Future-proofing the NHS: how the UK’s largest workforce is gearing up

This article was taken from: https://www.theguardian.com/healthcare-network/2018/may/23/future-proofing-how-nhs-future-uk-largest-workforce

By Debbie Andalo , The Guardian

As the service responds to changing developed

Seventy years ago the NHS launched with a workforce of around 144,000. Since then, the health service has grown to become the single biggest employer in the UK, with 1.7 million workers across England, Wales, Scotland and Northern Ireland, making it the fifth-largest workforce in the world. It is probably the most diverse workforce in the UK – for instance, some 62,000 NHS staff in England are EU nationals. It’s not unusual to be treated by a nurse from the Philippines or India or seen by a doctor from Egypt, Korea or even Russia.

As the workforce demographic has changed there have also been huge advances in medicine. There has been a move towards more patient self-management in an integrated health and social care system, with more people looked after outside of hospital nearer home. At the same, time patient demand has soared, and it is anticipated that 190,000 more staff will be needed in England alone by 2027 if the current pressure on services continues apace.

All these factors are influencing the careers landscape. The challenges, according to NHS leaders, are three-fold: to attract new staff; to retain and develop those who already work for the NHS; and to create new roles where skill gaps are identified.

mand and medical advances, more staff – and new careers – are being developed

The government is committed to increasing nursing associates – a bridging role between healthcare assistant and registered nurse. By 2027 some 45,000 will be in post, with 17,000 expected to become registered nurses. The development, according to Health Education England (HEE) chief executive Prof Ian Cumming, has already triggered a rise in the number of people applying to become healthcare assistants because there is now a defined career path. A growth in medical associate professions is also expected – such as surgical care practitionerstrained to perform some supervised surgery and advanced critical-care practitioners who look after hospital patients with life-threatening conditions. In future, more physician associates – who can carry out many of the duties typically provided by a GP – are also likely to be found across the NHS.

Helen Gilburt, policy fellow at the King’s Fund thinktank, says: “Physician associates have taken up roles in general practice and hospitals; they are adaptable with a broad skills set. In the US they are found in hospital and surgical teams and treating people with long-term conditions, so it will be interesting to see where they develop and grow in other parts of the NHS.” While these new roles are emerging, it’s also crucial to build on the skills of existing staff, she says: “Getting people who have different skills to work more closely together is more effective than redesigning traditional roles.”

Opportunities for existing staff to become advanced clinical practitioners – experts often working autonomously – will increase in future. Danny Mortimer, chief executive at NHS Employers, says: “I think there is more interest in roles around advanced clinical practice in nursing and the allied health professions than, for example, physician associate, because there are more of these roles and the people are already there.”

Most of the growth in jobs is expected to happen in the community as more people are treated outside of hospital. Technological advancements, which enable patients to self-monitor their condition at home, will also have an impact on how health careers develop: “I think the iPad will transform primary care,” says Cumming. The desire of doctors for more flexible careers will also influence how medical paths develop. Chair of the BMA’s junior doctors committee, Dr Jeeves Wijesuriya, predicts there will be more portfolio careers in medicine in future and hopes there will be more flexibility in junior doctor training, including the chance to work overseas – an avenue HEE is already exploring. Cumming says: “More people want the option to work internationally, and we are looking at what we can do to build links.” Nurses might in future spend some of their training in Australia, while Australian nurses work in the UK as part of a job swap, he suggests.

The employment options in the health service today could never have been envisaged when the NHS began. The service still offers a career for life, but it is its status as a national treasure that is probably its biggest selling point: “The public feels that the NHS is linked to our national identity,” says Mortimer. “People working in it feel part of something and can make their contribution – that shared ethos, which was there after the war, still continues today.”

Working in healthcare: professionals have their say

When I qualified 29 years ago, my role was to dispense prescriptions and give advice to patients when medicines were dispensed. That had changed a lot from what my dad did when he opened his pharmacy in 1961; then he used to make up potions and lotions and medicines.

In 2005, I moved to new premises, which included a therapy centre and a patient consultation room too, as I could see the way that the NHS was moving. The pharmacy has a real local presence. We deliver services such as flu immunisation, smoking cessation the morning-after pill – we’ve moved away from just medicines. We are a great asset to the NHS and I think we will become much more integrated into the NHS.

Pharmacists now work in GP practices and urgent care centres. Locally, NHS 111 is looking at using community pharmacists for urgent cases instead of people going to A&E, out-of-hours GPs, or a walk-in centre. I think Dad would be amazed.

Michelle Chapman 36, is a physician associate (PA) in acute medicine at East Surrey hospital, Redhill; board member of the faculty of physician associates at the Royal College of Physicians.

The PA role appealed because it is public-facing and I liked the combination of science and medical. Being a PA is about team work, it allows you to be a generalist, which means it offers mobility, so I could move into general practice, or elsewhere, with my core training.

I am part of the medical team alongside junior doctors. Sometimes I am on the consultant-led ward round, or I might manage patients referred from A&E. I work under the supervision of a doctor. I can decide a patient management plan – which is reviewed by a consultant – and I can take on the management of that patient. I can order investigations, but I can’t prescribe or order x-rays. We aren’t replacing doctors, but we are there to complement them.

Owen Williams 50, chief executive, Calderdale and Huddersfield NHS foundation trust.

If you look at workforce diversity, then we have seen growth. There is still work to do at a senior level. We have made progress, particularly around doctors, but there is still work to be done on the nursing side.

One of the biggest changes I have seen is a commitment to end this notion of competition, which has led to more collaboration. Competing against each other to provide care doesn’t seem logical when we are all financially challenged. Collaboration gets people or organisations that are different, with different cultures, working together and that has an impact on health inequality. I would hope that we will be more diverse in 10 years’ time, not because it’s something we have to do, because it’s PC, but [because diversity] can take us to a better place.