NHS 24 Transitional Workforce Plan 2016/17
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Item 11.1
(2)
NHS 24
Transitional Workforce Plan
2016/17
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Contents
Introduction Page 4
NHS 24 Current Position Page 4
NHS 24 Strategic Vision Page 4
Workforce Planning Process Page 6
Section 1: Drivers for Change Page 7
1.1 Factors influencing the Workforce Page 7
1.1.1 Population Demographics Page 7
1.1.2 Age Demographics Page 8
1.1.3 Population Diversity Page 11
1.1.4 Remote and Rural Living Page 11
1.2 NHSScotland 2020 Workforce Vision Page 12
1.3 Pension Reform Page 13
1.4 Out of Hours Review Page 13
1.5 NHS 24 Service Changes Page 14
1.5.1 Clinical Model for NHS 24 Unscheduled
Care Service Page 14
1.5.2 Pharmacy Service Page 15
1.5.3 Physiotherapy Service Page 16
1.5.4 Scheduled Care Services Page 16
1.5.5 Health Information Services Page 17
1.5.6 Scottish Emergency Dental Services Page 18
1.5.7 Scottish Centre for Telehealth & Telecare Page 19
1.5.8 Breathing Space Service Page 19
1.5.9 NHS 24 Living Life Service Page 19
1.6 Development of new services/roles Page 20
1.6.1 Alzheimer Lead Nurse Page 20
1.6.2 Cardiac Nurse Specialist Page 21
1.6.3 Nurse Revalidation Facilitator Page 21
1.6.4 National Speak to Doctor Service Page 21
1.6.5 Advanced Nurse Practitioner Page 21
1.7 Financial Implications Page 22
Section 2: Defining the Required Workforce Page 23
2.1 Unscheduled Care Workforce Requirements Page 23
2.2 Frontline Preferred Position Page 25
2.3 Non Frontline Establishments Page 26
2.4 Data Quality Page 27
2.5 3 Year Projections Page 27
Section 3: NHS 24 Workforce Intelligence Page 29
3.1 Current Workforce Profile Page 29
3.2 Age Profile Page 31
3.3 Gender Profile Page 37
3.4 NHS 24 Workforce Turnover Page 38
3.5 Recruitment and Retention Challenges Page 39
3.6 Attendance Management Page 42
3.7 Supplementary Staffing Page 45
2
Section 4: Workforce Development Page 47
4.1 NHS 24 Workforce Development Page 47
4.2 NHSScotland Staff Survey Page 48
4.3 Everyone Matters: 2020 Workforce Vision Page 48
4.4 e:ESS Implementation Page 49
Section 5: Action Plan Page 50
5.1 2020 Workforce Vision Action Plan Page 50
5.2 Risks Page 50
5.2.1 Workforce Risks Page 50
5.2.2 Financial Risks Page 50
Section 6: Implementation and Monitoring Page 51
Appendix 1: Unscheduled Care Service Planning
Assumptions Page 52
Appendix 2: Career Framework Page 54
Appendix 3: NHS 24 Current Roles Mapped to Page 55
Career Framework
3
Introduction
NHS 24 is Scotland's national telehealth and telecare provider. NHS 24 uses its
national technology and telephony platform for the provision of a wide and
developing range of services for the people of Scotland. Recognising that the
public already interact with many services through multiple channels, such as the
telephone, web, social media, short messaging service (SMS) and digital TV, NHS
24 is delivering and developing national telehealthcare services. These channels
are designed to blend and support the hands-on delivery of NHSScotland’s
services.
Having staff appropriately skilled in the delivery of telehealthcare is the driver for
the workforce planning process within NHS 24.
NHS 24 Current Position
The technology platform on which the core unscheduled care service operates is
changing during 2016/17, which will bring significant benefits to service users and
facilitate the development of new services. The successful implementation of the
new Future Programme is likely to result in changes to future planning
assumptions beyond 2016/17. As yet, these cannot be fully quantified, careful
monitoring of the Workforce Plan will be required during 2016/17 and in
subsequent years as this work develops.
Due to the impact anticipated as a result of the above changes the NHS 24
Workforce Plan for 2016/17 will be transitional, largely based on a refresh of the
2015/16 Workforce Plan. It will provide an overview of NHS 24's workforce over
the next 12 months as we move towards 2020. The plan is based on known future
service demands, developments and skills required to deliver safe and effective
patient services for the people of Scotland
Our future workforce will have to be affordable, available and above all adaptable.
It is recognised that the biggest opportunity to reshape the workforce lies in
developing the skills of the current workforce. Our aim is to develop the right
clinical skills and roles to enhance the services we offer to ensure that we have the
right blend of clinical and support staff to deliver safe, effective and efficient
services.
NHS 24 Strategic Vision
Whilst the plan is intended to provide a basis for future plans, it aligns as far as
possible to the NHS 24 five year strategy aimed at continuously striving to improve
the quality of services whilst recognising the increasing demand and the significant
financial challenge facing all public services.
NHS 24 has set a corporate vision for 2020/21 to offer a citizen friendly,
"navigation free" access route into health and social care services.
4Figure 1: NHS 24 Corporate Vision 2020/21
1.Virtual Integrated Joint
Patients, Families and Patient Boards
and Carers Facing
7.Proactive 2.Multiple
and Channels
Preventative and
Services technologies
Territorial Health
Scottish Connecting people
and providing Boards
Ambulance healthcare advice,
Service information and
6.Delivering support wherever 3.Serving
Services and whenever it is everyone in
24/7, 365 "In needed. Scotland
and OOHs" equally
4.Supporting Independent and
Scottish 5.Outcome the whole
Focussed health and Voluntary Sectors
Government
care system
If NHS 24's infrastructure and capabilities were to be deployed in this way, it has
the potential to achieve greatly simplified access for service users at the same
time as reducing pressure on overstretched parts of the system.
The corporate vision recognises that NHS 24 could more effectively use the NHS
24 infrastructure, clinical and triage capability and estate both in and out of hours.
The main service provision is currently in the out of hours period, however there is
capability to move to become a 24/7 service which could more effectively support
the front end access to the rest of the NHS and where possible to social care.
This could be done with the support of improved pathways of care for unscheduled
care along with innovations in technology enabled care which could support a
fundamental shift in the way we use technology to support care and the
development of innovative roles.
A set of principles have been established, which will apply to everything we do in
realising the organisational vision. The key principles are that all NHS 24 services
will be:
Virtual and patient facing;
Delivered using multiple channels, technologies and platforms;
Serving, with equal dedication, everyone in Scotland;
Providing support to the whole health and care system;
Results focussed;
24/7 and 365 days a year;
Both preventative and proactive.
5Workforce Planning Process
The Workforce Planning process within NHS 24 aligns HR Workforce Planning,
Service Planning, and Financial Planning, thus ensuring that NHS 24 has the
capability, capacity and skills within the workforce to deliver a clinically safe,
effective and affordable service.
This plan has been written in line with the principles of Workforce Planning for
NHSScotland, as directed in CEL 32 (2011):
Overall, the workforce planning process aims to:
Design the future workforce by understanding influences and constraints
placed upon it and ensure integration with service and financial planning.
Develop the future workforce by including education commissioning, staff
development, recruitment and retention processes.
Deliver the future workforce by identifying management actions to ensure
plans are delivered, processes are effective, all staff groups are engaged
and best practice is shared.
NHS 24 has received information advising that there is a plan to review CEL 32
(2011) and the requirement to produce a Workforce Plan on an annual basis.
NHS 24 still await a revision of CEL 32 (2011) which is anticipated sometime
during 2016/17 which will incorporate a requirement for Health Boards to move to
a 3 year workforce plan with annual updates provided.
6Section 1 Drivers for Change
Although it is difficult to predict the range of factors that will influence the delivery
of NHS 24's services in the coming year, this section aims to assess the drivers for
change and the likely impact of known changes on the organisation and the
external environment and hence the workforce
1.1 Factors influencing the workforce
Demographic change is one of the most significant issues that will impact on NHS
24 and its workforce.
There is an urgent need to reshape the NHS workforce to equip it to meet the
changing demand from the population it serves. In addition, competitive labour
market forces will require NHS 24 to be innovative, flexible and agile in its
approach to workforce issues.
1.1.1 Population Demographics
Population indicators are key in determining NHS 24's service profile. By better
understanding the profile of the population that NHS 24's serves and the manner
by which they access services, we can more efficiently deliver effective patient
care.
International research demonstrates the need to develop population led, needs
based workforce planning, which uses an epidemiological and population
distribution evidence base.
Scotland faces a demographic challenge in future years with a projected increase
in the overall population. A large part of this rise is attributable to higher levels of
migration into Scotland and to people living longer.
Source: General Registrar for Scotland
7Figure 2, shows the estimated population change based upon 2014 confirmed
figures. The projected increase shows that by 2020 it is anticipated the population of
Scotland will reach 5,444,919 which is a 1.82% increase since 2014, with a further
4.8% projected increase by 2039 (5,701,476).
1.1.2 Age Demographics
The age composition of a population is one of the most important aspects of
population demographics as those of varying age will have different socio-
economic impacts for Scotland.
Life expectancy in Scotland has improved greatly over the last 30 years,
increasing from 69.1 years for males and 75.3 years for females born around 1981
to 77.1 years for males and 81.1 years for females born around 20131.
The increase in the population size of Scotland coupled with projected change in
age profile, shown in table 1 below, further illustrates the potential challenges on
health and social care services with those people aged between 60-74 increasing
by 16% by 2039. In addition those aged 75 and over will have almost doubled by
2039 (85% change from 2014).
Table 1: The projected percentage change in Scotland's population by age
group, 2014-2039
All ages 2014 2024 Change 2039 Change
0-15 911,282 931,131 2% 924,133 1%
16-29 976,037 888,795 -9% 901,530 -8%
30-44 1,019,302 1,085,001 6% 1,010,386 -1%
45-59 1,156,789 1,064,989 -8% 1,078,148 -7%
60-74 850,955 987,183 16% 984,027 16%
75+ 433,235 557,303 29% 803,252 85%
Total 5,347,600 5,514,402 3.12% 5,701,476 6.62%
Source: General Registrar for Scotland
Changes in projected population will impact on service demand and will inform
workforce capacity and capability for the future.
1
The Registrar General’s Annual Review of Demographic Trends 2014
8Source: General Registrar for Scotland
By 2039 31.3% of the Scottish population will be aged over 60 which will inevitably
increase the demand on services and the workforce. Increases in life expectancy
do not necessarily correspond to an increase in the number of healthy years of life.
It is predicted that in the coming years, those effected by long term conditions
such as dementia and diabetes will also increase.
As part of the Scottish Government's 2020 Vision, NHSScotland has been tasked
with supporting "everyone to live longer healthier lives at home or in a homely
setting." A key element of delivering this vision will be the successful integration of
local health and social care partners coupled with the transformation of the
services available for older people within the community. Telehealth and telecare
services will have an essential role to play in this arena.
The challenges presented by the 2020 Workforce Vision taking into account the
projected changes in Scotland's demographics and population include planning to
meet the needs of an ageing population with an ageing workforce, managing the
increased presentation of complex long term conditions and addressing the
considerable variations in life expectancy between different geographical and
socio economical groups.
9Figure 4, below further illustrates the increasing population trend for those aged 70
and over.
For NHS 24's Unscheduled Care Service in 2015, those aged over 65 accounted
for approximately 22.8% of calls to the service (figure 4). The predicted increases
in life expectancy are likely to have a continuing impact on the number and types
of calls received by the service.
The aging population also presents new dynamics within the workforce. By the
year 2020 for the first time in modern history there will be four generations in the
workplace; Baby Boomers, Generation X, Generation Y and the Millennial
Generation2. The multigenerational workforce will bring a new dimension to
workforce planning with opportunities to capitalise on the strengths of each
generation.
2
AARP 2007
101.1.3 Population Diversity
A significant proportion of Scotland's population increase can be attributed to net
in-migration. Since 2001 Scotland has experienced an increased net in-migration
as opposed to net out-migration. In 2014 the movement of people into Scotland
from the UK and oversees increased the population by 17,600. Most of those
moving to Scotland are aged between 16 and 34.
Current predictions indicate that net in-migration will continue to rise steadily.
The 2011 census highlighted approximately 4% of people in Scotland were from
minority ethnic groups. This is a 50% increase on the figures from the 2001
census. The Asian population is the largest group (3% of population), followed by
the Polish community (1.2% of population).
In Glasgow City 12% of the population were from a minority ethnic group, with 8%
of the population in both the City of Edinburgh and Aberdeen and 6% of Dundee
City from minority ethnic groups. These areas also saw the largest increase since
2001 in the proportion of their population who are from minority ethnic groups.
In order to make NHS 24’s services accessible to as many of the Scottish
population as possible, NHS 24's operates a Language line service, providing
translation and interpretation services in over 50 languages. For 2015/16 this
service received 234 calls, in 30 different languages. By far the most popular
language was Polish, receiving 44% of the services total calls.
1.1.4 Remote and Rural Living
The observed increase in Scottish population size is not consistent across
Scotland. Areas such as the City of Edinburgh and Kinross have seen upwards of
a 10% increase in population since 2001, compared to a national average of 3.8%.
Conversely areas such as the Western Isles and Argyll and Bute have seen a
decrease in population during this period. Rural areas have a lower percentage of
the population in the 16-34 age group, but a higher proportion of people aged 45
and over. In health terms, there are a lower proportion of adults with long term
limiting illness or disability living in rural areas than urban areas.
It was also noted in research conducted to examine how NHS 24 is being used
and the publics understanding of the service that those interviewed living in rural
areas reported the benefits of living in a community where you can get
appointments and home visits relatively quickly mitigated against the need for
them to use NHS 243.
Delivering NHS services consistently to the population of Scotland regardless of
geographic area is essential in achieving the Scottish Governments 2020 Vision.
NHS 24 seeks to support the expansion of the 24/7 access to services such as the
Telestroke Hub, currently live in Orkney, Ayrshire and Arran and Lanarkshire and
continue to develop new digital tools/technologies to expand the capability and
cover of such services.
3
Investigating the public's use of Scotland's primary care telephone advice service (NHS 24) a
population based cross-sectional study (2016). By Anne McAteer, Philip C Hannaford, David Heaney,
Lewis D Ritchie and Alison M Elliott
111.2 NHSScotland 2020 Workforce Vision
In developing the 2016/17 Workforce Plan, we have sought to align our
commitments with those set out in the 2020 Workforce Vision – 'Everyone Matters'
which will facilitate delivery of the NHS in Scotland vision that by 2020 everyone is
able to live longer, healthier lives at home or in a homely setting:
Everyone Matters: 2020 Workforce Vision
"We will respond to the needs of the people we care for, adapt to new, improved
ways of working, and work seamlessly with colleagues and partner organisations.
We will continue to modernise the way we work and embrace technology. We will
do this in a way that lives up to our core values."
"Together we will create a great place to work and deliver a high quality healthcare
service which is amongst the best in the world."
Scottish Government has identified a Route Map4 to achieving the 2020 Vision,
which has a triple aim at its core. NHS 24's LDP targets are structured around
these aims:
Quality of care
Health of the population
Value and financial sustainability
In addition to ensure NHS 24 develop a workforce capable of delivering the
highest levels of quality service and clinical care, in line with the NHS Quality
Strategy5 and the National Clinical Strategy for Scotland6.
We want the people of Scotland to live as healthily as possible at home, supported
by high quality telehealth and telecare services that are person centred and
integrated with face to face services. We want telehealth and telecare services to
be recognised as an essential component of Scotland's future health and social
care services.
We want to see the innovative use of digital channels and services deliver the
greatest possible benefit to patients, carers and citizens, across health and social
care services.
We want Scotland's reputation as a leading telehealth and telecare region in
Europe to continue to develop, supported by NHS 24. We want to be recognised
for excellence and innovation in the design, development and deployment of
telehealth and telecare services.
Work has commenced on developing a new National Telehealth and Telecare
Delivery Plan which further recognises that long term, sustainable progress to fully
4
Route Map to the 2020 Vision for Health and Social Care, May 2013
5
The Healthcare Quality Strategy for NHSScotland, May 2010
6
The National Clinical Strategy for Scotland February 2016
12embed telehealth and telecare within an integrated healthcare system in Scotland
is essential.
1.3 NHS Pension Reform
New pension arrangements were introduced for the National Health Service
Superannuation Scheme (Scotland) from April 2015.
These changes will result in existing and new members moving across to the
new 2015 Pension Scheme. The exception being active members, who on the
1st April 2012, were within 13 years 5 months of normal pension age. Those in
this group within 10 years of their normal retirement age will have full protection
and remain in the existing Scheme, with the remainder having tapered protection,
moving across to the 2015 Scheme at a later date, dependent on their normal
pension age.
The two main differences between the Schemes have significant implications for
the workforce:
A member's normal pension age will now be linked to their state pension age.
A member's pension will now be calculated using a Career Average revalued
Earnings (CARE) rather than length of service and final salary.
Over the past three years, probably as a direct result of the impending changes,
NHS 24 has seen a significant increase in the number of staff eligible to retire
who actually choose to do so. In 2015, 40 staff opted to retire at an average age
of 57 years and 6 months (previous years 2014 – 27 staff with an average of 58
years and 1 month, 2012 - 25 staff with an average of 57 years and 9 months).
Given that full protection is applicable until 31st March 2022 it is likely that this
trend of an average retiral age of 57 years will continue in the coming few years.
Following this, it is likely that the average retiral age will rise, probably by around
5 years, and we will have a greater number of staff working until, and over, age
65. This change in the demographic of the workforce will require changes to the
way staff are deployed, managed and supported.
1.4 Out of Hours Review
NHS 24 is embarking on a full review of the efficiency and effectiveness of the
core service. This includes working collaboratively to determine how NHS 24
integrates more effectively with the range of local Health Board out of hour's
services as part of the national out of hours review report. The NHS Board Chief
Executives national group is actively promoting this work, which will also include
closer working and planning of service delivery with the Scottish Ambulance
Service. Working closely to review care pathways to ensure better coordination
of care which will ultimately provide a better experience and outcomes for
patients and their carers
The review also recognised the importance of improved information technology
and eHealth systems taking into account the aspirations of the Scottish eHealth
Strategy 2014-17. NHS 24 will seek to support people to communicate with
NHSScotland, manage their own health and wellbeing, and to become more
active participants in the care and services they receive by supporting the
delivery of a number of Digital Programmes throughout 2016 and 2017 including:
13 Support the technical and digital development of the Home Health
Monitoring work stream within the Technology Enabled Care Programme;
Extended digital provision and availability of Health Information Services
within NHSScotland by continuing to develop the infrastructure and
systems used by NHS inform as the primary quality assured web-based
health information communication channel to the Scottish Public.
Refresh the NHS24.scot and current Digital Self Help Guide to deliver
increasingly flexible digital experiences for citizens using the online service
for clinical advice using internal NHS 24 digital expertise and capability
wherever possible.
1.5 NHS 24 Service Changes
1.5.1 Clinical Model for NHS 24 Unscheduled Care Service
Capacity to fully develop the workforce and clinical model for an extended period
has been restricted whilst work has been ongoing to implement the Future
Programme.
The continued development of a multi-disciplinary team approach will enrich the
traditional nurse model, leading to a blend of clinical and non clinical staff to
deliver quality driven healthcare.
In building the Clinical model, the following challenges have to be taken into
account:
Predicting call volumes and patient demand to service in the short,
medium and long-term, particularly in relation to impact of 111;
Building rotas which best meet the needs of the service and staff;
Resourcing peak periods of activity such as Public holidays, Protected
Learning Times (for GP’s), and peak periods such as Festive and Easter;
General challenges in the wider National Unscheduled care system.
14Overarching principles
Continued delivery of safe, effective and person centred care to ensure
timely management and onward referral to the population of Scotland,
avoiding unnecessary waits
Clinical resource and expertise available and accessible to the public.
Clinical resource will be maximised to perform clinical roles
NHS 24 is only part of the unscheduled care system provision in
Scotland. Any model of service delivery needs to ensure cognisance of
and coherence with the National landscape, and should minimise any
detrimental impact on partners, by ensuring consistency in care, and
minimisation of variation where applicable and appropriate.
A focus on developing Centres of Excellence to lead the provision of
defined models of service delivery (e.g. Rapid Triage), to ensure
expertise in place, and avoiding additional variance in performance
leading to detrimental variation in practice
Make best use of financial resource to enable safe and effective patient
care.
Proposed model
1. Maximise multi-disciplinary clinical skills and expertise to ensure the
right professional deals with the right call presentation to provide best
value for patient care.
2. Commence planning to incrementally develop from a telephone triage
model, to expansion to a multi channel model over the next 5 years.
3. Support, where possible, the National USC model, offering solutions to
Boards to convert unplanned care into planned care where appropriate.
4. Continue to develop career pathways for staff, enabling and supporting
progression opportunities to both clinical and non-clinical roles.
1.5.2 Pharmacy Service
Currently, NHS 24 Pharmacy Advisors provide frontline support and advice mainly
through the Pharmacy Support Line, and to a lesser degree through Call Back and
Rapid Triage activity. Medical teleprescribing has already been enabled within
NHS 24 and has been used on occasion by sessional GPs working in our East
Contact Centre to support our frontline service. Going forward, the same model
will be used by non-medical independent prescribers within the organisation, such
as those NHS 24 Pharmacy Advisors who are qualified prescribers. They will be
enabled to prescribe for select groups of patients or cases that can safely be
treated on the basis of a telephone-based symptomatic assessment, and effective
collaboration with partners will inform the list of suitable conditions that can safely
be treated.
The developing role of pharmacists within Primary Care Out of Hours services was
recognised as part of the National Out of Hours review. It was recommended that
with appropriate education and training support additional clinical skills and
prescribing capability should be further encouraged and utilised. This would
improve the patient journey and would enable NHS 24 to manage more calls that
require a prescription, removing the requirement for onward referral to partner. A
model for this is required to be development and a pilot to be undertaken in order
to determine any impact on the workforce.
15In the longer term, our pharmacist prescribers might work between NHS 24 and a
territorial Board out of hours service (on a sessional basis), helping maintain the
right level of knowledge, skills and experience for them to undertake
teleprescribing activity in defined clinical areas. The future introduction of
telehealthcare e.g. video consultation, would further expand the range of
conditions that could safely be prescribed for remotely. The development of the
Pharmacy Advisor role in these ways would not only help make the role more
varied, but it may have a positive impact on NHS 24 recruitment and retention as
well as providing an improved patient journey.
1.5.3 Physiotherapy Service
The NHS 24 physiotherapists continue to provide input to NHS 24 services.
Currently this role has focussed on musculoskeletal care within Unscheduled
Care, Scheduled Care Services and In House Physiotherapy Clinics.
The longer-term aim is to continue and develop the role of physiotherapists within
the multi disciplinary team where value can be identified and impact measured.
NHS 24 Physiotherapists role currently utilises face to face and telephone
interventions. Going forward it is anticipated that this role will expand with more
regular use of telehealth and eHealth in delivering care.
Exploratory work is being carried out to investigate what further roles NHS 24
physiotherapists can play. Examples of where physiotherapists could have an
impact are:
The National Falls agenda
Early intervention for post arthoplasty discharge
The model of MSK delivery could also be adapted to provide input from
other Allied Health Professions and other conditions such as pulmonary
rehabilitation
The provision of specialist physiotherapy input to clinical support will also
be scoped
Development and delivery of specialist training to other clinical colleagues.
To enhance recruitment and retention of physiotherapy staff we will continue to
refine the role.
1.5.4 Scheduled Care Services
Scheduled Care Services offer a portfolio of a broad range of safe and person
centred telehealthcare/digital services that have the potential to improve public
sector capacity, efficiencies and quality outcomes. A range of national Scheduled
Care services are currently operational within NHS 24 including Cancer Treatment
Helpline, Musculo-skeletal Services, Scottish National Blood Transfusion and Fit
for Work Scotland.
These services offer inbound and outbound functionality and are operated by a
Call Operator ( Band 2) skill set, supported by a clinical supervision model. It has
been recognised that significant efficiencies can be achieved by blending the
portfolio of Call Operator services. The Call Operator workforce requirement to
meet the 2016/17 activity forecast is 22 WTE. Due to the planned implementation
of the Future programme there will be a measured approach to new service
16development in 2016/17, therefore the workforce requirement will remain
consistent
1.5.5 Health Information Services
The strategic vision for Health Information Services (HiS) is to be a digital delivery
partner which supports the provision of increased channel choice through
organisational transformation and is recognised as a digital leader who can
support digital delivery externally to health & social care partnerships. NHS 24’s
Digital Services is also the delivery partner of choice for Scottish Government.
Through the continued delivery of high quality services and products, the Digital
Delivery team would support NHS 24 in it's delivery of 2020 strategy, support user
lead design, provide increased channel choice to users which could provide
efficiencies to the broader organisation through channel shift of Unscheduled Care
contacts to digital.
Identified, through the different areas of the HiS team are the key areas of focus
for the team over the lifetime of the workforce plan. This links and supports the
Health Information Services strategic vision.
Digital Delivery Team
Continued work with partners and seeking out funding channels to support
development of services and products e.g. Technology Enabled Care bids and
through potential income generation services e.g. smoking cessation service.
Promotion of scalable services and products, working closely with partners
including boards, local authorities, Healthcare Providers and third sector to work
collaboratively to develop and design services built on user need. Leading
awareness raising of services and potential joint working opportunities across all
sectors.
Service Delivery Team
Building on the embedding of the restructure, the continued progress in
development of the roles and team. With this increased volume, potential
increase in management support to support delivery of services and team, this
would also support potential individual development route and build skills within
the team. Continued recruitment to Health Information Operator and Health
Information Advisor roles, in line with current requirements. Looking to support
individual development between the roles through the promotion of SVQs aligned
to each skill set, along with up skilling through the delivery across new services
and channels.
Continued management and delivery of services via webchat, ensuring range of
channel choice for public and users of services. Up-skilling team to deliver
across increased range and complexity of channels for new services. Continued
development and streamlining of existing services, to support local boards at a
national level e.g. Smokeline follow-up activity, and provide efficiencies to
NHSScotland.
17Partnership & Engagement
Exploration of a hub approach to partnership & engagement, aligning all
Partnership and Engagement roles within the organisation, to make best use of
existing relationships and partnerships within and out with the organisation. This
would support a consistent approach within NHS 24 and ensure awareness of all
services/products which NHS 24 provides are clear to all partners. This would
highlight opportunities for future work and partnerships.
Embedding of the HiS user lead design approach to development of products
and services, facilitated by P&E team. Utilising existing and new partnerships to
identify user lead improvements to services and supporting their delivery.
Digital Content Team
With the development into the Digital Services team, an increased resource
requirement around the Content and development element of the Digital Services
team would be required to support the strategic aims. The potential to reshape
the team to be more focused on delivery of developments, whilst having a clear
governance model in place to support the quality of the content available would
be required to be taken forward. A revision of this structure could bring with it
clear development for individuals and retaining of key skills within the
organisation. There is also a potential income stream for the organisation
through picking up work centrally from Scottish Government and other boards,
where previously external agencies would have been recruited.
Promotion of digital development both internally within NHS 24 and externally
with partners would raise the profile of the activity of the team and support the
delivery across NHS 24 of services.
1.5.6 Scottish Emergency Dental Service
Scottish Emergency Dental Service (SEDS) which is incorporated within NHS
24 continues to work in partnership with NHS Boards to provide an out of hours
emergency dental service.
At present, the SEDS workforce consists of a Lead Nurse Dental, Senior Dental
Nurses and Dental Nurses who are supported by a Senior Hub Administrator
and Hub Administrators.
In June 2015 SEDS integrated with East Lothian, Edinburgh City and
Midlothian Community Health and Care Partnerships (CHCPs), making SEDS a
nationally available service for the people of Scotland.
The Lothian integration has subsequently resulted in an increase in call
volumes; however these calls can be accommodated within current workforce
establishments.
During 2016/17 SEDS is planning to undertake further work to allow Dental
Nurses to work in collaboration with Childsmile Nurses, this will offer a
comprehensive pathway to the Childsmile Programme.
18Throughout 2015/16, the Dental Booking Hub has been involved in delivering a
pilot service, where calls for Social Work and Environmental Health are
managed for Aberdeenshire Local Authority during the out of hours period, any
impact, of this pilot, on the workforce has yet to be determined.
1.5.7 Scottish Centre for Telehealth & Telecare
SCTT's role is to facilitate, expand and embed technology enabled care 'at
scale' to improve health and wellbeing for the people of Scotland. Its key
priorities are to;
Provide consultation and facilitation services in support of
technology enabled care;
Share information and good practice, outcomes and evaluation
(includes knowledge transfer and workforce development);
Support the development of new 'at scale' technology enabled
services and service redesign programmes;
European engagement in the field of technology enabled care.
The focus for SCTT in 2016/17 will be to maintain stability, while its Business
Plan is revised, this will determine key activities and deliverables for 2016/17.
Thereafter the staffing and resource model will be reviewed to ensure that the
agreed strategic priorities can be effectively addressed. This will include a staff
training and development plan.
1.5.8 Breathing Space Service
NHS 24 continues to provide a specialist Mental Health out-of-hours,
confidential and anonymous phoneline. The future direction of Mental Health
development within NHS 24 is outlined within the NHS 24 Mental Health
Strategic Framework. Breathing Space and NHS Living Life will play a part in
the future delivery of Mental Health initiatives and will be supportive of any new
developments in Tele(mental)health services over the coming years in NHS 24.
During 2016/17 it is planned that other channels of engagement such as email
and text phone services for Breathing Space will be fully developed and utilised
in 2016/17. In addition further development work in Prisons and 'hard to reach'
communities is to be explored.
At present, Breathing Space is supported by a combination of Specialist Phone
line Advisors, with Breathing Space Supervisors supporting four Teams of
Advisors throughout the business.
The projected 2016/17 workforce plan for the above services remains consistent
with previous years totalling of 20.27 WTE Specialist phoneline Advisors and
Supervisors.
1.5.9 NHS Living Life Service
NHS 24 (NHS Living Life) provides a Cognitive Behavioural Therapy and Guided
Self Help appointment based service for people in Scotland who present with low
mood and depression. This service provides Cognitive Behavioural Therapy
(CBT) and Guided Self Help (GSH) interventions to patients throughout Scotland.
19It currently has a workforce comprising of Support Officers, Guided Self Help
Coaches and Cognitive Behavioural Therapists.
Table 2: Weekly Living Life Service Hours
Therapist Hours 142.5 3.8WTE
Coach Hours 40.5 1.08WTE
SO Hours 67.5 1.8WTE
The service became a national resource in March 2012 and this has increased the
use of the service throughout all Health Boards. The service currently has a
waiting list of up to 7/8 weeks for a CBT appointment, however it is hoped that the
period of waiting can be reduced. Should the referrals to the service continue to
increase as the service becomes better known, then consideration has to be given
to increase the staffing capacity of the CBT provision. Currently it is too early to
evidence the exact numbers of additional staff necessary, but it is envisioned that
to further improve the attractiveness and efficiency of this service to the Health
Boards the patient waiting list should be no more than a maximum of 4 weeks.
Over the last year the service has been further promoted and developed its
service within the Scottish Prison Service and the service is currently live in 5
establishments. There is a plan to extend this reach to all 14 prisons throughout
the coming year.
The Operational Model within the NHS 24 Mental Health Service is currently being
reviewed.
1.6 Development of new services and roles
During 2016/17 NHS 24 will continue to work with NHS Boards to support the
implementation of a range of services.
As NHS 24 further evolves we will aim to take a blended approach to delivering
the service, with multi-skilled staff groups working across a range of services to
deliver maximum efficiency, with potentially new roles being developed. As
highlighted earlier, NHS 24 needs to adapt to the growing presentation of complex
long term conditions, which requires professionals with a broader range of skills to
support the service and develop staff skills and knowledge.
1.6.1 Alzheimer Lead Nurse
In line with the NHSScotland Dementia strategy and growing demand across the
Scottish population for services and support for patients and carers with
dementia, NHS 24 and the Golden Jubilee National Hospital have jointly
appointed an Alzheimer Lead Nurse funded by Alzheimer Scotland.
This post will provide professional clinical leadership, strategic direction and
expert consultancy on all aspects of clinical practice and care of people with
Dementia across the patient pathway in the Golden Jubilee Foundation and NHS
24.
201.6.2 Cardiac Nurse Specialist
In recognition of the volume of calls relating to cardiac disease, NHS 24 will
appoint a Cardiac Nurse Specialist in 2016/17 to support the service from a
clinical development perspective.
1.6.3 Nurse Revalidation Facilitator
To support nurses and midwives working in NHS 24 in preparing for NMC
revalidation a Nurse Revalidation Facilitator will be employed on a temporary
basis. This role will be a visible and knowledgeable resource regarding
revalidation implementation, which will contribute to the preparation and
development of nurses and midwives across the NHS career framework.
1.6.4 National Speak to Doctor Service
It is proposed that NHS 24 hosts a GP out of hours speak to doctor function in
partnership with the GP Out of Hours service. It is anticipated that this service
will start with a limited number of doctors working initially at weekends providing
a support function for NHS 24 frontline staff and in support of paramedic decision
makers in the Scottish Ambulance Service East and West control centres.
The initial aims of the new service would be to:
Reduce the volumes of speak to doctor calls going to Board OOH services
Provide national clinical decision support
provide remote prescribing
to further reduce the onward referral of patients to face to face care.
The proposal is still being considered by the Scottish Government, however
should this initiative be progressed, a phased implementation would be
progressed.
1.6.5 Advanced Nurse Practitioner
The National Review of Primary Care Out of Hours Services highlighted the need
for all staff to work in different ways including the development of specialist nurse
posts. As a result, the Scottish Government has proposed funding for 500
additional Advanced Nurse Practitioners for Scotland.
Work has commenced to look into the possibility of developing and introducing
this role within NHS 24, which would provide an alternative career pathway for
registered nurses within the organisation and contribute to the strategy for nurse
retention.
The role would compliment and support the existing NHS 24 frontline clinical
teams by managing patients presenting with:
Complex clinical presentations – reducing the number of transfers to
collaborative Boards;
Patients recently discharged from hospital (48 hours) requiring urgent
medical assessment/non-core admission;
21 Prescribing issues
Calls from the Scottish Ambulance Service stacker
1.7 Financial Implications
It is recognised that the financial situation across the whole of Scotland's public
sector will continue to present significant challenges in the coming years. This
creates pressure for the Scottish public sector to reduce expenditure whilst
ensuring long-term sustainable public services.
Within the Five Year Financial plan, approximately £45.4m out of total planned
revenue expenditure of approximately £70.8m relates to pay costs in 2016/17
(64%). It is therefore vital that the Workforce Plan is closely linked to the NHS 24
Financial Plan and Local Delivery Plan.
Significant work has been undertaken to ensure that workforce targets are
consistent with available resources. The methodology for establishing the
workforce requirement from a volume (WTE) perspective has been detailed
within section 3. From a costing perspective, the baseline assumptions used are
as follows;
Agenda for change cost of living uplift to be 1% in 2016/17, assumed to be
1% in 2017/18 & 2018/19;
Incremental drift has been calculated as potentially costing NHS 24 up to
£0.350m per year;
Where funding has been allocated on a non-recurrent basis, staff are
employed on fixed term contracts on the same timescales to avoid any
potential cost pressures;
NHS 24's financial plan makes provision for the recurring cost from
2016/17 in relation to the rebate on the National Insurance contribution
rate; and
For frontline staff, average unit costs are used for each skill set and
uplifted for the agenda for change cost of living uplift.
The current forecast financial risks are provided within the risk analysis within
section 5.
22Section 2 Defining the Required Workforce
The information contained within this section has been informed by the predicted
service changes and drivers detailed in the previous section.
2.1 Unscheduled Care Workforce Requirements
The Unscheduled Care Service remains a key focus and priority, delivering a
safe and effective service to the people of Scotland. The implementation of the
Future Programme may have an impact on how this service is delivered and the
skill mix required to deliver the service.
For all frontline telephony based services, workforce requirements are defined
using the Erlang theory of Resource Planning. This methodology takes into
account call demand forecasting in conjunction with average call handling time,
utilisation rates, and access service levels to predict resource requirements. Full
details of the planning assumptions currently used for each skill set within the
frontline service can be found within appendix 1.
Based upon current information and modelling, the workforce requirements for
this service are detailed below for the Call Handler and Clinical Frontline skill sets
for 2016/17:
Skill Set 2016/17 Requirements 2015/16 Requirements
Call Handlers 327 WTE 421 WTE
Clinical Frontline* 221.42 WTE 189.39 WTE
Table 3
*The clinical frontline requirements include total frontline Nurses, Clinical Supervisors, Physiotherapists
and Pharmacists.
Further modelling work and assumptions are being progressed to determine the
required Clinical Supervisor ratio.
Full details of the Workforce Plan numbers for all front-line skill sets are shown in
table 4 and 5.
It is advised within CEL 32 (2011) that all NHSScotland Boards are to use
workload and workforce planning tools, which would support evidence based,
workforce planning. The CEL recommended all NHS Chief Executives ensure
professional, validated workforce measurement tools were used.
"For the nursing and midwifery workforce, professional validated
workload measurement and workforce configuration tools should be
used. NHS Boards should reference the national nursing and
midwifery workload and workforce planning tools (as appropriate)
used in deriving the nursing numbers for each clinical area (as
appropriate). These tools should be used as part of the triangulated
approach incorporating professional judgment with quality
measures”.
Source: CEL 32 (2011) Revised Workforce Planning Guidance
Recommendations in the Francis Report (February, 2013) and in the Keogh
Report (July, 2013) also outlined that standards in care should include evidence-
23based tools for establishing staffing needs , in terms of staff numbers and skill mix,
although it is recognised that guidance needs to be flexible and take cognisance of
the need of different specialties and limitations on resources.
NHS 24 have identified the requirement for a clinically focussed workload tool to
supplement current resource planning. The National Workforce Planning Team
together with Dr Keith Hurst and colleagues from NHS Highland and NHS Ayrshire
& Arran are working with NHS 24 to develop a tool, which will be appropriate to the
care delivery method with in NHS 24.
The workload tool will be based on a national mandated process of "triangulation"
using a care delivery tool developed to reflect a specific care area, professional
judgment and a quality tool.
Once testing is complete and the tool approved it will be utilised as a benchmark and
applied at agreed intervals however as a minimum on an annual basis.
242.2. Frontline Forecast Preferred Position
Table 4 below details the Workforce Preferred Position for the NHS 24 Frontline skill
sets during 2016/17.
Table 4: NHS 24 Frontline Workforce Preferred Position 2016/17
WFP Preferred WFP Annual
Position Establishment
CLINICAL FRONTLINE 2016/17 2015/16
WTE WTE
Clinical Service Managers 15 16
Lead Nurse - Dental 1 1
Team Leaders 65 65
Nurse Practitioners (band 6 and band 5) 200* 167
Mental Health Nurse Practitioners 4.44 Inc above
Clinical Supervisors 1.60 Inc above
Total Frontline Nurses 206.04 167
Regional Pharmacy Advisors 3.77 4.77
Pharmacy Advisors 10.38 12.38
Physiotherapy Specialist Advisor 5 10
Senior Dental Nurses 4.48 4.48
Dental Nurses 30 30
Total Clinical Frontline 340.67 310.63
WFP Preferred WFP Annual
Position Establishment
NON-CLINICAL FRONTLINE 2016/17 2015/16
WTE WTE
Call Handlers 327** 421
Senior Call Handler Unscheduled Care 28.06 28.06
Health Information Team Managers 3 3
Health Information Advisors 8.2 10.88
Health Information Operators 6.72 6.72
Senior Dental Hub Administrators 2 2
Dental Hub Administrators 11 11
Living Life Team 5.81 5.52
Breathing Space Service Operations
Supervisor 3 3
Breathing Space SHAs 17.67 17.67
Senior Call Handler Scheduled Care 3.2 1.1
Call Operator 22 28.77
Total Non Clinical Frontline 437.66 538.72
A detailed breakdown of the planning assumptions that sit behind these requirements can be found in
appendix 1.
* 2016/17 Service requirement is for 200 WTE, however from a financial perspective it is affordable as
a year end position.
25** The 327 WTE figure is a service requirement, however the starting position for 2016/17 was far
greater (412.81 WTE in April 2016), and the forecast is to be at 341.35 WTE at year end.
*** An in year reforecast of requirements for 2015/16 saw an increase for the Nurse Practitioner
establishment to 202 WTE, therefore the preferred year end position of 200 WTE is reflective of current
service demand.
2.3 Non Frontline Establishments
The requirements for NHS 24's non-frontline skill sets are reviewed on an ongoing
basis. Table 5, below shows the predicted requirements for the Non-Frontline
services during 2016/17.
Table 5: NHS 24 Non-Frontline Workforce Annual Establishments 2016/17
Recurrent Non- Recurrent Non-
WTE 2016- Recurrent WTE 2015- Recurrent
Directorate 17 WTE 2016-17 16 WTE 2015-16
Medical 5.3 0 6.8 0
Nursing and Care 21.3 0 19.3 0
Service Delivery (inc
Technology) 66.57 0 69.77 0
Breathing Space 4.41 0 4.41 0
Living Life 0 1 0 1
Health Information
Services 18.90 0 19.4 0
Scheduled Care 2 1 2 1
SCTT 14.4 9.8 20.8 9.8
SEDS 0.7 0 1.7 0
CLINICAL TOTAL 133.58 11.8 144.18 11.8
Chief Executive 10.72 0 10.72 0
HR 37.68 0 41 0
Finance 15 0 17 0
Board 10 0 10 0
Future Programme (part
year) 0 1 0 12.4
Central Ops/Facilities 2 0 2 0
CORPORATE TOTAL 75.4 1 80.72 12.4
East 7.91 0 7.91 0
West 8.8 0 8.8 0
Cardonald 9.43 0 9.43 0
North 5.46 0 5.46 0
CONTACT CENTRES
TOTAL 31.6 0 31.6 0
GRAND TOTAL NON-
FRONTLINE 240.58 12.8 256.5 24.2
262.4 Data Quality
Key to successful workforce planning is the quality of workforce intelligence available
to better understand the current workforce profile. To support this, NHS 24 have been
making ongoing improvements to the quality of workforce information available. A
data quality action plan has been implemented to resolve identified data quality
issues to ensure that the workforce information used to inform workforce and service
redesign is accurate.
The ongoing auditing of HR Management Information is imperative. This is to ensure
that workforce data is held accurately, both for reporting at a local and national level.
A significant challenge in the provision of workforce data currently, is that the
information that is used comes from a range of sources including Ciphr, e:ESS,
Payroll and the Workforce Information Repository (WIR) were the data is held in
different formats which adds to the complexity of reporting.
In addition to routine monthly audits, quarterly data quality checks are conducted in
collaboration with ISD. This will highlight any inconsistencies or inaccuracies in the
way data is recorded within the organisation, and ensure they are rectified in
advance of national publications.
As part of the Pan Scotland Workforce Planning recommendations, there is a
requirement to establish a common core data set to deliver consistent workforce
reporting across NHSScotland. The implementation of e:ESS has been identified as
a means to provide a consistent technical solution to the management of workforce
data, which will be used by both NHSScotland Health Boards and ISD.
2.5 3 Year Projections
Workforce projections are an integral part within the Six Step Workforce Planning
Methodology as set out in CEL 32 (2011). NHS Boards are asked to complete a
standardised template agreed by the Scottish Government.
It is worth noting that the projections are based upon known intelligence early in the
financial year and a number of factors could emerge and impact upon this,
throughout the year.
Within the workforce projections, cognisance has been given to the significant
change and development that NHS 24 is currently undergoing as an organisation, in
addition to the planned implementation of the Future Programme. However, as the
impact, on the operating model, of the implementation cannot yet be fully
determined, it is possible that a revision of the workforce skills mix and numbers will
be required, any revision would be contained within the financial allocation given for
2016/17.
The figures reflected in the National Workforce Projections which were submitted to
the Scottish Government in June 2016 indicate the staffing levels NHS 24 anticipate
employing as at 31st March 2017. The forecast has been developed in line with NHS
24's Financial Plan, which, given the considerable number of unknowns, will largely
reflect the existing Workforce Plan.
27The figures relate to actual staff in post and do not take into account supplementary
staff usage.
Work has commenced nationally to review the workforce projections collection
process; however, it is anticipated that this will not be implemented until 2017/18.
28Section 3 NHS 24 Workforce Intelligence
3.1 Current Workforce Profile
A local HR Workforce Report is produced on a monthly basis for the Executive Team
which identifies and monitors key workforce trends such as WTE employee changes
by staff cohorts, sickness absence rates, workforce retention, eKSF completion and
health and well-being.
As at 31st March 2016 NHS 24 employed 1552 staff (1057.07 whole time
equivalent) across 4 main contact centres, 5 local centres and 6 remote working
sites. There were a further 88 staff (0.88 WTE) on the bank.
The chart detailed below shows the breakdown of workforce composition across the
defined national job families
Figure 6: NHS 24 workforce composition by Job Family as at 31 st March 2016
(WTE)
NHS 24 Workforce Composition by Job Family as at 31st
Personal March 2016
and Social
Other Care Senior Managers Support Services
Therapeutic 1.59% 1.17% 2.02%
3.37%
Other
(Consumer
Focus)
0.14%
Nursing/Midwifery
24.77%
Administrative
Medical and Services
Dental 62.33%
0.19% Dental
Support
3.81%
Allied Health
Profession
0.60%
*It should be noted that NHS 24 Call Handlers, Senior Call Handlers and Call Operators are included
within Administrative Services, however they perform a frontline patient facing role.
Overall the largest proportion of NHS 24 staff are within the Administrative Services
job family (62.33%), followed by the Nursing and Midwifery job family (24.77%).
Job families are nationally defined and applied across all NHS Boards. Figure 4,
below is a high level breakdown of the staff groupings adopted by ISD for reporting
workforce information and where NHS 24 clinical, non-clinical frontline skill sets and
non frontline staff are located within each job family.
29Table 6: Breakdown of NHS 24 skill sets by Job Family
Job Family NHS 24 Skill sets Job Family NHS 24 Skill sets
Medical Associate Medical Director Personal and Health Information Team Manager,
social care Health Information Advisor, Health
Information Operator
Dental Senior Dental Nurse, Dental Nurse, Senior Support Service Support Manager, Service
Support Dental Hub Administrator, Dental Hub services Support Co-ordinator, Service Support
Administrator. Administrator, Service Support
Assistant.
Other Head of Pharmacy, Regional Pharmacy Administrative Call Handler, Senior Call Handler, Call
therapeutic Advisor, Pharmacy Advisor, Breathing Space services Operator, administrative roles within
staff Service Operations Manager, Breathing HR, Finance, Medical, Nursing and
Space Service Operations Supervisor, Care, Chief Executives Office, Service
Breathing Space Phoneline Advisor, Living Delivery, Technology, Scottish Centre
Life Self Help Coach, Living Life Cognitive for Telehealth and Telecare.
Behavioural Therapist
Allied health AHP Programme Project Manager. Senior NHS 24 Executive Directors, Non
professions Physiotherapist Managerial Executive Directors
Nursing and ADONS, Nurse Consultants, Associate Director of Nursing and Care, Clinical Gov and Quality
midwifery Improvement Facilitator, Head of Clinical Systems Development, Senior Nurse Mental Health/Learning
Disabilities, Clinical Services Manager, Team Leader, Nurse Practitioner Band 6, Mental Health Nurse
Practitioner, Clinical Supervisor, Nurse Practitioner Band 5, Senior Clinical Development Nurse, Practice
Educator, Practice Educator Facilitator, Lead Nurse – Dental, General Manager North and SEDS, SCTT
Senior Nurse Practitioner
Figure 7, illustrates the composition of NHS 24 staff by Agenda for Change grade (this
does not include staff within the Medical and Dental Consultant, Executive Pay bands
or those not employed under Agenda for Change terms and conditions).
Figure 7: All NHS 24 staff employed at 31st March 2016 by Agenda for Change
grade (WTE)
NHS 24 Wte by Afc Band
9
8D
8C
8B
8A
Afc Band
7
6
5
4
3
2
1
Wte
Wte staffing by Afc band
1 2 3 4 5 6 7 8A 8B 8C 8D 9 Total
31.75 464.99 54.36 111.02 192.89 100.80 34.92 33.84 14.00 4.00 1042.57
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