New care models: the workforce issues

Five Year Forward View sets out the challenge: “…We can design innovative new care models, but they simply won’t become a reality unless we have a workforce with the right numbers, skills, values and behaviours to deliver it”.

As 70% of recurring NHS provider costs relate to staffing, one of the primary drivers of future health care costs will be workforce. In previous national reorganisations and changes to service provision, workforce issues have tended to be addressed relatively late in the day. The scale of change anticipated by the new care models will mean, however, that this cannot happen this time. There is some recognition that, in the same way that models of care should be created to meet patient needs, the NHS workforce should be shaped around the new care models.

The new models of care emerging will both mean changes for the existing workforce and will introduce some new roles. Each care model will present different workforce issues but there are some key themes associated with most new models of care. In this article I give an overview of these key themes and the main challenges to provider organisations.

A high level of integration, which is required by each of the new care models, will require a flexible workforce. There will be a need for new roles and significant changes in the skill mix to ensure that the appropriate workforce fits around the service provided by the new care models.

Some of the key areas of challenge are as follows:

  • Seven-day services – this is anticipated by a number of the new models most obviously in Urgent and Emergency Care Networks but also in more community based models
  • Individual roles and responsibilities – there has been discussion about a number of completely new roles within the NHS (e.g. “hospitalists” who are doctors who focus upon admissions from the primary care sector, physician associated/ assistants and consultants working for multispecialty community providers)
  • Geographical mobility – with a focus upon being more community based and with the need to provide more multi-site services, there will be an increased requirement of geographical mobility from employees
  • Knowledge of other sectors – more integration will require NHS providers to work more closely with local authorities, charities and private providers and so having employees who understand other sectors will become more important
  • Managing different contracts and procedures – although NHS HR professionals will already be used to this, there will be an increase in the number of different contracts, policies and procedures being run alongside each other as integration increases. This will require a greater vigilance and the potential need for new HR systems.

At times within the NHS the phrase “workforce planning” has seemed almost oxymoronic. The disconnection between national workforce planning and local workforce planning has often been a barrier to making significant changes to roles and responsibilities. The need for better national and local workforce planning is particularly acute at a time when there is likely to be a significant undersupply of GPs, nurses and mental health practitioners.

There is work being done by Health Education England and others nationally to ensure that there is a
focus on longer term national planning but this does not remove the need for significant changes in workforce planning at a local level. Good information about the current workforce and what it does will be a useful starting point for local workforce planning.

The first step, both on a national and on a local level, is to ensure that the make up of the current workforce is understood but this in itself presents some difficulty. The King’s Fund report “Workforce Planning in the NHS” earlier this year found that there were significant data gaps in information on agency spend, vacancies, and bank spend. It is important for NHS providers to ensure that, as far as they
can, their existing workforce profile has been properly assessed before it can be re-shaped.

Changes to the way staff work will mean issues such as terms and conditions, pensions and transfer of
employment will need to be considered.

The legal challenges

The new care models are likely to involve some degree of structural change across organisations, which
means we are likely to see an increase in the numbers of TUPE transfers, secondments and changes to terms
and conditions.

  • TUPE – with closer integration and with organisations working closer together there is always the potential risk that a TUPE transfer could take place, as a matter of fact and law, without the organisations becoming aware of it. It will be important for the HR professionals working with the new care models to look out for this potential risk
  • Changing terms and conditions – There have been developments on the national stage in terms of new consultant and junior doctor contracts and we expect that this will continue with the potential for further changes to the Agenda for Change framework. In addition to these national developments, there will undoubtedly be a need to look at changing terms and conditions on a local level to introduce the required level of flexibility in the workforce. This could, in principle, lead some NHS employers to move away from AfC Secondments – working across different sectors is often best achieved by the use of secondment arrangements. There will be a need to ensure that the arrangements are robust and fit for purpose
  • Pensions – moving to new care models could have important implications for employees’ continued membership of the NHS pension scheme and access for new members. It is quite possible, given the nature of some of the new care models, that staff will lose their eligibility under the NHS scheme. It will be key, at the outset, to understand the pensions implications of a new care model
  • Professional regulation – it is important to be aware, at this early stage, that changes in roles and responsibilities are likely to lead to new issues of professional regulation. Some of the “hybrid” roles being considered at the moment could arguably be regulated by more than one of the existing professional regulators. Careful thought will need to go into how these new roles are to be regulated. There is also the related issue of how far existing indemnity arrangements will cover new roles and new arrangements.

In summary there are likely to be significant changes required to the NHS workforce profile under the new care models. It takes a long time to make significant changes to workforce and so it is important to start thinking about what changes will be required as soon as possible.

We are starting to advise clients on the issues presented by new care models so please contact us for more detailed information.

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Full articles:

Seven day working: but will it really ‘work’?; Client spotlight: Pennine Acute Hospitals NHS Trust; Integrated care models: the consequences for the provider trust estate; Healthcare startups.