1. Workforce and skill mix review Focus on diagnostics – 18 week project Lancashire and South Cumbria Cardiac Network

2. Background Focus on diagnostics project Service improvements Waiting list initiatives Implementation new services

3. Cardiac Physiology workforce Complexities and issues –Long training period –Extra training BSE accreditation and specialisation –Range of procedures –Often 2 or more clinical physiology departments run as one –Developments as a profession (degree, registration, SCST, AFC, student routes, access and commissioning)

4. Aim of review To provide baseline of clinical workforce and skills available and to ensure the workforce can meet the demand for diagnostics, thus ensuring sustainability of targets achieved. Clinical review - protected managerial and training time is excluded

5. Baseline data Collection baseline data –Number of qualified CP –WTE CP –Number of AP/ATO staff –WTE AP/ATO staff Exceptions – maternity leave, non clinical heads of department Explanation of workforce capacity – 80% (A/L, BH, study leave, sick/carer)

6. Analysis Collection sessions clinical staff available for each diagnostic Julie (boss) 0.6 WTE Echo 0.2 wte Admin 0.2wte ETT 0.1wte Tape analysis 0.1 wte Linda 1.0 WTE 1.0 wte Shiela 0.8 WTE 0.4 wte Ian 1.0 WTE (newly qualified) 0.2 wte (training) 0.4 wte

7. Echocardiography – staff available 3.9 WTE, 80% = 3.12 WTE Number of Echos that could be performed each week Number of staff required (inclusive additional sick/leave) Number of staff available (at 80%) Number of Echos based on demand per week Number of staff required (inclusive additional sick/leave) 2004.0 (5.0) WTE 3.9 (3.12) WTE 1462.7 (3.375)

8. Analysis Perform breakdown analysis for each diagnostic performed Staff available clinically and allocation of time protected for managerial and training sessions should add up to the overall WTE cardiac physiology staff Can include Respiratory and ATO/AP duties also, but if not these sessions need to be removed from the staff availability at the start

9. Workforce template summary Highlight clinical areas of match, excess and deficit to inform managers to move the workforce where it is needed Perform match analysis (example below) –Overall cardiac workforce availability = 9.6 WTE, 80% = 7.68WTE –Cardiac workforce required to meet demand = 7.5 WTE, allowing (at 100%) = 9.38 WTE – Marginal surplus workforce = 0.22 WTE (near perfect match)

10. Potential challenges and issues Specialised workforce with limited access to bank/locum staff and national shortage One stop clinics – impact on scheduling and rostering of staff Imminent retirements, vacancies, maternity leave Development of future services Data challenges – demand recorded, demand hotspots

11. Recommendations for workforce review and developments Report informs workforce planning Managers may require site by site analysis –Staff movement between sites - ? Permanently may be required Working differently, role redesign Ensure pyramidal structure of support staff, introduction of AP roles Ensure protection training time

12. In practice LSC – 3 reports across each acute trust – DGH Tertiary workforce reviews – weighted for highly complex case mix Almost impossible to achieve an exact match Defecit of staff identified – lead to investment in the workforce and recognition that staff shortages are real, also highlights non-sustainable targets regardless of service improvement work Excess/surplus of staff identified – lead to restructure and analysis of workforce roles –Highly specialised Clinical staff – performing admin duties, data collection and analysis, unspecialised procedures

13. Reasoning for reviews Not about working harder, working more effectively CP time is expensive and should be utilised appropriately Previously - shortage has driven demand for Cardiac Physiology - trusts to appoint higher grade staff as a recruitment initiative Development of sustainable workforce – protecting NHS Cardiac Physiologists and developing cardiac physiology as a robust and manageable workforce.

14. Any questions?