The Forward View recognises that new care models will not deliver the necessary improvements without a workforce with the right skills, values and behaviours in place.

One challenge for organisations is to make sure that the existing workforce meets these criteria. There is a necessary focus upon improving staff health and wellbeing and reducing obstacles to better performance (for example discrimination and reluctance to raise concerns) as well as taking steps to improve training and fill skills gaps. With the emphasis on flexibility comes the suggestion that organisations need to look again at terms and conditions (including pay and working patterns) to ensure that they support high performance and service redesign.

Another challenge is to consider whether organisations need a different skill mix to deliver new care models. So, for example, ideas suggested by the Forward View include:

  • GPs employing or partnering with hospital consultants: GPs will need to consider whether to adopt standard terms and conditions when employing consultants. If GPs want to allow consultants to become co-owners of their businesses they will need to ensure that they still meet the relevant ownership criteria for holding a GMS or PMS contract
  • Trusts credentialling GPs to admit patients to hospitals: To permit this Trusts will need to explore the changes to hospital admissions procedures including in relation to training, systems and processes and privileges that may be required.

New care models may also mean changes in the organisations delivering services. This may give rise to transfers of staff between organisations under TUPE, changes to terms and conditions redeployment/redundancies in some cases. Early consideration of these issues will be vital to ensure staff are engaged and consulted with, employee liabilities are identified and consideration is given to dealing with them and TUPE and, where relevant, redundancy procedures are followed.
Staff transfers may also have pensions implications, though pensions law and guidance now make it much easier for NHS and local authority staff to retain access to their existing pension schemes when they transfer to new employers.

Workforce implications – key questions

  • Have you taken full advantage of existing workforce flexibilities before considering changing terms and conditions?
  • What new workforce flexibilities will the new models require?
  • How will you manage the transfer of staff if that is required by the new model?
  • How will you work with others to fill identified skills gaps?
  • What are the potential employment litigation risks associated with your chosen new model?

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