1. Health Education England Developing the GPN role Nursing in Primary Care Conference

2. www.hee.nhs.uk Context

3. www.hee.nhs.uk Introduction “HEE will provide leadership for the new education and training system. It will ensure that the shape and skills of the future health and public health workforce evolves to sustain high quality outcomes for patients in the face of demographic and technological change.” “HEE will ensure that the workforce has the right skills, behaviours and training and is available in the right numbers, to support the delivery of excellent healthcare and drive improvement. HEE will support healthcare providers and clinicians to take greater responsibility for planning and commissioning education and training through development of the Local Education and Training Boards (LETBs) which are statutory committees of HEE.”

4. www.hee.nhs.uk DRAFT HEE’s purpose… HEE exists for one reason and one reason only: to help improve the quality of health and healthcare by ensuring that our workforce has the right numbers, with the right skills, values and behaviours, at the right time and place. Investing in our current and future workforce is the only way to ‘future proof’ the NHS. The healthcare workforce is the means by which the ambitions of the NHS are realised.

5. www.hee.nhs.uk We are one of 15 ALBs in health HEE is accountable to the Secretary of State for Health Department of Health Health and Social Care Information Centre Health Education England Care Quality Commission National Institute for Health and Care Excellence Public Health England NHS England (NHS Commissioning Board) Monitor NHS Trust Development Authority NHS Litigation Authority Human Fertilisation and Embryology Authority Human Tissue Authority NHS Blood and Transplant Medicines and Healthcare products Regulatory Agency NHS Business Services Authority Health Research Authority Accountability of HEE

6. www.hee.nhs.uk HEE’s roles and responsibilities Workforce Planning NHS Careers Recruiting for values and behaviours into education and the workforce Commissioning undergraduate and postgraduate education (numbers and content) Education, training and development strategy for the non- professionally qualified workforce Leadership of CPD £4.9bn per annum = £10,000 per minute £4.9bn per annum = £10,000 per minute 159,000 students directly or indirectly funded by HEE

7. www.hee.nhs.uk LETBs Total of 13 LETBs Committees of HEE Not Statutory Bodies Provider led Stakeholder representation Core leadership of: Managing Director Independent Chair Director of Education and Quality Head of Finance Dispersed HEE leadership Deaneries part of LETBs

8. www.hee.nhs.uk HEE’s Priorities for Workforce Planning Establish a clear and robust workforce planning process That enables us to make pragmatic decisions during transition whilst delivering our wider strategic objectives Underpinned by effective and inclusive governance structures to enable better decision making

9. www.hee.nhs.uk Features of the historic system Separation of Medical and Non-medical planning Separation of planning for future workforce supply from planning for service / workforce transformation. No ability to compare priorities and risks across professions Medical planning had limited local or employer engagement (and therefore challenges to implementation) Medical planning strongly influenced by supply side issues (due to reliance on training grade doctors for service delivery) Non-medical planning local with limited national sense check or shared intelligence. Significant opacity and duplication - not clear who is accountable Mainly focussed on future workforce numbers Lack of confidence in forecasting and analysis Lack of provider engagement and senior leadership input

10. www.hee.nhs.uk And of course, nobody even thought about the GP Nurse workforce

13. www.hee.nhs.uk Designing our new workforce planning approach Making better decisions - The new arrangements will ensure that: - Our decisions are driven by the needs of current and future patients - Informed by the advice and expertise of our stakeholders - With clarity about where accountability for decisions lie - A stronger connection between local workforce requirements and national policy and advice (and visa versa) - Reduced duplication of effort - Safe transition but geared to deliver our ‘2028 Strategy’

14. www.hee.nhs.uk Workforce Planning Guidance Launched June 2013 Aims to secure future workforce to maintain safe staffing levels whilst supporting transformation of services. First comprehensive workforce planning guidance for the NHS Clarity of roles, responsibilities, milestones, and timelines Transparent, evidence based, and risk assessed decisions Creates the opportunity to consider priorities; between professional groups between current and future workforce between numbers and skills/values /behaviours How we undertake planning – open conversations between providers, commissioner and other stakeholders Workforce Planning Guide 2013

15. www.hee.nhs.uk DRAFT Workforce Trends 2002 - 2012 Phases of service and workforce growth; Wanless – 2002-2005 Hewitt / NHS Financial Deficit – 2005-2007 Wanless II – 2007-2010 QIPP – 2010 onwards Francis – 2012 onwards?

16. www.hee.nhs.uk Investment Wrong Direction

17. www.hee.nhs.uk GP Nurses Competent, confident nurses for the 21 st Century Practice Setting.

18. www.hee.nhs.uk Role Models

19. www.hee.nhs.uk SPENDING REVIEW: NHS protected but must save £20bn

20. Rising life expectancy

21. Rising numbers of older people

22. More people living on their own

23. Population lifestyles present significant risks to their health 23

24. Growing numbers of people with long term conditions and multiple conditions

25. www.hee.nhs.uk

26. PRIMARY SECONDARY CARE RELATIONSHIP General Practice 310m consultations per year 90% of NHS contacts 20m contacts per year in A&E Typical day in Y&H 150,000 consultations GP 5,000 OPD and A&E attendances 600 admissions Even marginal shift from primary to secondary care has potential to overwhelm NHS

27. www.hee.nhs.uk “Our analysis of the available evidence on the demand for GP services points to a workforce under considerable strain. The existing GP workforce has insufficient capacity to meet current and expected patient needs.” Centre for Workforce Intelligence 2013

28. www.hee.nhs.uk THE DAILY TELEGRAPH “10,000 more GPs needed” for the NHS to cope with increasing workload Ten thousands more GPs are need for the NHS to cope with its increasing workload and ensure patients are properly cared for out of hours, the head of the Royal College of GPs has said. The Daily Telegraph, 16 th February 2013

29. www.hee.nhs.uk GP WORKFORCE Unbalanced growth in medical workforce 1995 to 2012 Consultants more than doubled GP workforce increased by 21%

30. www.hee.nhs.uk NHS HCHS Census 2012 GPN head count increased from 20,983 in 2002 to 23,458 in 2012 (12% increase) GPN WTE increased from 11,998 in 2002 to 14,695 in 2012 (22% increase)

31. www.hee.nhs.uk GP and GPN Workforce Whole Time Equivalent NHS HCHS Data 2012

32. www.hee.nhs.uk WRT Primary Care Futures 2008 Skill mix scenario for future General Practice Increase ratio of Practice Nurses to GPs 1995 ratio 0.37 2002 ratio 0.41 2012 ratio 0.41

33. www.hee.nhs.uk Practice Nurse Age Profile 56% aged over 45 and over Compared with 42% of all nurses Ref: RCN (2007) Holding On – Nurses’ employment and morale

34. www.hee.nhs.uk Figure 1: Age profiles of practice nurses and all qualified nurses in the NHS, England

35. www.hee.nhs.uk Practice Nurse Banding 42% Band 6 compared with 27% all nurses 26% Band 5 compared with 52% all nurses Ref: RCN (2007) Holding On – Nurses’ employment and morale

36. www.hee.nhs.uk Catch 22 – No training pathway No job without skills : no skills without job “I applied for a job as a practice nurse, but was told I didn’t have the appropriate skills” “I applied for training, but the PCT told me I needed to be employed in General Practice” “A nurse is a nurse is a nurse, how hard can it be to be a practice nurse?”

37. www.hee.nhs.uk NESC Primary Care Taskforce Plan Create a training pathway for nurses into general practice Based on model of the GP VTS Workplace based training with equivalent day release course, developed from WIPP competency framework Recruited GP training practices to host the training and employ the nurses (NESC salary contribution plus GP trainers grant) Procured HEI for accredited training provision

38. www.hee.nhs.uk Practice Nurse Development Career Pathway Career Structure Professional Recognition Continuing Professional Development What can HEE do to support?

39. www.hee.nhs.uk Transferring Care into the Community DH/NHS England Stategy for GP Nursing Community Nursing Advisory Group Training pathway for GP Nurses Primary care placements for Student Nurses Not just “foundation” but career progression Health Care Assistant Nurse Practitioner Mentorship for GP Nurses Recommendation of GP Taskforce

40. www.hee.nhs.uk Questions simon.plint@wessex.nhs.uk