1. Workforce Transformation
September 2017
Del Mehet, Assistant Director, Workforce Transformation, Strategy and Transformation.

2. Executive Summary
The Sustainability and Transformation Plan (STP) has given North West London a renewed impetus and opportunity to transform care by working in a more integrated way. Our existing and future health and social care workforce will be integral to delivering the service transformation and vision.
Therefore a robust workforce strategy is being implemented under the joint leadership of Health Education England (HEE) North West London and CCG Collaborative, Strategy and Transformation Team (S&T) working as a unified team within a newly designed governance structure, which ensures service led decision making.
The overarching aim of this STP workforce strategy is to ensure that high quality, evidence based workforce transformation activity is planned and implemented to support the delivery of the STP.
The NWL STP workforce strategy is centred on four workforce priorities that cut across all five STP delivery areas. These are:
1. Workforce planning and addressing workforce shortages
2. Recruitment and Retention
3. Workforce transformation to support new ways of working
4. Leadership and Organisational Development (OD)

3. Context – NW London workforce

4. Ways of working and governance
Workforce Transformation and HEE NWL are now working as a unified single team. We have recently appointed to a joint social care workforce role to help map the challenges in social care and build these relationships. The NWL Workforce Strategic Plan has been developed jointly by the CCG Collaborative workforce team and HEE agreed by Workforce Transformation Delivery Board.
The strategy is being delivered under the leadership of Health Education England (HEE) and a newly established Workforce Transformation Delivery Board (fig 1) that is co-chaired by a CCG Chair, Social Care Director and HEE Director. This CCG and HEE joint team is being guided by:
1) A Workforce Transformation Advisory Council, a vision setting group and vehicle to develop and test the strategy and work programme with senior stakeholders in a large forum, and,
2) A Workforce Transformation Delivery Board that will then translate the vision into a workforce strategy and delivery plan for NW London, and will have responsibility for steering investment and resources.
Our refreshed governance structure ensures that we have the strategic leadership, guidance and advisory input from a broad representation of individuals with experience and expertise in workforce planning, development and transformation across the sector
These two groups report to the overarching Health and Care Transformation Group that is responsible to delivery of the STP and is accountable to the 8 sets of CCG governing bodies, provider boards and local authority cabinets.

5. S&T and HEE NWL Joint Business Planning - summary
The S&T Workforce Transformation Team and HEE NWL Team held a joint business planning session on 26th January.
Upon reviewing our joint NWL Workforce Strategy, the following themes were agreed, around which our work will be framed:
The teams agreed an approach and time frame for writing the delivery plans that will underpin the NW London Workforce Strategy
Summary of the session outputs:
Agreed key themes (above)
Agreed headings for the delivery plan template
Began mapping projects and deliverables against the headings
Next Steps (by February):
Update to be given at Workforce Transformation Delivery Board (31st Jan)
Delivery plans to be drafted in preparation for review at next group session (2 weeks’ time)
Further group session to work through delivery plans
Use session to agree our priorities and deliverables for 2017/18
Stakeholder mapping to take place (to be amalgamated)
Communications plan to be agreed, to underpin all stakeholder engagement
Workforce planning
Sub categories (broadly aligned to STP delivery areas)
Primary care and prevention (DA1)
Long Term Conditions (DA2)
Older people’s care (DA3)
Mental Health (DA4)
Inpatient care (DA5)
Talent, Leadership and Organisational Development
Recruitment and retention
Workforce Transformation

6. Mitigation (latest progress)
Progress and immediate next steps summary
PROJECT AREA/WORKSTREAM
PROGRESS SUMMARY
NEXT STEPS SUMMARY
1 DA2
GP Federation HR Support
Pilot site identified for merger (three GP practices in Hammersmith and Fulham) Supplier appointed. Design work for transfer process started.
Map merger requirements with management team and develop transfer documents, collect due diligence data for affected staff
2 DA2
Primary Care Resilience - GP retirement
Advisory Group established. GP support and career resources mapped.
Set up, promote and recruit focus groups for GPs nearing retirement and use this intelligence to inform development of retention strategy 3
DA2
Practice Manager Development programme
Accredited programme for practice managers to apply business skills to support practices to run more efficiently, thus increasing capacity and integrated effective working in primary care. London South Bank University(LSBU) procured, design underway
Design and planning of the course programme. Recruitment of 25 practice managers. Launch in April. Semester one commences April, semester two starts in September. 4
General Practice Development - Time for Care
Implementing 10 High Impact Actions to support Time for Care locally. Engagement with NHSE Sustainable Improvement Team to co-ordinate activity across NWL.
Continue engagement with Primary Care leads; Hillingdon, Ealing, Brent, West London.
5 DA 1,2 & 3
Activating the workforce to support patients to self care
160 professionals trained in health coaching skills to support patients to self-care. 14 local health coach trainers trained to ensure sustainability and larger impact of programme. The Performance Coach has been appointed to deliver a Health Coaching programme for Carers .
Delivery of programme for 25 community leaders. Health Coaching for 100+ Carers to be delivered from end February; (5 courses with 23 carers in each cohort). Continue to deliver 2 day health coaching courses.
6 DA3
Older Peoples Workforce
Proposal to create a baseline workforce data collection for rapid response and intermediate care
Complete data collection for rapid response and intermediate care and map current workforce support available across health and social care
7 DA4
Serious & Long Term Mental Health model of care
Mental Health Workforce Delivery Group established. Detailed workforce planning to support implementation of SLTMHN model of care is underway locally and will be supported by Workforce Team.
Agreed approach to be presented to Mental Health Transformation Board. Includes gap analysis, validation and amalgamation of workforce plans and business cases to give oversight and assurance to the Board.
8 DA5
NWL Staffing Project (aligned to Carter Report)
Captured staffing spend baseline and agency trajectory baseline, agreed immediate priority focus areas to reduce spend (through new agency framework) and promote rostering improvements. Business Case for technology support for rostering submitted. Conservatively 1-2% improvement in staffing costs could be achieved (Financial saving of £20-40 million)
Develop capacity and capability to use the technology and understand the benefits of effective rostering; embed this into organisational culture. Synchronise rosters for nursing, fix agency pay rates into system, benchmark bank pay rates, collect bank utilisation data
9 DA5
Radiology Project
Radiographer career framework published. Practice Educator role JDs drafted for the Faculty to support modality-specific training and development of radiographers (band 5+). Work with trust HR Directors to review and redesign radiography bandings underway
Accredited career day to be held with Society & College of Radiographers to support recruitment and retention: 28 Jan. Support business case and pilot of networking of reporting through technology, and potential roll out.
10 DA 3,4,5
Change Academy
Systems Leadership Development programme
GE Healthcare Finnamore and Cobic appointed to deliver programmes to build skills and behaviours to support transformation across the system: High Performing Care (~80 participants), Leading Transformation and Commissioning for Outcomes (2 cohorts, ~50 participants). Design meetings held with clinicians and lay partners. Engaging through DASSs (30th Jan).
LSBU appointed (Prof. Becky Malby). Intro meetings with Board chairs held. Work commenced with DA4 Programme Board
Local government engagement and design group to take place in next 2-3 weeks following DASS meeting. Open application process to launch from Feb to start programme mid March/early April.
Prof. Malby to attend board meetings to commence work with each Board. First meeting: Mental Health Transformation Board (27 January )
11 All
Social Care workforce
Engagement with social care providers to understand the workforce challenges and map out existing support requirement which will include renewed delivery plans around system review and more integrated delivery plans around shared outcomes .
Business case/ strategy to set out how we address the workforce challenges in social care within the context of delivering Integrated community based health and social care
12 under- pins all delivery areas
HEE NWL - supporting future workforce growth
“Fast Follower” pilot sites being secured for the new Associate Nursing role
30 nurses recruited onto Practice Nursing BSc
Economic analysis of retention work extended to incorporate medical and AHP professions
Capital Nurse rotation programme for newly qualified staff has been launched by HEE in NWL. 10 NWL Trusts are currently recruiting to 350 funded places.
First joint (HEE & NHSI) workforce data collection
Several local education providers are establishing new Physician’s Associate training programmes with placement funding from HEE.
Data to inform workforce data dashboards to support STP planning and analytics.
Delivery of the 18 month Capital Nurse programme to support staff development and retention
Data validation underway.
DELIVERY RISKS AND ISSUES FOR NEXT PERIOD #
Risk / Issue
Mitigation (latest progress)
Score
Issue 1
Change Academy launch delay to enable more engagement with local government colleagues
Working closely with local government colleagues to input into a design meeting. Engagement through Joint Health & Care Transformation Group, DASS meeting. Joint social care workforce role recruited to, to help build these relationships and map the challenges.
Amber
Risk 1
Risk that social care workforce challenges may not be fully understood and met
Joint social care workforce role recruited to (Julie Rice), to bring expertise , map the workforce challenges and ensure we meet need and keep up momentum.
Risk 2
Risk that there is low take up from CCGs in the national Time For Care offer
Concerted effort from S&T to engage with and encourage CCGs and CEPNs to see the value in the programme and take up the offer.

7. Primary Care
Based on modelling work we have done we know we will not see an increase in GP numbers over the next five years - largely because of the age of the current workforce and therefore the number of retirements which offset new recruitment of GPs who increasingly work part time
We also expect demand for GP services to increase based on an increasing and aging population as well as out of hospital strategies that will mean increased primary care focus for patients
The GPFV sets out a national approach to address these two issues and in NW London we are focussing on three areas, recruiting staff into primary care, retaining existing staff and supporting practices to increase GP clinical capacity through improved ways of working
Recruitment
Retention
GP Capacity
GPs
Fill for NW London GP training places was 99% in 2016, NW London participates in national and local recruitment campaigns
NW London will offer Step On Step Off training to make places attractive
To make sure there are enough GP educators a series of workshops have been set up to attract new GP educators working closely with the Medical School and Foundation School for a more co-ordinated approach to attracting new educators.
Opportunities for newly qualified GPs with a programme for Urgent and Emergency Care post-CCT fellowships which started in Jan 16 with 2 places and 4 more in September 16
Nurses
24 BSc Primary Care places, 3 per CCG funded for nurses new to primary care to increase numbers
District Nursing and General Practice Nursing Service Education and Career Framework has been developed and provides clear education and career pathways for District and General Practice Nursing which will also support the increase in recruitment and support the current and future workforce.
Continuing to increase nurse mentor numbers in primary care, currently 75 across NW London. This will allow increased numbers of pre-reg placements in primary care
GPs
4 workshop set up for GPs and GPNs nearing retirement for over 50 offering coaching to help them choose alternative career pathways rather than retirement option.
Running two focus groups in March with 55+ GPs to understand actual motivations for decisions around retirement, what factors would promote the intention to remain in the workforce and what support GPs need to remain in the workforce
Developing a retention strategy for GPs including a recognition scheme for retiring GPs and increased opportunities for support to explore other career options
Nurses
4 NMC revalidation sessions have been set up to support nurses through the processes which is known to be a reason nurses are likely to leave the workforce
Increasing opportunities for learning and education for nurse which is known to promote retention including protected time for training, reactivating nurse forums through CEPNs and primary care educator roles
NW London is working with NHS England’s team to deliver the Time for Care Programme and 10 High Impact Actions
Boosting GP capacity through increasing the numbers of nurses, pharmacists and HCAs in primary care.
8 existing GPNs, one per CCG, supported through the BSc Primary Care course to increase skills and capacity of nurses
24 practices across Ealing and H&F were part of the first wave pilot for clinical pharmacists in general practice pilot. The second wave pilot is now open for applications from practices
Major focus on training HCAs with the Care Certificate
HEE NWL are supplementing NHS England funding for receptionist and admin training to reduce the admin burden on GPs
Promoting the development of at-scale primary care through supporting the merger of 3 GP practices in H&F. This will allow the new organisation to focus on utilisation the 80 staff across the practices more effectively
Practice manager development course will increase capacity and capability to promote more effective ways of working in practices to deliver 10 High Impact Actions and improve practice staff recruitment and retention
Workforce modelling delivered working with HLP to identify priorities for development and support leading to the focus on retirement issues and increasing the wider team