Chart 2 below shows the split between whole and part-time working by job family. Support Services continues to be the only job family with a higher ratio of part-time to whole time working. Chart 2: Split between Whole-Time and Part-Time by Job Family 31 March 2017 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 34.7% 65.3% ADMIN SERVICES 41.6% 58.4% ALLIED HEALTH PROFESSIO N 38.3% 61.7% DENTAL SUPPORT 21.0% 79.0% HEALTHCAR E SCIENCES 14.6% 85.4% MEDICAL AND DENTAL MEDICAL SUPPORT NURSING / MIDWIFERY OTHER THERAPEUT IC PERSONAL AND SOCIAL CARE SENIOR MANAGERS SUPPORT SERVICES % Part-time 34.7% 41.6% 38.3% 21.0% 14.6% 17.4% 39.7% 30.1% 34.7% 5.3% 53.9% % Whole-time 65.3% 58.4% 61.7% 79.0% 85.4% 82.6% 60.3% 69.9% 65.3% 94.7% 46.1% 17.4% 82.6% 39.7% 60.3% 30.1% 69.9% 34.7% 65.3% 5.3% 94.7% 53.9% 46.1% 1.3 Whole Time Equivalent and Headcount Table 1: Headcount and WTE (Whole Time Equivalent) as at 31 March 2017 Job Family Headcount ADMINISTRATIVE SERVICES 2204 ALLIED HEALTH PROFESSION 1201 DENTAL SUPPORT 228 HEALTHCARE SCIENCES 499 MEDICAL AND DENTAL 1478 MEDICAL SUPPORT 58 NURSING/MIDWIFERY 6252 OTHER THERAPEUTIC 401 PERSONAL AND SOCIAL CARE 88 SENIOR MANAGERS 36 SUPPORT SERVICES 2121 Grand Total 14566 Job Family wte ADMINISTRATIVE SERVICES 1831.34 ALLIED HEALTH PROFESSION 940.83 DENTAL SUPPORT 188.72 HEALTHCARE SCIENCES 430.60 MEDICAL AND DENTAL 1299.60 MEDICAL SUPPORT 54.32 NURSING/MIDWIFERY 5254.25 OTHER THERAPEUTIC 336.68 PERSONAL AND SOCIAL CARE 71.05 SENIOR MANAGERS 35.45 SUPPORT SERVICES 1620.51 Grand Total 12063.35 28 P a g e

2. Age and Gender Profiles Understanding the workforce age profile is important to ensure appropriate and considered succession planning, and prevent a gap in knowledge, and/or experience within any profession. It should also be recognised that there are increasing numbers of individuals who are choosing to work beyond State Pension Age (SPA) and many have to work longer than planned to assure their income in retirement, particularly in light of recent changes to State Pension Age 13. The chart below shows the age profile of the workforce. The three largest clinical job families have been plotted relative to each other, along with the overall age profile of the workforce, which is represented by the dotted line. Nursing and Midwifery, as the largest group within NHS Grampian, is influencing the overall age profile and highlights the drop in the number of nursing and midwifery staff in the 30 to 44 age brackets as well as the nursing and midwifery staff soon to potentially retire of age 50 and over. Chart 3: NHS Grampian Age Profile by Three Main Clinical Job Families 31 March 2017 21.00% 16.00% 11.00% Overall Staffing Medical and Dental (inc Trainees) Allied Health Profession Nursing / Midwifery 6.00% 01 thru 19 20 thru 24 25 thru 29 30 thru 34 35 thru 39 40 thru 44 45 thru 49 50 thru 54 55 thru 59 60+ 1.00% 13 2016. http://www.ilcuk.org.uk/images/uploads/publication-pdfs/the_missing_millions_web.pdf 29 P a g e

Chart 4: Age Range by Headcount 31 March 2017 1200 1000 800 600 Headcount 400 200 0 01 thru 19 20 thru 24 25 thru 29 30 thru 34 35 thru 39 40 thru 44 45 thru 49 50 thru 54 55 thru 59 60+ 2.1 Ageing Workforce 30.2% of the Nursing workforce are aged over 50; 34.7% of Healthcare Scientists are aged over 50; 24.0% of Administration Services staff are aged over 55 and 29.1% of the overall workforce are aged over 55. With a high percentage of over 50 s across a number of job families and the increase of the Scottish Public Pensions Agency (SPPA) retirement age, in line with state pension age, there is a requirement for NHS Grampian to continue monitor the age profile. To ensure a sustainable workforce, NHS Grampian must support professions such as Nursing and Midwifery to remain in the workforce longer than was historically required. Return to Practice programmes and the strengthened links with Robert Gordon University, to support the recruitment of Nursing staff, has the potential to mitigate some anticipated gaps in workforce capacity and experience when staff choose to retire. Given the identified risk of an ageing workforce, supporting staff to maintain their health and well being will influence their ability to remain in the workplace and will improve stability of the workforce. 30 P a g e

Chart 5: NHS Grampian Age Range as at 31 March 2017 Headcount 2500 2000 1500 1000 500 16.00% 14.00% 12.00% 10.00% 8.00% 6.00% 4.00% 2.00% 0 01 thru 19 20 thru 24 25 thru 29 30 thru 34 35 thru 39 40 thru 44 45 thru 49 50 thru 54 55 thru 59 60+ Headcount (left axis) 91 947 1641 1514 1608 1644 2018 2169 1794 1140 Percentage (right axis) 0.62% 6.50% 11.27% 10.39% 11.04% 11.29% 13.85% 14.89% 12.32% 7.83% 0.00% 2.2 Gender This gender profile indicates that the organisation is, and will continue to be, predominantly female. Chart 6: NHS Grampian Gender Split Male 17% NHS Grampian s workforce is predominantly female (83%). Female 83% 3. Sickness Absence NHS Grampian s sickness absence rate has fluctuated throughout 2016/2017, between 4.30% and 5.39%. NHS Grampian s sickness absence levels remain consistently below the average for NHS Scotland. Throughout the year, the absence rates reflect a pattern, as seen in previous years, with lower absence in summer and higher in winter. NHS Grampian s long term absence is consistently below all other territorial Boards in Scotland. This reflects the work by managers, HR and Grampian Occupational Health Services to support staff back to work using appropriate adjustments, where required. 31 P a g e

Chart 7: NHS Grampian Sickness Absence Rates, Monthly ISD, April 2016 - March 2017 6.00% 5.00% 4.00% Scotland 4.83% 4.94% 4.87% 4.91% 4.99% 4.98% 5.20% 4.30% 4.40% 4.33% 4.29% 4.43% 4.64% 4.71% 5.37% 4.90% 5.52% 5.69% 5.27% 5.39% 4.94% 4.55% 5.24% 4.95% 3.00% 2.00% 1.00% 0.00% Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Long term Short term Total Scotland HEAT Target Short-Term = 28 days or less Long-Term = greater than 28 days ISD = Information In comparison with other Boards within the north region, the year ending annualised figures are as follows: Highland 5.08%, Orkney 5.03%, Tayside 4.79%, Western Isles 5.65%, and Shetland 4.51%. Compared with Grampian at 4.77%, this illustrates a relatively good performance compared with the Scottish average, and also at regional level. The Scottish average for 2016/2017 was 5.20%. 3.1 Attendance Management Whilst the overall sickness absence of NHS Grampian is below the NHS Scotland average, it presents an ongoing risk to a sustainable and capable workforce. With absence levels fluctuating across professions and sectors, the need to help staff to return and stay in work through appropriate management and Occupational Health support must be maintained. This could have an impact on reducing bank and locum usage which is a continued risk for NHS Grampian. 32 P a g e