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Health Education Kent, Surrey and Sussex
Skills Development Strategy
Primary and Community Care Workforce Development Programme
1. Introduction and purpose 2. Key objectives of this programme 3. Education, training and workforce needs 4. Workforce profile 5. Education and Training needs identified to date in Kent Surrey and Sussex 6. Primary and Community Care Workforce Development Programme Developing people
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1. Introduction and purpose

The need to strengthen engagement with Primary Care to ensure a robust workforce development strategy for their services, is a priority of Health Education Kent, Surrey and Sussex (HE KSS). This is to ensure security of supply of competent and capable staff who are able to manage patients with increasingly complex and multiple conditions closer to home. This is also a national priority with the need to ensure that people with long term conditions are better looked after outside the hospital system, thus reducing their need for emergency services. To give focus to this area there have been discussions led by the Primary Care representative on HE KSS Governing Body, which have included both Local Medical Committees for primary care, GPs, the GP Dean and senior members of HE KSS. This programme of work has been identified by providers as a priority for HE KSS, and fits within the Skills Development Strategy. In March 2013, in partnership with the Local Medical Committees, a baseline survey was undertaken to determine the size and shape of the workforce, and current and future training needs. The outcomes of that survey which were reported to HE KSS Governing Body in March 2013 have informed the work stream objectives and key deliverables. The key challenges identified through the survey are;  The need for robust workforce information on staff working within primary care  To respond to identified future workforce supply issues , in particular Practice Nurses and GPs,  To enable staff to meet the needs of patients with complex health and social care needs, especially those with long term conditions through education and training,  To increase clinical placement capacity for learners in primary and community care  To realise the potential of staff in Bands 1-4  To underpin the above through the development of a sustainable high quality education and training infrastructure in primary The programme aims have also been informed by stakeholder feedback obtained during the consultation process on the Skills Development Strategy which took place in autumn 2012. 2. Key Objectives of this Programme

 To strengthen engagement with Primary Care providers.  To produce a 5 year workforce and education development plan which will describe the competencies and resources required to deliver high quality patient services, with an enhanced patient experience and outcome of care.  To develop workforce planning skills in primary care.  To make recommendations to the Governing Body and Partnership Councils about on-going engagement with KSS LETB and 3. Education, training and workforce needs

A recent large study of 1100 GPs nationally (Br J Gen Pract 2013;) has acknowledged the broadening job role of GPs and identified the need to develop new competencies for GPs to recognise how their work impacts on local communities and wider health systems. These new skills include community involvement, leadership, resource management, commissioning and effective team working. 11 independent competency domains have subsequently been identified as required for effective practice; 1. Empathy and perspective training 2. Communication skills 3. Clinical knowledge and expertise 4. Conceptual thinking and problem solving 5. Organisation and management of resources 6. Professional integrity 7. Coping with pressure 8. Effective team working 9. Respect for Diversity and the Law 10. Learning and Development of self and others 11. Leading for Continuing improvement GP training in the future will be extended to four years to enhance preparation for working in new ways with a special emphasis on child health and mental health. This extended training will have implications for education and training delivered in primary and community placements. The Nursing and Midwifery Council has also recognised through their Education Standards the need to ensure that pre- registration nurse programmes prepare newly registered nurses for careers in primary and community care. There is a need to develop clinical placement capacity in primary and community care to support the new curricula. To support the transition from student to registered practitioner, The Chief Nursing Officer developed a Preceptorship framework (DH, 2009) for student nurses which was later extended to include Midwives and Allied Health Professions. The purpose of Preceptorship is to enhance the confidence and competence of new registrants as autonomous practitioners through a programme of individualised support. This model has the potential to be used more widely in primary and community care to enable more junior staff to work in these settings. There is also scope to develop new roles in primary and community care. Some community health trusts and GP practices have introduced the Assistant Practitioner role and there is potential to extend this into primary care. This is different to the Physicians Assistant role. Assistant Practitioners have normally have had 1 years experience as a healthcare assistant and then undertaken a 2 year Foundation degree. This preparation then enables them to work under the broad supervision of a registered professional, usually in a Band 4 level post. Specific skills can be factored into training according to local need, and these could include both health and social care competencies. One of the benefits of the Assistant Practitioner role is the opportunity to develop new ways of working allied to patient care pathways rather than traditional professional boundaries. It is anticipated that the number of people with learning disabilities in Kent Surrey and Sussex will increase, yet there is little information available about the current and future needs of the workforce required as the majority of healthcare staff are employed in social care services. A programme of work is planned to develop a better understanding of this workforce and also to ensure that people with learning disabilities receive excellent care in all healthcare settings. 4. Workforce Profile
Primary Care compromises of independent and separate organisations. For the purposes of this paper the focus is on the workforce employed in GP practices. Kent, Surrey and Sussex have approximately 640 practices within its region. HE KSS does not have robust workforce information on staff working within primary care. All the service commissioning plans clearly state the need to treat patients outside of secondary care and to develop primary and community services, but these plans are not detailed at this stage. Together with the October 2012 census information, the following is a summary of the baseline: The most up to national source of data on the GP workforce is provided via the Information Centre for NHS Health and Social Care (IC). The IC gathers primary data from a combination of;  extracts from payments systems  surveys of practices, in the past conducted via Primary Care Trusts The 2012 data indicates that in Kent, Surrey and Sussex there were: 640 practices, of which approximately 100 are single handed. 3,350 GPs (approx. 3,000) WTE), including 360 GP registrars. 1,800 practice nurses occupying 1,000 WTE 1,000 ‘other direct care’ staff occupying 560 WTE. Post graduate medical data at Feb 2013 indicates that of the 869 trainees on the GP pathway;  Approximately one third were under 30, one third aged 30 to 34 and the remaining third aged were aged over 35 or over.  More than one hundred GPs in training were aged over 40.  Two thirds were female 5. Education and Training needs identified to date in Kent Surrey and Sussex
104 GP practices responded to the baseline survey undertaken earlier this year and a range of needs were identified. The most frequently cited need was to train staff in the management of patients with chronic conditions, namely diabetes, cardiac, respiratory, musculo-skeletal conditions, and obesity. Some practices have identified the need to develop non-medical prescribing, and to increase skills in undertaking minor surgery. The second largest area was in promotion of health including family planning, cervical cytology, immunisation and vaccinations, infection prevention and control, smoking cessation and travel advice. Practices have also identified management skills including commissioning and contracting, practice management, health and safety employment law, and financial skills. Many have also identified information management needs including information governance, coding, data protection and basic competence in office packages. Other miscellaneous areas include safeguarding of vulnerable adults and children, basic life support, triage skills ear care and ear syringing, wound care, and working with difficult patients. 5.2 Strategic Primary Care Workforce Project – NHS Kent and Medway Jan 2013 This project was undertaken by NHS Kent and Medway in Jan 2013 using analysis of CCG commissioning intentions against the NHS Kent and Medway Integrated Strategic Operating Plan. It identified the following learning needs;  Management of minor illnesses by practice nurses  Management of minor accidents by practice nurses  Management of long term conditions including dementia  Effective triage to reduce A and E attendance Further work is being undertaken by CCGs to look at the needs for bariatric surgery, and for learning disability care in the community  GPs with Special Interests in ENT, Audiology, Ophthalmology and Cancer.  GPs with paediatric background  Capacity for GPs to take n diagnosis of dementia and prescribing of Aricept  Developing capacity to provide Annual Health Checks  Staff with diagnostic GI endoscopy skills  The need to revise skill mix to maximise Practice Nurses skills 6. Primary and Community Care Workforce Development Programme

Through the HE KSS Investment Plan, £1m has been identified to support this work programme for 2013/14 the following Health Education England funding streams; 6.1 Future Workforce 6.2 Workforce development 6.3 Educational support The Primary and Community Care Workforce Development Programme has been written using these three headings, identifying the aims, actins and outcome measures for Year 1 as follows; 6.1 Future workforce
Ensure a secure supply of primary and community care workforce staff with the skills and knowledge to meet the needs of
patients closer to home

Outcome measure
Identify need by Education provider/profession to Work with practices with limited / no mentor capacity to increase this through investing in education underway to increase mentor capacity. HEIs have identified leads to work with new placements. HEIs have allocation plans to optimise the use of new placements Pilot a route for registered nurses to change career to Communication strategy to Practice Nursing through the establishment of a Agree the core learning outcomes and assessment Work in partnership with education providers to provide education support through work based Identify GP practices which are able to provide a suitable learning environment and provide mentors. Raise awareness amongst potential applicants and work with NHS Careers to promote the role. Define the funding offer and supporting HR arrangements Review pre-registration curricula to ensure there are placement opportunities in GP practice Develop staff in Bands Scope the demand for the development of Assistant Practitioners to work in General Practice. Define the core competencies required for Assistant Practitioners to work in General Practice. Work in partnership with education providers to Work with social care to explore feasibility of health/social care Assistant Practitioner role Identify opportunities to establish apprenticeship roles in primary and community care settings Develop a strategy to identify and meet the future workforce needs to care for people with learning 6.2 Workforce development
Ensure the current primary and community care workforce has the skills and knowledge to meet the needs of patients
Outcome measure
Ensure Practice Nurses are educated to Develop minimum education provision and Practice nurses has identify gaps. scoping the need and cost for backfill . and community settings are educated to education provision for consistent high quality care and work to for purpose and identify stakeholders the new Code of Conduct Allocate resources required to support training and education Plans in progress to address any gaps in education provision Agreed method and metrics for tracking impact on patients the training needs identified, and can be training needs analysis community settings have access to preceptorship programmes to enable them to work with confidence Through providing financial and educational support 6.3 Educational support

Ensure that primary and community providers have the educational infrastructure to support learners

Outcome measure
Agree governance arrangements and expected primary outputs Agree evaluation process

Source: http://kss.hee.nhs.uk/files/2013/09/6-Enc-E-HE-KSS-Primary-and-Community-Care-Workforce-Development-Programme.pdf

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