11/04/2014 General Practice Primary Care Workforce Planning & - PDF document

11/04/2014 General Practice Primary Care Workforce Planning & Development Community Education Providers Network Abdol Tavabie Dean of Postgraduate General Practice Education April 8th 2014 Heath Service Needs strong General Practice General Practice Primary care is considered to be the bedrock of NHS care provision, offering entry into the system for all new needs and problems….(it) provides person focussed (not disease oriented) care over time, provides for all but very uncommon or unusual conditions, and coordinates or integrates care provided by others’ Starfield, 1998 2 The NHS General Practice • Demands on general practice have never been greater • Primary care sees more patients than ever with complex needs • Constant drive to meet higher standards of safe care and report back • Primary care's share of NHS funding has fallen. The budget for the NHS is unlikely to increase any time soon. • Changing workforce and challenges in recruitment and early retirement 3 1

11/04/2014 2012 Provider driven survey in KSS General Practice • 640 practices, of which approximately 100 are single handed. • 3,350 GPs (approx. 3,000 WTE); 22% are over age of 55 • 1,800 practice nurses occupying 1,000 WTE ; 20% are over age of 55 • 1,000 ‘other direct care’ staff occupying 560 WTE. • 7,000 admin staff occupying 4,300 WTE. • Large vacancies of practice nursing and health care assistants • Shift of services and long-term conditions dealt with in primary care; A need for longer consultation time • Workforce work patterns is changing to be more Less Than Full Time 4 Primary Care: Mission Critical to the NHS General Practice There are 4.3 million people in Kent, Surrey and Sussex. On a typical day such as today: • 80,000 people will visit their GP or primary care nurse • 3500 people are referred by GPs to specialists • 5,000 people will attend Accident and Emergency departments • 800 people will be admitted acutely to hospital Variation in Primary Care provision has a disproportionate effect on secondary care General Practice 2

11/04/2014 HEE Future Workforce Trends 7 KSS Future Workforce Trends 8 Health & Social Care Information Centre Census 2013 National Picture • 2014- 51% of Drs in England are female. • By 2021 - 16,000 GPs short - RCGP annual census figures show greater number of female GPs than male counterparts for the first time. • UK trained Drs, Nurses and AHPs choosing to move abroad. • Medical Procedures and Information Technology changing type of work. • National Quality Board - Safe Staffing Levels • 24/7 Service– skills mix, new ways of working • Better Care Fund • Integrating Health and Social Care – One Team 9 3

11/04/2014 Our starting point is that GPs make up around 20% of the Primary and Community Services Workforce Primary and Community Care Registered professionals GPs 6884 Practice nurses Qualified Nurses, Consultants and GPs in Health and Care 31578 Community nurses Workforce 50000 2012 2005 District nurses 14695 FTE % FTE % Hospital Based 275590 62.8% 267007 62.1% Community MH 31269 and LD nurses 18035 Primary & Community Based 163280 37.2% 162883 37.9% Nurses in social All Medical & Nursing 438870 429890 6381 care settings AHPs The pharmacy workforce has not yet been quantified 75.8% of the community and primary care professional workforce are nurses. • • GPs represent 19.9% of this workforce and AHPs 4.3%. • These figures do not include the pharmacy workforce as there is currently no reliable measure • The setting of care in which Consultants, GPs, and qualified nurses practice has remained broadly static over the past seven years. Currently this is 62.8% in Hospital and 37.2% in community & primary. www.hee.nhs.uk www.hee.nhs.uk • Rapid growth in the community nursing workforce has been offset by the growth in the hospital consultant workforce. Coulter (2013) in Ziebland et al Understanding & using health experiences OUP Medical Listening advances to patient experience Medical advances Complexity & fragmentation Seventh National GP Work life Survey 2012 General Practice Job satisfaction The level of overall job satisfaction reported by GPs in 2012 was lower than in all surveys undertaken since 2001. On a seven-point scale, average satisfaction had declined from 4.9 points in 2010 to 4.5 points in 2012 in both the cross-sectional and longitudinal samples. This change is robust to the changing age-sex composition of GPs, which has remained relatively stable in recent years. The largest decreases in job satisfaction between 2010 and 2012 were in the domains relating to ‘hours of work’ and ‘remuneration’. The changes were much smaller in the other specific domains of job satisfaction. Intentions to quit The proportion of GPs expecting to quit direct patient care in the next five years had increased from 6.4 % in 2010 to 8.9% in 2012 amongst GPs under 50 years-old and from 41.7% in 2010 to 54.1% in 2012 amongst GPs aged 50 years and over . Conclusion The 2012 survey reveals the lowest levels of job satisfaction amongst GPs since before the introduction of the new contract, the highest levels of stress since the start of the survey series, and a substantial increase over the last two years in the proportion of GPs intending to quit direct patient care within the next five years 12 4

11/04/2014 Over the last decade, the number of GPs has risen by 18% and the number of nurses in community settings by 32% Rate of Growth in the Community & Primary Care Workforce 2002 -2012 90.0% 70.0% 50.0% Other Community Nurses Community Mental Health 30.0% Practice Nurses GPs 10.0% District Nurses -10.0% -30.0% -50.0% 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 • The total number of qualified nurses in community settings has increased at a faster rate than all other professions except hospital consultants and hospital pharmacists. • The picture for the different components of this nursing workforce is mixed, ranging from a 39% decrease in District Nurses to a 71% increase in other Registered Community Nurses. www.hee.nhs.uk www.hee.nhs.uk • The main driver of these changes are the decisions of local commissioners and providers in terms of how they have chosen to staff community teams and services. RCN “Frontline First More than just a number March 2014 special report” published 11/3/14 14 HE KSS Create the capability to lead patient experience and outcome focused education and development Move from historic strategies To integrated education strategies focused on based on each professional group patient care groups, that are evidence based and evaluated in isolation Patient care groups Healthcare Pharmacy Scientists Integrated Education Nursing Medicine Strategies Bands Service GPs 1 - 4 Redesign Evidence Evaluated based Dentistry AHPs 5

11/04/2014 Key Messages • Workforce must be aligned to service – not vice versa. • Care closer to home through care pathways. • Effective teams are more important than individual excellence. • Funding should align with training need – not based on history. • Most of the future workforce is already working in the NHS – CPD Spend should reflect this. 16 HE KSS • HEE - £5b annual budget, spending over £9,500 a minute on education and training. • HE KSS £280m annual budget, spending over £528 a minute on education and training. 17 HE KSS SDS Priorities 1. Dementia care Ensure staff have assessment and diagnostic skills so that people with dementia benefit from early diagnoses; Ensure those looking after people with dementia have support and training to provide excellent care; Develop supportive and effective on-going care planning and case management skills from diagnosis to end of life care. 2. Primary care Ensure the primary care workforce is able to meet the challenges of the future by developing a primary care workforce strategy 18 6