NHS England » Work force planning for advanced practice

Hello, ladies and gentlemen, welcome to Advanced Practice Weekly. I’m joined by a couple of very special guests, one who hasn’t been on the podcast since it very first started, so we’re welcoming back Tim Yorston, who will introduce himself and also a very special guest, Richard Ansel, who’s joining us from the NHS England workforce planning team.

So I’m going to let Richard tell us a little bit about the offer that they give about workforce planning to trusts, to employers, to enable them to try and plan their workforce. And we’re specifically taking a lens from advanced practice, as you know, this is Advanced Practice Weekly and everything we talk about is advanced practice. So we’re going to hand over to Richard and then we’re going to invite Tim to come and come on in, who has taken part in some of this workforce planning. And we’re going to find out about how the training has taken hold, what they’ve done with it and what’s actually happened with the actual output of that training. So Richard, welcome to the program. Tell us all about workforce planning. And if I’m using that terminology wrong, do let me know.

So there’s quite a few different options there available for employers or people that want to get involved in workforce planning or workforce redesign. What is the current terminology? What should we be using for this, for this type of conversation? What do people like to call it?

Because I think workforce planning is maybe a little bit old or outdated now. Is that right? I think.

has connotations that’s perhaps linked very much to numbers and operational planning and filling out a spreadsheet potentially. Workforce transformation perhaps goes too far the other way, whereas I think workforce redesign seems to get the most traction.

We’ve just started a program with Northwest London, for example, and they were keen. They chose workforce redesign as their title. We’re happy to work with all three, but workforce redesign I think is top of the pops at the moment.

Right. Great. And so your offers are ranging in different lengths and times, and that’s amazing. So for people that just want a little taste. So if they’re thinking about trying to redesign something within their, within their sort of team or within their environment, then they can just come and get a half a day taster and be like, actually, OK, this is what I needed.

Maybe I want to go on and do the faster class and then the master class itself later on. OK, great. Thank you for that. And all of the resources are on your portal, which we will share with everybody at the end of the podcast so they can know where to go for that. And this offer is open to everybody. Is that right?

Yes, in London anyway, so you need to be based in London, apart from our demystifying, so that’s our entry level. That’s just like an hour, hour and 15 minutes. That’s open to anybody, anybody across England. So that’s the real intro, and that gives people more details.

But yes, any, we like a mixture of clinical and non-clinical, ideally, I’m probably just saying the master class and the faster class are slightly different approaches to the same thing. So you wouldn’t do both. You’d choose the one that was most appropriate. Right.

And if someone had an idea for a redesign, they would approach yourselves and say that this is what I’m thinking of doing, what course is most appropriate for me.

Yes, so if you’ve already got a workforce project and a workforce project team, the Masterclass makes a lot of sense. That’s how we recruit to that program.

The Fasterclass, we actually give people a scenario. It’s more of a, it’s a three day immersion sort of program, three days in a row. The idea is then you then apply it to your local workforce project. It depends on your kind of level of readiness and where you’re, you know, how you’ve mobilized your local teams, which can be tricky for clinicians and non-clinicians, I think. That’s the challenge. But again, we would help people, support people through that. So if in doubt, contact us and yeah, we can hopefully customize to a degree what people might need.

Okay, brilliant. Thank you. So that’s the offer. So Richard, do you want to tell me about the six steps?

Yeah. So the six step methodology is really just a framework and it follows a kind of a logical path. So you literally take the steps in order one through to six. There’s a little loop between two, three and four, but fundamentally, yes, it’s a logical path. It’s been around actually since the late 1990s. I’ve got the CD-ROM version at some point, but, and it’s lasted the test of time, I think, just because it’s relatively simple. It’s quite flexible and it is literally just a guide. So the six steps has got some science to it, but really it’s just a framework to link together key parts. So each step builds up your support for your business case or your case for change or your workforce project. I think that’s probably the most helpful way to think about it.

And it’s probably most useful to see in terms of examples. So we have case studies on a resource hub, but actually Tim’s probably the best person to speak to in terms of how it worked for him and which bits of it. So you might not do every single exercise that we put for every step. But some of them will be useful and relevant and the order’s important, but not crucial. You can mix and match a little bit. Do you want to tell me what the six steps are? Yeah. I mean, it starts off with kind of defining your plan. That’s kind of the key starting point. What’s your aim? What’s your scope? Who are your stakeholders? That’s all part of the first element. Step two is mapping the service change. So that’s a little better at how do you work? What are the drivers and constraints? What are your bottlenecks? What are you trying to improve? That kind of thing. Step three is defining your required workforce. So we talk a lot about skills and competencies and skill myths, and then start to think about the future state as well. Step four is understanding workforce availability. So some people call it the data step. We kind of introduced the idea of the workforce supply, and that is about, yeah, kind of workforce numbers, but other intelligence that might be relevant to the workforce. Step five is developing the action plan. So in many ways, that pulls it all together. There’s some other analysis, gap analysis and other things at that step, which are quite important. And then finally, step six is that kind of implementation, monitor and refresh. So how do you know if it’s made a difference, has it improved it? Are you going to go back and review it in three months, six months, 12 months time?

Right, so it’s quite logical really, isn’t it? The way it works, it’s about looking at what you kind of need and how you’re going to do it. It’s very much broken down into those sort of steps.

OK, amazing, that sounds great. Right, let’s bring Tim Yorston in, who has been waiting patiently in the background there for us. Tim, welcome back to the programme after a very long time. Do you want to tell us about your journey with the Masterclass, with Richard?

Thank you, Ajay. Hi, Richard. Yes, we first started looking into workforce planning because we completed the advanced practice maturity matrix that is a centre for advancing practice produce. And when we looked at where we scored, one of our weaker areas was in workforce planning, and certainly in my sort of career history, I’ve never done any workforce planning.

And, you know, on reflection, you know, we do spend like 45% of the NHS budget on on staffing and potentially looking at fixed costs, which is not much we can do around workforce is, you know, dynamic. It changes. And, you know, I’m sure we’ve all witnessed changes the way our roles have evolved. One of the challenges that we faced was that obviously, so my role is consult nurse in urgent emergency care, but half my job is advanced practice lead in a big central London trust. And certainly looking at both of those in our experience, our teams grow organically and but there wasn’t planning behind it, but it wasn’t very structured in many ways. And given the relatively new innovation of advanced practice and the way that roles have changed, we faced a challenge of how do we shape workforce planning around that and create roles. It’s not just a nice to have it say, you know, why are we actually doing it. So we started looking for workforce planning courses and came across Richard’s course on NHSC, we actually did the demystifying session, and then we went on the full 18 week course. I would recommend anyone to do it. In fact, I’m surprised it’s not incorporated on many management courses because, you know, there’s so much around developing and transforming workforce. So yeah, that was a background to it. We did the demystifying course, thought, right, well, we need to do some more. We need to develop some internal resources. And that’s where we went on the course then and we worked through a project throughout the whole 18 weeks.

Great Tim, thank you for that. So you’ve been through the 18-week course now, what would be your biggest takeaways and reflections after undertaking the course?

What have you taken away from it that you think would be really useful for our listeners to other than going on the course themselves, which is what you’ve recommended? What would be your biggest reflections and takeaways from the course?

some really stick in my mind. The first one is the most obvious one, which is, and it’s the point that Richard made really early on in the course that we’re all, well, I’ll own it myself, I am guilty of jumping straight to step four, which is understanding workforce availability. So we look around, and we see who’s got some skills, who’s got some potential, and we take it from there. Whereas, and you know, that has worked in some certain circumstances, but it’s not planned really, you know, sustainable way of doing things.

So first top tip is always go back to step one, define the plan. What’s the problem we’re trying to solve? And really, it comes around to sort of quality improvement methodology, which is, you know, asking that first question, and thinking around the current sort of financial and political state within the NHS is I think it’s really important to look at demand. So what it’s not a nice to have, it’s a we need to create roles that are there to manage demand. And along with that, the current financial situation within the NHS, it’s got to be financially sensible to follow that path. So, you know, in a way, you have to go in almost objectively and look at the facts around costings and demand. And you know, it may be like all things you get, you get halfway through and you see side actually, the route that maintain an open mind that may not be the route you want to go down, it may be a different one. So I suppose adopting that quality improvement methodology, also looking going right back to the beginning, what are the what’s the national direction on here? So we’ve got a long term plan, we’ve got the long term workforce plan, and we’ve got a new one, I think coming out this year. So aligning it’s a sort of strategic national strategic direction, especially around long term plan, the three key shifts, you know, so, you know, thinking ahead about how we create sort of integrated workforce, how can we integrate secondary care with community and neighborhoods? How do we, you know, along with that, we have to consider digital, and you know, if there is a health promotion element to it even better. So you just go right back to the beginning of thinking that and along with step one comes in that so once you’ve got the problem you’re trying to solve, and it matches demand, the financial expenditure plans, and it’s within that, and actually, if it can, if it can be efficient, even better, what is your stakeholder group, because definitely mistakes I’ve made in the past are not getting the correct stakeholders right from the outset. So you know, you get the right people in the room at the same time, and they talk about the stakeholder matrix, which is really useful. And I use that all the time. And it’s actually there’s been some side issues because it’s this I use it in other projects, when you’re trying to make sort of quality improvement projects that you know, I found it quite useful in that sense.

Yes, those are the top, the main top tips is always go back to step one and follow them through some steps you may go through quicker, but I think unless you go back to the fundamental step one, then ultimately, you know, it’s going to be a lot harder journey. Step two, is when you think considering mapping the service, you’re looking at the benefits, you’re looking at the drivers and constraints, and you’re looking at potential models. But you’re also the important thing is that we also always have in what’s the, you know, what’s making sure we have in the potential model, the action of actually doing nothing, no change. And that’s quite good at focusing your mind as well, because you know, things are unlikely to sort of remain in status quo. But if you think about what’s the what’s the consequence of doing nothing, I think that’s a really useful tool as well. So I definitely use that.

And then when we get around to defining step number three, defining the workforce required, I think the single most useful tool on there, the skills optimization matrix, which you can do it on a small scale or a big scale. But you know, if we’re looking at, you know, workforce redesign or transformation or workforce planning, I think it’s a really useful tool to really take a step back and take a broad look at your workforce. And you know, there’s two specific questions in that, in the matrix, if you imagine a matrix, we’ve got different roles going across the top. So you may have, you know, band five nurse, clinical specialist advanced practitioner, and you may have pharmacist or you may have medical roles or all different roles, depending on where you’re working. And then down the left hand side, you’ll have skills or abilities or capabilities, and then you will map those across and you’ll ask four questions of each. The first question is, does that role currently do this task and it is appropriate? With that is the case, then there’s not necessarily a need to change. The second question, which I think is really valuable for two different reasons is, does that role currently do this task? However, it is not appropriate for that role.

Now, Richard, you can correct me if I’m wrong, but I see that now it may be that somebody is, they’re quite capable of doing a task like it might be an administrative task, or it might be a clinical task, doesn’t mean they’re not, not capable of doing it but it’s just is it appropriate is this where they’re adding the most value or would their value be better served doing higher level activity for want of a better word so the third question is question three is the role doesn’t currently do this task and it is not appropriate for this role so they don’t currently do it it’s not appropriate in that case is not really a case for change but we’ve asked the question and then the last question is doesn’t currently do this task but could be appropriate for this role and this is the one that i’ve seen brought to life every day that we’ve seen this organic growth of roles in all our roles i mean to put it in context when i first qualified as a nurse you know nurses couldn’t give intravenous drugs they wouldn’t cannulate it was a totally different career really and it sort of evolved into a highly you know like in many professional roles highly technical highly skilled way off what i first started out and we’ve seen a massive transformation in the workforce we just probably haven’t seen it in because it’s happened over a time and so this the last question is how could we optimize people within their roles to take on potentially other duties but make a more planned approach to it so that could be you know in a case of a band five nurse what work could they uh offset to take on a higher value activity that’s well within the within their scope and their ability it may require some extra training but that’s the way it works that’s the way i see it works is that if you look do that across your whole workforce then you’re optimizing your whole workforce and there was also a case i think that here it isn’t mentioned in here but i think there’s always a question you know with the advent of ai we want to go to digital with one of the key shifts so is where is there a role where we can you know such as using ai documentation tools whether it be voice recognition software wearables that kind of thing where can we bring that in as well to support as an adjunct to workforce so yeah so that’s the skills optimization matrix.

It’s great to hear that Tim’s using them in his leadership role, but in different ways.

Can I just jump in there? Because Tim, yeah, I totally agree.

It’s, where does agreement on not doing it or doing it and is appropriate to do it? That’s great, but actually what’s really interesting is that, yeah, could they do that and should they do that is really interesting. And for certain tasks, there’s lots of elements that might make that relevant or not. So how often it happens, the volume of that activity, the availability of all the professions might be an issue, the context, repeatability, all those kinds of things are important. But yeah, the two most interesting things are, where you get variation, so where people agree or disagree and it’s really important that there’s a set of clinicians and perhaps a wider group of people that have that conversation the better. But yes, where are people that could be doing it but aren’t? And it may be just custom and practice, it might be historical, but it’s perhaps not appropriate. And we keep using the word appropriate, but because I think, again, the language is important. But yes, for advanced practice in particular, that’s where there’s loads of examples where this exercise really teases out where, yeah, where you can optimize, hence the quite difficult to say title, but it comes down to, yeah, what would be the best use of those resources at the end of the day. And sometimes it’s about different professions being in the room and understanding the scope of practice and the level of practice that goes with it. The example you give to him I think is a really good one.

Brilliant. Thank you, guys. Tim, do you want to tell me those other reflections that you had?

So the skills optimisation matrix is really useful. And then we get on to understanding work, step four, understanding workforce availability, which is the probably the bit that is most comfortable for us. Essentially, that’s looking around our current workforce gives an opportunity to do that thing around the long term workforce plan, which is, you know, train and retain staff and look at that, but also to look at supply because you know, whatever you’re putting in place has got to be sustainable, you know, you’ve got to know the workforce is coming in.

And so in step four, there’s a really useful graphic that NHSC and Richard kindly let us borrow, which is the mandatory NHS leaky booklet model, which is a really good graphic of describing the, you know, the flow in from the taps of staff from join us to the NHS, newly qualified return to practice international recruitment, all those. And then we’ve got the bucket in the middle. So the water is gradually filling the bucket up with all these fantastic new staff. But in the bucket, we do know that obviously people retiring, leaving the NHS, you know, flexible working is really being pushed to people reducing their hours. And, you know, so we’ve got a constant challenge of people joining and leaving and it’s getting that balance. And then if we add in the mix of the different skills required, it gets even more complicated. But step four is really useful. Step five is planning to deliver, you know, so it’s really looking at using all triangulating all that information you’ve got and developing a shared understanding. And this is when it was really important you get your stakeholders involved, because really it starts to get a bit more serious then about making plans.

It’s, and again, it’s considering the risks and benefits of all the different proposed models and then and then coming up with a plan. And then step six is the final one, which is to obviously to implement it and the tool recommended on the workforce planning course is the PDSA methodology. So plan do study act, which is, I think most of us that work in the NHS are familiar with this. And it’s great because it’s a cycle based intervention where you will monitor and amend and it’s a great tool for the NHS. So it’s the great thing is most people are used to it. So it won’t be a great surprise. So it fits with stuff we already know. Yeah, so in summary, some of the other lessons I learned were that, you know, going back to stakeholders, making sure we’ve got the right stakeholders, but also some of the softer stuff that is really difficult around, you know, by, you know, we all come from our different professional backgrounds, we all belong to a certain tribe and, you know, whether we like it or not, we’ve probably come with a different sort of standpoint about, you know, what skills people have, what people’s capabilities are, but getting people in the room to get a shared understanding with some great examples of where it’s been introduced in other places and working through the skills optimization matrix together and taking that journey really together is really important.

There’s some great tools we got taught on there. Like one is the six sinking hats, which is a really useful tool. You’ve not used it before. It’s great. There’s several ways to do it, but it gets everyone an opportunity to adopt a different way of approaching a specific issue or a question. So it’s another way of reducing the things like group thinking where sometimes the dynamics within a group can, you know, make things go in one particular direction when, you know, it encourages much broader stakeholder engagement.

So we learned some really good tools there and also just to think about the biases we all come when we are doing workforce planning. Because some of that human stuff is really quite powerful, much more powerful than sometimes we give it credit for. And then finally, just the only thing I was going to say was about implementation and reflection. We’ve done these fantastic courses and we did have ambition to develop a whole toolkit for use across the trust, multidisciplinary that people can access. And I think what happened was, you know, time got away with us and reality here in actually a lot of these tools are there. Richard’s team have developed the skills maturity matrix, which is an excel based format, which is available on their web page. And so that’s already in existence. A lot of the other tools are also out there. But I reflected on is actually how are we going to implement this on a local way that will actually work? Everyone is so short of time. So we came up with an executive sort of format, which is the workforce plan on a page. And I’ve used this on a couple of occasions. So essentially, it just condenses six step plan with an abbreviated format. So but it uses the six steps. So right, so what’s the problem we’re trying to solve? But it’s got a mini sort of skills optimization matrix on there where you at least consider how that would work. And but just following it through. But but in the sense of like, this is the kind of thing that term could anybody could do if they were just if they were thinking about redesigning their workforce. How could I get that on a page, circulate it to their directorate management team that was easy to understand format that could perhaps go to exec board that people could actually read and understand. So we developed this and it’s all borrowed, but essentially we’ve put some examples in there where people might find useful for when they’re trying to construct it because we’ve all found that a new form, what’s the wording I need to use. And so I’ve used it on a couple of occasions and it’s been really useful. One was successful. The other wasn’t, but again, it’s a learning process. We’ll go away and have another think about how it’s done. Doesn’t necessarily mean it has to be that, this is a, I think this is a small part of the process. It can be a preliminary step in then going on to develop a much deeper workforce plan. So yeah, that’s been really useful. Happy to share that with anyone and everyone wants to see it, but thank you.

Okay, that’s it ladies and gentlemen. Thank you so much for listening to Advance Practice Weekly.

Special thank you to Tim Yorston and Richard Ansell for coming on to the program and talking to us all about workforce planning. Take care everyone, see you soon, be safe.

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