1. www.hee.nhs.uk yh.hee.nhs.uk UPDATE ON PROCESS Initial submission 1.9.13 Financial Model issued Second submission 4.10.13 CONTENTS 1.Strategic direction 2.Recent findings 3.Training changes in 2014/15 4.Financial impact 5.Key risks Development of the Investment Plan October 2013 Update

2. www.hee.nhs.uk yh.hee.nhs.uk Staff able to function in primary and community care settings New roles recognised alongside more familiar roles More integrated and team training with patient experience focus Full usage of flexible training routes so can be more responsive Build confidence and competence to work within high tech service delivery alongside patients as experts in their own care Strategic Direction: Transformation Themes that cut across Spending Programmes

3. www.hee.nhs.uk yh.hee.nhs.uk Investment Plan: Our Strategic Direction Investment CategoryStrategic Direction 1Future Workforce a)FW Non-Medical Increase current output of qualified nurses and others to maintain numbers due to retirements or training for other roles, e.g. Health Visitors, Sonographers, Advanced Practitioners to address gaps in medical staffing capacity in hospitals and community, provide a higher quality of service to patients and maximise staff potential b) FW Undergraduate Placements – Medical, Dental and Non-Medical Continue to provide sufficient high quality clinical placements for current and future student numbers; increased confidence in primary and community care settings; continue transition to a standard national placement tariff c) FW Postgraduate Medical and Dental Increase the number of GP trainees and trainees in other shortage areas; reduce in areas where there is evidence of oversupply due to widespread CCT expansion; begin implementation of a standard postgraduate tariff 2Workforce Development Increase the quality and capability of support staff in order to ensure minimum standards met and to take on assistant roles. Support team development; good management and leadership; specialist post registration training, e.g. dementia and other mental health issues, older people, use of technology 3Education SupportMaintain capacity to effectively support and quality assure training 4Running costsReduced spend Cross cuttingEnsure focus on values and behaviours, skills development and primary care. Quality of training. Deliver regional leadership development strategy.

4. www.hee.nhs.uk yh.hee.nhs.uk Confirmed overall strategic direction Medical workforce gaps now at consultant level in Psychiatry, A&E, GP, Anaesthetics & Medicine gaps now at specialty training level ( Acute & Emergency Medicine and medical) high locum spend extended training lengths (Paediatrics, Obstetrics and Gynaecology) Non-medical workforce seeking to increase advanced Nurse Practitioners but numbers not firm gaps now in some areas in midwives, health visitors and nurses skills gaps exist within specific services particular challenges in providing physical and mental health care simultaneously and patients that are older, more frail and more dependant pharmacists and healthcare scientists areas of risk not always fully recognised Support staff – plans indicate intention to reduce number of clinical support staff despite narrative and dialogue to the contrary Advanced Practice and Post Registration specialist training - priority in Acute Medicine, Emergency Medicine, Paediatrics, Surgery and Anaesthesia * a more detailed feedback report is available from Jonathon Brown Our Most Recent Findings: What Trusts have been telling us (in relation to our Investment Plan)

5. www.hee.nhs.uk yh.hee.nhs.uk Investment Plan: Training Changes in 2014/15 - Work in Progress What we are investing more inWhat we are investing less in 1Future Workforce a)FW Non-Medical Nursing (+182 or 9%) plus small increases in ODP, Paramedics, IAPT practitioners + Clinical Psychology, Radiography, Scientists. Large increase in advanced practitioners (circa +150) Health Visitors (-98, because the national target is on track) b) FW Undergraduate Placements – Medical, Dental and Non-Medical More placements in primary care and other community settings Approx 50 fewer medical student placements as prior year over recruitment peak works through c) FW Postgraduate Medical and Dental 52 additional GP trainees, ACCS Emergency Medicine, Intensive Care Medicine, Radiology Circa 70 fewer hospital posts across core and higher anaesthetics, surgery and higher medical specialties 2Workforce DevelopmentIncreased leadership investment Some reduction maybe required – work in progress 3Education SupportMaintain current levels 4Running costsWork to 15/16 lower target 5National activitiesImplications of changes in training GPs, pharmacists and HCS

6. www.hee.nhs.uk yh.hee.nhs.uk Range of course lengths and entry points into nursing to increase flexibility with aim to get all nurses more adaptable and flexible so first post can be anywhere Consideration of demand for return to practice + secondments to training New models of induction into first roles in primary and community care Run through training from radiography qualification into sonography Change to degree level ODP training (with paramedics to come) Better idea of what schools require from health input to link with increased IAPT activity (rather than just school nursing) More detailed work with primary care on competences for practice nurses and support staff and associated training available to fulfil these requirements Groups looking at range of HCS and pharmacy developments required / possible Specifics

7. www.hee.nhs.uk yh.hee.nhs.uk Financial Costs: tuition fees (BMP) and pay and prices Total Funding: 14/15 Allocation: for HEE How the cake is cut - impact of activity-based Financial Model on ability to fund ‘new roles’ and reallocate resources Postgraduate tariff Impact of national formula for education support Impact of tariff transition on HEYH Leadership Ability to implement the plans (recruitment, take up of new roles, etc.) Medium term cumulative impact of GP expansion and national training model changes Tuition fee support to medical students, including the intercalated year Service and outcomes Posts reductions, transformation challenges Service delivery does not change and new posts not created to take up advanced and associate practitioners and other new roles Investment Plan Key Risks – as at October 2013