A letter sent out earlier this week by Dido Harding, Workforce Implementation Plan Chair, and Julian Hartley, National Executive Lead, outlines plans to devolve more responsibility for NHS workforce policies from national bodies to local areas.

The overarching aim is to improve the quality of care for patients by transforming the workforce ensuring staff are recruited in the right numbers and remain engaged, motivated and supported by compassionate and inclusive leaders.

There are five main themes.

  1. Theme 1: We can make a significant difference to our ability to recruit and retain staff by making the NHS a better place to work.
  2. Theme 2: If our workforce plan is to succeed, we must start by making real changes to improve the leadership culture in the NHS.
  3. Theme 3: Although there are workforce shortages in a number of professions, disciplines and regions, the biggest single challenge we currently face nationally is in the nursing and midwifery profession.
  4. Theme 4: To deliver on the vision of 21st century care set out in the LTP will not simply require ‘more of the same’ but a different skill mix, new types of roles and different ways of working.
  5. Theme 5: We must look again at respective roles and responsibilities for workforce across the national bodies and their regional teams, ICSs, and local employers, to ensure we are doing the right things at the right level.

The PMA asked Nicci Hilson, Primary Care Development Specialist, whether these are the right areas of focus and whether they are achievable and sustainable.

‘I would think one of the biggest areas that needs to be looked at, particularly in relation to theme 5 are the models of employment. At the moment ICS or primary care networks are not legal entities able to employ their own staff, so another organisation has to provide the employment framework and hold the contract – and therefore the risk and cost of an employee going on long term sick leave or maternity leave. Embryonic organisations such as GP Federations do not have the cash on reserve to sustain this long term. So, there is a question of who, and how staff are paid for. There is a lot of talk about portfolio working and deploying skills across a greater segment of the population, but without working out the funding and contract behind it, it is difficult to get off the ground.

Many Federations and PCNs want to contract in the expertise of ‘consultants’ who will come in and do a piece of work, or get a project established, however, the IR35 tax rules place a liability on them as an ‘employer’ and they have to deduct tax and NI, as well as make employer contributions, which again makes it more expensive and unsustainable for both the organisation, and the contractor, who may work with a number of organisations through their own company. Again, these small, and forming organisations often do not have the funding available to employ that many staff, or the right level of staff.

The reason we’re facing a crisis in nursing and midwifery can be largely directed towards the removal of the nursing bursary. A short-sighted approach which meant less people are able to afford to be able to train as a nurse. So then nursing apprenticeships were designed. Uptake is still low on the few courses that are available, because first you have to be in a job, in an organisation that has the infrastructure to support such programmes – in reality this means trusts only, again leaving general practice behind. To fill the gap, the powers that be decided Nursing Associates would be the answer. Except, NAs aren’t going to be able to do much more in primary care than highly trained HCAs. The pilot for NAs to undertake cervical screening is on hold. And again, the only way to get NA training is via an apprenticeship. Again, primary care is ill equipped to support that as a programme, and furthermore, universities are requiring entrants to the programme to already have attained level 2 Functional Skills, which precludes a large number of people undertaking this training. The money that is being ‘invested’ in NA and nursing apprenticeships, including ‘training grants’ to employers (in one region of London, employers were offered £16k per NA apprentice) would more than cover bringing back the nursing bursary.’

The hope is that there will be a rapid influx of input on all five themes outlined. Feedback is requested by 15th March. The Interim Plan will be published in early April outlining a details vision for transformation of the workforce over the next ten years. We look forward to it with interest.

If you would like more information, please contact the PMA Team at enquiries@practicemanagersuk.org