1. General Practice has a workforce crisis.
Dr. Hari Pathmanathan
Chair
East & North Hertfordshire CCG

2. East & North Hertfordshire CCG
60 member practices
572,846 patients
Budget £566,000,000
362 GPs (284 WTE)
ENHCCG
LAT
NHS
Patients per FTE GP
2019
1982
1600
% FTE GPs aged > 55
24.4%
22.9%
22.7%

3. The problem is that there is a shortage of GPs in East & North Hertfordshire CCG. This makes the local health economy unsustainable.
GPs are essential for a UK style healthcare system.
Gatekeeper role that ensures cost effective healthcare.
Ageing population and rising demand
Government policy to deliver more care in the community.
Data shows that there is a retirement time bomb and we are currently under doctored.
To reach England’s average list size, we need an extra 74 FTE GPs.
The objective is to recruit and retain an additional 74 WTE GPs to East & North Hertfordshire CCG by August 2017.

4. Root Cause Analysis GP Workforce Crisis Demographics Policy
Poor primary care estate, space.
High buy in costs, outdated partnership model.
Isolated, silo working.
Demographics
Workload, visits, OOH.
Retirement of overseas doctors who worked in deprived areas
Poor pay.
Be part of a larger organisations.
Lack of personal and career development
Greater female workforce (PT work)
Policy
24/7 culture
Recruitment
Trainees move to London or Australia.
High property prices in Herts. and buying into partnership.
Early Retirement
Burnout due to targets, hours, changes
Tax and pension changes.
Premises
Lack of respect for profession.
Retention GP
Workforce
Crisis

5. Strategy Selection Root Cause Strategic Options Timely Resource Impact
Premises
New, purpose built.
Health Campus N H
Policy
Patient education L
Early Retire
Retain, pay, models Y M
Demography
Salaried, Large employer
Flexible working, Rotations
Recruitment
Advertising
Incentives
Salaried Schemes
Retention
Pay, Incentives
Rotational job plan with variety
Y Y Y
H L L
M H M

6. 4 Clinical sessions in practice with CCG Board GP mentor
Strategy
The CCG as an employer will recruit salaried GPs, predominantly from local training schemes. The GPs will have the following job plan for 3 years:
4 Clinical sessions in practice with CCG Board GP mentor
2 sessions in OOH/AIVS/UCC/Hospital Clinics
2 sessions in commissioning/GP education (working towards a qualification e.g. MBA)
The doctors we hope to attract will be like the HIV virus infecting our organisational cells and be the catalyst to a change in culture.

7. Project Group of key stakeholders
Implementation Plan
Project Group of key stakeholders
-CCG, LMC/GP Federations, HEEoE, University, Hospital, HUC
Business Case June 2015
Pilot 24 posts August 2015 (4 in each locality)
Evaluate March 2016 (future employer)
Further 24 posts August 2016
Full staff numbers August 2017
Replacement posts 2018

8. Uptake of posts Wave 1 August 2015 (process)
Evaluation Plan
Uptake of posts Wave 1 August 2015 (process)
Retention, effectiveness at 6 months: soft intelligence and appraisals (process)
Staffing levels at August 2017 (outcome)

9. Draft business case discussed at CCG Board
Progress
Draft business case discussed at CCG Board
Escalate to CCG priority but deliver as part of CCG Primary Care Strategy, so tackle both GP and nursing recruitment and retention.
Project group involving stakeholders to be led by Board GP and Director of Nursing.
Delivery vehicle will be new Integrated Provider Board, longer term and sustainable.
Concerns of future provider size, market in NHS, can of worms!

10. Don’t meet resistance with resistance!
Leadership lessons
Multifactorial problems across organisations do not have a simple solutions. I felt the need to make a start rather than wait for political masters to come up with the wrong solution.
Leadership is about engagement and a shared approach to problem solving.
Working in groups, tackling the group dynamics (organisational boundaries) and a degree of flexibility are key.
Don’t meet resistance with resistance!