Planning your workforce for future uncertainty


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Demands on the healthcare sector will evolve with changing demographics and societal shifts, and primary care providers must plan for and develop the healthcare workforce to meet these demands, CfWI Chief Operating Officer Greg Allen advised the Primary Care & Public Health Conference in Birmingham NEC today.

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  • Competition ratios tell you how many applications were received, relative to the number of specialty programmes that were available. Importantly they are historical data and currently reflect what happened during the previous year's recruitment. 
  • Planning your workforce for future uncertainty

    1. 1. The CfWI produces quality intelligence to inform better workforceplanning that improves people’s livesPlanning your workforce for futureuncertaintyPrimary Care & Public Health Conference22 May 2013Greg Allen, COO CfWI
    2. 2. 2The new healthcare system in England
    3. 3. Our MissionTo become theprimary source ofworkforceintelligence for healthand social careWe produce qualityintelligence to informbetter workforceplanning that improvespeople’s lives
    4. 4. Our visionTo be the nationalauthority on workforceplanning anddevelopment,providing advice andinformationto the NHS and socialcare system.Our values Everyone workingtogether Quality counts Respect Improving lives Dignity Compassion Care
    5. 5. The care and health workforce inEngland is significant…...because of its size...over 1.4 million people in the NHS...1.63 million adult social care workers...and also because of the work itself
    6. 6. 6Demands on the healthcare sector...... will evolve with changing demographics and societal shifts. How can weplan for and develop the healthcare workforce to meet these demands?
    7. 7. 7The future of primary care & generalpractice Those starting training now will still be inpractice in 2050 The pace of change is increasing The NHS is facing unprecedentedchallenges We will be working differently in thefuture
    8. 8. 8Some statistics about primary care• 90% of all patient contact is in primarycare• The NHS Budget is expected to beunder significant pressure despite being“ring-fenced”• Spending on primary care rose by 1.3%last year compared to 5.1% forsecondary care• 22% of GPs are aged over 55• 20% of Practice Nurses are aged over55• 10,000 GPs intend to retire in the next 5years• Doubling in demand for consultations inthe next ten years
    9. 9. 9GPs as a proportion of all NHS doctors(England)
    10. 10. 10Our workforce planning frameworkImproving the quality of workforce intelligence
    11. 11. 11Macro-levelresearchHorizonscanningScenarioworkshopsParametersdefiningpossible futuresWorkforcemodelForecastsupply anddemandSensitivityanalysis toidentify criticalparametersWorkforcedata andassumptionsDelphiMicro-levelresearchPolicyinterventionsOur horizon scanning work aligns withwider scenario generation andworkforce modelling. Our outputsinform later research activities toproduce workforce intelligence.From horizon scanning to final report...
    12. 12. 12Scenario generation workshop
    13. 13. 13Our medical workforce supply modelmedicalschoolFoundation1Career postFoundation2CoretrainingRun-throughtrainingGP training GPHigherspecialtytrainingHospitalconsultantConsultantto GPtrainingNot shown but modelled• Attrition from stocks• Exits out of system• Inflows from overseas and re-joiners• Re-sits1. Highly configurable2. Ageing in one-year bands3. Migration can be modelled (butwe lack data)4. SAS doctors data and modellingneed improving
    14. 14. 14What is our review seeking toaddress...Considering the likely changes to service deliveryand the role of GPs over the next 20 years, how dowe ensure sufficient supply for the future generalpractitioner workforce?
    15. 15. 15How are we addressing this? Review current workforce capacity issues in general practice Assess the current GP recruitment target for England and reviewoptions for GP training and recruitment targets beyond 2015 Understand the likely impact of possible future shifts in care in themedium and long term Develop and refine the CfWI’s GP system dynamics model Make recommendations, if appropriate, on GP service delivery modelsand affordability of different options
    16. 16. 16Sources: NHS HSCIC 2006a, 2006b and 2012aGPs (excluding retainers andregistrars)Practice nurses 01234567805,00010,00015,00020,00025,0001995 1997 1999 2001 2003 2005 2007 2009 2011RatioGP:practicenurseNumberofpracticenursesPractice nurses headcount (left axis)Practice nurses FTE (left axis)Ratio GP: practice nurse (right axis)The general practice workforce
    17. 17. 1702040608010012005,00010,00015,00020,00025,00030,00035,00040,0001995 1997 1999 2001 2003 2005 2007 2009 2011GPsper100000populationNumberofGPsGPs per 100,000 population (right axis)GPs, headcount basis* (left axis)GPs, FTE basis* (left axis)Source: NHS HSCIC 2012a and ONS (2012a and 2012b*Excluding GP registrars and retainersThe GP workforce 1995-2011
    18. 18. 18Source: NHS HSCIC 201105001,0001,5002,0002,5003,0003,5004,000Under 25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70 andoverUnknownHeadcountAge bandMen WomenGPs by age band and gender
    19. 19. 19Source: GP National Recruitment Office (2012), Health Education England (2013a),0002,0003,0004,0005,0006,0002009-2010 2010-2011 2011-2012 2012-2013 2013-2014CompetitionratioGPtraineenumbersRecruitment yearApplicants (right axis)Vacancies (right axis)Accepted offers (rightaxis)Competition ratio (leftaxis)GP postgraduate trainee recruitment(left axis)(left axis)(left axis)(right axis)
    20. 20. 20• CfWI’s analysis points to a GP workforce under strain. GPworkforce numbers need to be lifted to more sustainable levels• If the recruitment target of 3,250 GP trainees per year in Englandis achieved by 2015 and maintained it will result in an increaseof about 15,300 GPs by 2030 compared with 2011 levels• If this boost in GP training is coupled with other measures toimprove supply and manage demand, it may be sufficient to meetexpected patient demand to 2030Preliminary findings I
    21. 21. 21• By 2030, we expect women to be the majority of the GPworkforce• Our projections suggest the average age of GPs will belower, and the number of GPs in their thirties will havedoubled• There are fewer ‘single-handed’ practices; very largepractices now see around one in seven patients and aregrowing rapidly• There has been a shift towards more salaried GPs and fewerGP partners, which is likely to continuePreliminary findings II
    22. 22. 2230,00035,00040,00045,00050,00055,0002010 2015 2020 2025 2030Full-timeequivalentDemand - baseline GPsSupply - baseline GPsSource: CfWI system dynamics medical workforce model for EnglandGP supply and demand baselines
    23. 23. 2330,00035,00040,00045,00050,00055,0002010 2015 2020 2025 2030Full-timeequivalentDemand - baseline GPsSupply - baseline GPsDemand - scenario 1 - 6Source: CfWI system dynamics medical workforce model for EnglandWith demand scenarios added...
    24. 24. 24• Scenario 1: ‘Happy GPs, excellent patient care’• Scenario 2: ‘GPs good, commissioners bad’• Scenario 3: ‘Right plan, but wrong tools’• Scenario 4: ‘Meltdown in care’• Scenario 5: ‘Technology through regulation’• Scenario 6: ‘Rise of the machines’The six scenarios
    25. 25. 2530,00035,00040,00045,00050,00055,0002010 2015 2020 2025 2030Full-timeequivalentDemand - baseline GPsSupply - baseline GPsDemand - scenario 1 - 6Supply - scenario 1 - 6Source: CfWI system dynamics medical workforce model for Englandand supply scenarios
    26. 26. 26• Work to achieve the recruitment target for England of 3,250 GPtrainee places per year by 2015 and maintain training at that level• A substantial share of this workforce increase should go towardsimproving support for under-doctored areas• Other measures to improve workforce supply and managedemand• Regular reviews of the GP workforce at least every 3-5 years• More frequent data on GP activity and consultation ratesEmerging recommendations I
    27. 27. 27Source: NHS HSCIC (2011) and the CfWI system dynamics medical workforce model for England02,0004,0006,0008,00010,00012,00014,00016,00018,00020,00020 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79NumberofGPs2000 2010 2020 2030Age of GPs - 2000 to 2030
    28. 28. 28• Action needed to improve the attractiveness of general practiceand to retain the existing workforce• More flexible and open ended medical career pathways• NHS commissioners to encourage more innovative andcollaborative approaches to primary care deliveryEmerging recommendations II
    29. 29. Preliminaryfindings• We look forward to hearing the viewsof GPs, other healthprofessionals, professionalbodies, employers, patients and thepublic• Please email your views orevidence, or contribute to ourLinkedIn online forum:•• The Preliminary findings report canbe downloaded from:
    30. 30. Centre for WorkforceIntelligence