Call for updated approach to recruitment, retention and technological integration to address workforce crisis
A national workforce plan, combined with community-level innovation, is needed to tackle NHS staff shortages – according to healthcare experts who are warning against viewing digital solutions as a ‘panacea’.
In the latest Connect Health Change webinar, entitled ‘Workforce capacity – solving the supply and demand puzzle’, Ashley James, Director of Practice and Development of the Chartered Society of Physiotherapy (CSP) spoke of the “huge priority of growing and broadening the workforce to meet both population and NHS policy requirements, in a sustainable way”.
Highlighting “an attrition rate of 50% within the first five years*”, Ashley said:
The NHS long term plan wants additional roles in primary care, anticipating the needs of people with long term conditions, providing an urgent community response to prevent unnecessary admissions, getting people out of hospital quicker, not to mention ambitions to vastly improve access to pulmonary, cardio, stroke and pelvic health rehab.
Yet even before the pandemic, staffing levels were not sufficient. Now these needs are vastly increased. We have a large population with long term conditions and frailty whose health has deteriorated in the last few years.
Workforce plans need to result in the expansion of rehab staffing numbers. We must offer opportunities for staff to develop and grow as clinicians, clinical researchers, and workplace educators.
David Furness, Director of Policy and Delivery, Independent Healthcare Providers Network, addressed the workforce capacity issue from a national perspective, presenting current staffing figures.
We’ve already got about 103,000 full-time [roles to fill] across the NHS, including general practice – about seven percent of the total workforce. If we expect the demand to increase as it has, matched with the pipeline of new clinicians and non-clinical staff, as well as what we know about people moving out of the workforce [and] all of the other factors that contribute, [then] the gap is expected to get to nine percent in a couple of years’ time.
You’ve got this absolutely horrifying projection that if trends continue as they are, then virtually one in two GP posts will be vacant by the end of the decade. That would clearly render the current model of service delivery unsustainable.
You go to any NHS discussion at the moment and what you hear is ‘we need from government a fully funded workforce plan’. And they go on to tell you about all the things that aren’t possible in the absence of that plan.
We may get [a plan] from the government. But what this tells us is that regardless of how good that plan is, there are a lot of things that are going to have to happen differently over the next five to ten years.
We need to look at the skills mix and bring in people who are easier to train. We need to look at the pattern of immigration [and] the education piece in terms of the number of people who are training domestically as well. And we need to look at technology – although that’s sometimes viewed as a bit of a panacea, as if the answer is to put lots of different tech in the hands of clinical staff in a way that might actually make their jobs more difficult to do, not easier.
We have a rapidly changing NHS structure at a point where workforce is probably the single biggest challenge facing the system.
Michelle Wayt, Assistant Director of Development and Employment for NHS Employers, discussed best practice in recruitment and retention, drawing on lessons learnt from nursing and midwifery.
She said:
The pandemic has had a positive effect on the numbers of individuals going into training, but we have since seen this decline. And unemployed workers now have more job vacancies that match their skills than they would have done before the pandemic.
Not everyone knows about NHS jobs, so it’s crucial to think about how you attract people from different communities and age groups with tailored ads.
Michelle said, following a job offer,
it’s important to keep the successful candidate engaged. Share information about the team, a clear induction timetable [and] development opportunities to ensure they know you’re still really keen on them. Buddy programmes, supervision and one-to-ones can also be key to giving candidates the best possible start.
Michelle flagged the use of Nomis, an ONS service that publishes statistics on the labour market at national, regional and local levels, and enables organisations to
look at areas where there is unemployment or inactivity, and focus their efforts on that area, [targeting] vacancies towards those people in the community.
Ben Wanless, Consultant MSK Physiotherapist at St George’s University Hospitals NHS Trust, addressed how digital tools can help in overcoming workforce issues.
Highlighting that 88% of the population have smartphones, he said:
Many people suggest we can deliver standardised care via a phone, which we haven’t been able to do in the past. And of course, there’s the assumption that by providing something digitally and taking out some of the human [element], we will save money.
Digital interventions have several other advantages, because they can incorporate features that improve adherence to medication and exercise, plus, coaching, education and self-monitoring, but also give us the ability to remotely manage our patients.
However, flagging a need for further research, he said:
Digital solutions do offer potential benefits, but unfortunately there’s a distinct lack of evidence that they provide an efficacious intervention that is cost effective.
Dr Chris Tomlinson, Senior Sports Physician, English Institute of Sport for Lilleshall and Chief Medical Officer of British Gymnastics, outlined the importance of redefining and diversifying the MSK workforce, and of ‘getting the basics right’.
He said:
[It’s] really important that we do our jobs as well as possible. We need to align professionals [developing] clear pathways and processes for clinicians so we know we’re getting good baseline treatment. And we need to support workforce retention by allowing promotion, job satisfaction and ownership of the system.
We need to invest in multidisciplinary leadership. We need to partner, to collaborate. We need a voice shouting for the multidisciplinary team – to government and for government.
Andrew Cuff, Consultant Physiotherapist and Head of MSK for Connect Health spoke of ‘the productivity curve’ and the role of innovation to help us achieve more, with the same or less resources, highlighting the implementation of group consultations for MSK patients as an example.
He said:
What we’re seeing across healthcare is essentially this mismatch of demand and capacity. From a community perspective, if we look at the waiting list at the moment there’s about one million people waiting for community services, of which around 300,000 are presenting with MSK conditions.
We’re seeing that patients are becoming more complex in their presentations. We’re seeing that inequalities are widening. And at the same time, we have this workforce supply issue. Whilst that’s a challenge, the opposite of challenge is opportunity. That’s where things such as productivity, innovation and accountability really come in. Accountability and compassionate leadership are not mutually exclusive.
As new ways of working take time to embed, you won’t hit your straps straight away. It’s not uncommon when you’re introducing innovation that you’ll see productivity dip off for a period of time. Change and ideas often fail because of ineffective implementation, rather than necessarily being poor ideas.
Calling for an end to the ‘overtreatment’ of patients ‘with a good prognosis’ to enable those that need more intensive treatment to access it, he said:
Whatever we do in the short-term should align with where we want to be in the long-term. What are you doing now in your clinic or service that you weren’t doing five or ten years ago? And what have you stopped doing to make space for it? Whilst it’s challenging now, my takeaway is don’t be afraid to do things differently, but make sure you see it through to the end.
* based on all registered physios, source: HCPC
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