1. Where’s the evidence? The Hub’s approach to capturing the benefits and impact of skill mix change
Liz Hedgecock
Knowledge Development Manager
North West Workforce Modernisation Hub

2. Overview The background to our evidence base work Our aims
Overview of the evidence workstream
Partners and projects
Products and resources

3. Our evidence base work in context
The QIPP challenge:
bridging the £15-20bn QIPP gap
Quality
Innovation
Productivity
Prevention
What is the evidence that skill mix change helps to bridge the QIPP gap?

4. A clear ROI Potential Role Substitution Return On Investment (ROI)
Baseline: Cost of qualified registered professional Band 5 mid point £23,345
Cost of qualified Assistant Practitioner Band 4 mid point £19,495
ROI calculation
ROI = Basic Grade Radiographer cost – AP cost x 100
AP cost
23,345 – 19,495 x = 0.20
19,495
0.20 x 100 = 20% cost saving

5. Some national findings re: skill mix change…
There is a dearth of research (Sibbald 2004)
Cost-effectiveness not evaluated (Sibbald 2004)
Nurse/doctor substitution (Laurant et al, 2009)
Role revision has no detrimental effect & in some cases a positive effect on the quality of care (Health Foundation, 2010)
Labour Substitution report (CfWI, 2011)
Service developments are some way ahead of the research-based evidence in this area

6. Substitution: the Centre for Workforce Intelligence’s view
Quality
An appropriately trained substitute can deliver as high quality care as the original worker
Workforce shortages
Demand for the original worker can be reduced but not eliminated
Cost savings
Salary savings are often offset by lower productivity of substitute
Efficiency
Efficiency gains are possible only if the original worker stops carrying out tasks now delegated to the substitute
‘Labour Substitution…’ CfWI 2011

7. Some North West evidence re: skill mix change
NW evaluations of impact and process include Assistant Practitioners, Advanced Practitioners, Non Medical Consultants and Non Medical Prescribing
NW evaluations show improved access, reduced waiting times and care closer to home
Evaluations also highlight the importance of organisational readiness and culture (lessons learned)

8. Our aims for the evidence base workstream
To lead the development of the evidence base in relation to the impact of skill mix change, in particular the links to QIPP
To influence the national development of the evidence base in relation to skill mix change
Objective 1: In order to influence skill mix changes and commissioning, contribute to new evidence, identifying priority areas for investment and development
Objective 2: Review and summarise existing evidence relating to skill mix change and produce guidance on how to apply the evidence
Objective 3: Ensure organisations have access to sound evidence about skill mix changes

9. Overview of the evidence base workstream

10. Programme: the impact and benefits of skill mix change
‘The North West Workforce Modernisation Hub invites expressions of interest from health and social care organizations, to undertake a detailed analysis of their own skill mix change in order to provide evidence of the impact and benefits of skill mix changes within their workforce.’
Expressions of interest (EOIs) invited from NW organisations via Workforce Modernisation and Planning Networks
Partnership approach
‘Launch’ meeting with each organisational lead to explore and define the project scope
Backfill funding for each organisation, equivalent to c. 35 days at midpoint band 8a
Project length: usually 1-2 years
Planned overall outcomes:
Develop a benefits framework for workforce
Develop organisational capability in planning and evaluating benefits and impact of skill mix change
Produce and share adaptable, reusable resources to enable wider learning and practice

11. Partners and projects – impact and benefits
Wave 1: commenced mid-2012:
5 Boroughs Partnership – Assistant Practitioners, Community Health Services
Mersey Care – Advanced Practitioners, Mental Health
Royal Liverpool & Broadgreen University Hospitals – skill mix change for non-clinical support staff
Wirral University Hospitals Trust – Advanced Practitioners
Wave 2: commenced early 2013:
Cumbria Partnership – Assistant Practitioners
East Lancashire Hospitals Trust – Assistant Practitioners, community stroke rehab
Greater Manchester West Mental Health Trust – Advanced Practitioners, Mental Health
Lancashire Teaching Hospitals – skill mix change in pharmacy teams

12. Products and resources
Benefits tracker template
Project highlight report template
Project plan template
Online resource area planned as part of evidence base area of Hub website – including resources which our partners have agreed to share, e.g. presentations, questionnaires, project documentation, terms of reference, focus group questions…

13. Benefits tracker template
Benefit ID
Quantitative or qualitative?
Benefit
Quality, Productivity, Prevention or Cost-effectiveness?
Measure
Potential Question
Source of Baseline Measure
Non Recurring Financial
If cost or time saving please specify where reinvested
Units of Measure
Start Date
Baseline prior to go live
6 mth Measure
12 mth Measure
ID1
[enter evidence here when collected]
ID2
ID3
ID4
ID5

14. Using the tracker in practice
SKILL MIX SUMMARY FOR NEW ASSISTANT PRACTITIONER ROLES
What can you do now that you couldn’t before?
What will be seen in practice to show this skill?
What will it mean?
What is the benefit?
Assessment
Run triage clinic
Deliver routine care/ interventions
Patients will be seen quicker
Patient will be signposted
Less patients will ‘sit on’ the caseload
Reduced waiting times
Senior staff freed up
No waiting lists
Smaller caseloads
Practitioner caseloads will consist of complex and highly complex patients only
Reduced duration of active care
Generation of new business
New services being developed
Increased innovation
Monitor
Follow up
Key Worker
Education
Implement Action Plans

15. What would be seen in practice?
Using the tracker in practice
SKILL MIX BENEFITS PROJECT: OUTCOMES AND MEASURES
What is the benefit?
What would be seen in practice?
How might we measure?
improved career progression
retention of staff
reduced numbers of staff, at band 3, leaving the service; reduction in recruitment costs; reduced training costs; reduced sick days; use of saved costs

16. Benefit ID
Quantitative or qualitative?
Benefit
Quality, Productivity, Prevention or Cost-effectiveness?
Measure
Potential Question
Source of Baseline Measure
ID1
Both
Release of registered practitioner time from routine activities
Quality; Productivity, cost effectiveness
Time and motion; complexity, skill set
Does the development of the assistant practitioners via skill mix release registered practitioners time for more complex activity and innovative practice?
case study; proxy patient; caseload analysis; previous work; Paris
ID2
Qualitative
Positive patient experience
Quality, Productivity
patient satisfaction, safety, harm reduction, patient involvement and engagement
What difference does the AP make to the patient experience?
PROMS, Patient satisafaction surveys, review process, confidence
ID3
Sustaining clinical outcomes
Quality, Productivity, Prevention
re-referral rates; discharge rates
Does the development of assistant practitioners via skill mix improve clinical outcomes? Reduce re-referral rates, improve discharge rates
ID4
Quantative
Cost savings
Cost effectiveness
Cost of episode of care linked to a specific pathway; workforce profile pre and post redesign
Does the development of assistant practitioners via skill mix reduce the cost of an episode of care, and overall workforce profile costs for the service?
ID5
Staff understanding and satisfaction related to skill mix
Quality, Productivity, Innovation
Staff readiness
Does the development of assistant practitioners via skill mix preprare the workforce as a whole for change?
Readiness Tool
ID6
External partnerships???

17. Some local evidence sources
Formal evaluation studies:
Non Medical Consultants (Gavin-Daley and Mullen 2010)
Advanced Practitioners (Acton Shapiro , Holbourne 2006)
Non medical prescribing (UCLAN 2010)
Assistant Practitioners (University of Manchester , UCLAN 2008)
Journal articles on NW skill mix changes
Case studies
Posters
Presentations
Business cases
Award nominations

18. Learning to date/ key messages
Build benefits and measurement in from the beginning
Set boundaries
Get help!
Allow plenty of time to establish metrics and baselines – and obtain data!
‘And so what?’
Some learning may be unexpected – but valuable

19. Any questions? liz.hedgecock@5bp.nhs.uk 07785 528696 wmhub@5bp.nhs.uk
Attribution: Salazar210 at en.wikipedia