This webinar explores how use of enhanced roles can help Trusts in the delivery of seven day services, and aims to help trusts understand the practical issues associated with developing enhanced roles and implementing these into their organisations. During this session you will hear about: * Workforce planning and the delivery of 7 day Services. Health Education England will provide an update regarding the national picture and provide insight into innovative workforce solutions which will support the delivery of 7 Day Services * Practical examples from colleagues in acute trusts, where new roles have been utilised in delivering the 4 priority clinical standards Key speakers: Kevin Moore - Head of Workforce Transformation, Health Education England Miss Fiona Kew - Consultant Gynaecologist, Modernising the Workforce: Physician's Associates – Sheffield Teaching Hospital Darren McGuiness - Endoscopy Manager Royal Liverpool & Broadgreen NHS Trust. Seven Day Services in Endoscopy Nicky Taggart - General Manager, Radiology and Imaging, Royal Liverpool & Broadgreen NHS Trust. Seven day services in Radiology

1. www.england.nhs.uk
Workforce and
delivering 7 day
services
Jo James
Programme Delivery
Lead, North Region,
Sustainable Improvement
Team, NHS England
17th January 2017
.

2. www.england.nhs.uk
• Work to date has shown a key risk to delivery of 7DS
within the hospital setting is workforce.
• Workforce risks are most acute with respect to:
• Consultant workforce
• Diagnostic workforce
• This webinar will provide examples of ongoing work
to address these issues:
• Nationally and Regional supported by Health
Education England
• Locally in acute organisations
Purpose of the Session

3. 3
• The 10 clinical standards were developed by the NHS Services, Seven Days a Week Forum led by
Professor Sir Bruce Keogh.
• Priority standards are those identified as the minimum set of clinical standards needed to tackle
variation in mortality. Selection is supported by the Academy of Medical Royal Colleges.
• Standard 2: Time to consultant review
• Standard 5: Diagnostics
• Standard 6: Consultant directed interventions
• Standard 8: On-going review in high dependency areas
• Standard 1: Patient Experience
• Standard 3: MDT Review
• Standard 4: Shift Handover
• Standard 7: Mental Health
• Standard 9: Transfer to primary, community and social care
• Standard 10: Quality Improvement
Priority clinical standards
Clinical standards which
enable sustainable delivery
7 Day Hospitals – Clinical Standards
A set of clinical standards were identified to support seven day hospital services

4. www.england.nhs.uk
Kevin Moore
Head of Workforce Transformation, Health Education England
Miss Fiona Kew
Consultant Gynaecologist,
Modernising the Workforce: Physician's Associates
Darren McGuiness
Endoscopy Manager Royal Liverpool & Broadgreen NHS Trust
Seven Day Services in Endoscopy
Nicky Taggart
General Manager, Radiology and Imaging, Royal Liverpool &
Broadgreen NHS Trust
Seven day services in Radiology
Today’s speakers

5. HEE, Workforce and 7 Day Services
Kevin Moore
Head of Workforce Transformation
Yorkshire & Humber

6. Our purpose
"Health Education England exists for one reason only: to
support the delivery of high quality healthcare and health
improvement to the patients and public of England by
ensuring that the workforce of today and tomorrow has the
right numbers, skills, values and behaviours, at the right
time and in the right place."

7. Board
Executive
Team
LETBs
LWABs
Regional
Directors
HEE
co-chairs
Local
Teams
Key
Partners/
Advisory
Accountable
Support
Executive
Advisory
ALBs
Our place in the system
STPs
Workforce
Advisory
Board
ALB
Oversight
(HEE RDs)
FYFV
Board

8. Some of the HEE Initiatives
Nurse
Associates
Emergency
Medicine fill
rates
Record GP
Numbers
Paramedic
Education
Project
The Care
Certificate
Come Back
to Nursing
Widening
Participation
Pharmacy
Reform The Quality
Framework
Healthcare
Support
Workers
Physicians
Associates
Genomics
Dementia
Awareness
Training
CEPNs
Shape of
Training

9. The world has changed
Place based services and partnerships to meet
the quality, health and financial challenges.
The CSR reformed non-medical
undergraduate funding, cut our running
costs and gave us flat cash for five years.
The system needs HEE to be about the
current, not just the future.

10. Thinking and Leading…
Being proactive policy makers and
responsive problem solvers.
Being Thought Leaders, alone and with
others; using research, evidence and our
expertise to make a difference.
Turning the cutting edge of science into
real health interventions

11. Analysing and Influencing
Using our knowledge, analysis and expertise
to influence choices made about current and
future workforce solutions.
Providing an evidence based modelling,
intelligence and analysis service to the system.
Publishing regular data and intelligence
updates and reports.

12. Changing and Improving
Our workforce transformation and
leadership offer to LWABs and STPs.
Creating space for staff and stakeholders to
shared innovative and transformational
practice through technology.
Building leadership capacity and
capability for the NHS.

13. Delivering and Implementing
Our Priorities: Mandate: FYFV; improved medical
education and training system and sufficient
supply of the staff the NHS needs
Manage the education and training system for
thousands of individual clinicians, effectively
and safely.
Always being positive about the value we can add
including internationally, clinical academics, talent
management and careers not just jobs.

14. Focusing on Tomorrow
Always looking ahead: One Year;
Five Years; Fifteen Years…
Always about the new: roles;
professions; education and training
routes; career paths and new technology
Recognising that the workforce of today
is also the workforce of tomorrow

15. STPs and LWABS
• The LWAB is the means by which workforce issues arising from
the STP area based plans are addressed
• Broad membership – providers, commissioners, universities,
local authorities, third sector
• Developing workforce strategies to address particular challenges
• Shared Responsibility

16. Three options for change:
• Grow the workforce – example: an additional 75 Core EM
doctors commissioned per year for 3 years (2016 is third year)
• Upskill the existing workforce – £1.2m investment in advanced
practice training for existing paramedics
• Transform the workforce – examples: Nursing Associates and
Advanced Practice in Neonates

17. HEE Response to U&EC Review
• Additional EM doctors
• Paramedic training (PEEP)
• Physician Associates
• Clinical Pharmacists in ED
• Advanced Practice in ED
• HEE Local Office initiatives

18. South Yorkshire Workforce Initiatives
a) Excellence Centre Development for Bands 1- 4 to support new role
development and excellence in training
b) Area Wide Career Pathways – using a lead employer model enable
staff to move between organisations within an area to develop their
skills and expertise e.g. Paramedic secondments into urgent care
centres and emergency departments as part of their career rotation
c) CCG sponsorship of training places and development of a
preceptorship year to enable newly qualified PAs to take up new roles
in primary care
d) Continued development of new ACP roles and prioritisation of
funding to support such initiatives

19. North West - Workforce Transformation
• New ways of working• Up-skilling staff
• Workforce
Repository and
Planning Tool
(WRaPT)
• Population health
workforce planning
training
• International
recruitment
• OSCE Train
the Trainer for
International
Recruits
• Accelerated
registration of
overseas
qualified
nurses
• Developing supply
• Pharmacy
Technicians in
general practice
• Innovation
fundamentals
training
• Transforming
workforce culture
• Barratt’s
organisationa
l culture
assessment
• Team based
COM-B
approach to
changing
culture
• Assistant
Practitioners
• Advanced Clinical
Practitioners
• ED Pharmacists
• Community
Specialist
Paramedics & EMT
development
• Apprenticeships in
general practice
Contact: Kirstie Baxter, Head of Workforce Transformation
kirstie.baxter@nhs.net 0161 625 7283
@NHS_HealthEdEng
• Mental Health
Peer Support
Workers
• Nursing
Associate
• Physician
Associates
• Medical
Assistants
• New Roles

20. Articulating HEE’s
transformation offer:
the STAR tool
The STAR tool is a menu
of products and activity to
support workforce
transformation. The STAR
is a dynamic tool and will
be populated further with
developments to deliver
solutions to meet the
workforce challenges
emerging from STPs.

21. Transformation Challenge
• Why we need to transform is well known
• What we can transform into is known
• But How is the challenge addressed
Many of the workforce solutions have to be developed at
service level and accepted at service level if the change
is to effective.

22. Use the STAR tool to
identify and develop
workforce solutions

23. In Yorkshire & Humber we are
addressing the ‘How’ by using the
Calderdale Framework

25. Key Elements
• Facilitators trained in the use of the methodology
• Partnership working
• Sharing of learning and best practice
• Repository of competencies and job descriptions.

26. Application
• York Trust used the framework to develop the role of
the support workers – thereby releasing health
professionals within community services, emergency
services and laboratory services
• Define new ACP roles in Harrogate Trust
• Used within the 111 service to define new structures
and career frameworks. Currently being piloted
• Support worker roles within endoscopy services
• Supporting health professionals to work to scope of
practice

27. So what can you do?
• Engage with your local LWAB
• Through the LWAB develop area based workforce
strategies in partnership with all agencies
• Support other organisations with their plans and roll
out
• Share best practice

28. Any Questions?
Kevin Moore
kevin.moore@yh.hee.nhs.uk

29. Modernising the
Workforce: Physician
Associates
Miss FM Kew
Consultant Gynaecologist, Sheffield Teaching Hospitals

30. Physician Assistant

31. Briefly
• 1965 – Duke University
• WW1
• Vietnam War
• a health professional who practices medicine with the
supervision of a licensed physician
• The PA is distinguished from other health care professionals by
his education as a generalist, by the breadth of his clinical
knowledge, by the extent to which he is given decision-making
authority regarding patient care, diagnosis, and treatment,
and by the depth of his clinical experience.

32. What do physician associates do?
work within a defined scope of practice and limits of
competence. They:
> take medical histories from patients
> carry out physical examinations
> see patients with undifferentiated diagnoses
> see patients with long-term chronic conditions
> formulate differential diagnoses and management plans
> perform diagnostic and therapeutic procedures
> develop and deliver appropriate treatment and management
plans
> request and interpret diagnostic studies
> provide health promotion and disease prevention advice for
patients.

33. What can’t they do
• Prescribe
• Order ionising radiation
• Practice without clinical supervision

34. What does ‘my’ PA do

35. Megan’s timetable
Monday Tuesday Wednesday Thursday Friday
Outpatients
(oncology)
Theatre Theatre
(robotics)
Outpatients
(2ww clinic)
Outpatients
(2ww clinic)
MDT meeting Theatre Theatre
(robotics)
Outpatients
(gynae
oncology)
CPD

36. What does Megan say? Good
• Clear expectations
• Good job plan, reflecting all abilities
• Flexibility and re-assessment
• Working with a steady group of small consultants
• Close working relationships
• Being treated as a clinician and not a trainee
• Not being on the trainee rota
• No adverse affect on junior doctor training

37. Could be improved?
• Orientation and access to computer systems
• Not a nurse or a doctor!
• Make available an informational summary about what a PA is

38. What do I say?
• When can I get some more?
• Currently trying to draw up possible job descriptions for new
graduates
• Plan to use them in general gynae
• Recognise that they will not be Megan, at least not for quite a while
• Make sure they have a close working relationship with permanent
medical staff
• They are trained in a medical model – they are not advanced nurse
practitioners, and they are not junior doctors
• They form a complementary part of a team, they are not a
replacement

39. 7 Day Services

40. 7 Day Service
Seven Day Service Provision
• Level 0 – Five days a week – Routine service
Mon-Fri
• Level 1 –Departmental level, extended hours e.g.
8am – 8pm
• Level 2 – Services are delivered seven days a
week, but limited range of services on a Saturday
and Sunday. This limited range of services goes
beyond “on call”
• Level 3 – Services offered seven days a week
with several departments working together to
provide services across the organisation
• Level 4 – An integrated seven day service across
the organisation

41. 7 Day Service
Level 1 - 3 Session Day Working
• Monday to Thursday
• 3 Sessions working (8.30 am to
8.30pm)
• Increase Capacity-16 lists per
week.
• Increase Capacity- In-patients –
with Evening lists
• Increase Capacity- Complex
work- Move diagnostics to
evening increase daytime lists
for complex

42. 7 Day Service
Level 2 & 3 – Inpatients & 7 Day
Service• Increased Clinician and nursing workforce
• Reviewed all job plans and made it
equitable
• Increased PAs for on-call for consultants or
time-back
• In-patient List only
• Weekend- Ward Round/In-patient List on
Sat, Sunday, BH (Inc. X-mas)
• Re-issued 7 day contracts for endoscopy
nurses/HCA following consultation
• Centralised Decontamination to Endoscopy
Unit
Workforce 2005 2015
Consultants 6 13
Associate Specialist 0 1
Fellow 0 2
Nurse Endoscopists 1 5
Band 8A 0 1
Band 7 2 2
Band 6 2 5
Band 5 12 22
Band 4 1 3
Band 3 6 17

43. 7 Day Service
In-Patient Referrals
Patterns
0
2
4
6
8
10
12
14
16
Friday Saturday Sunday Monday
Pre-Working
Weekend Working
UGI Bleeding Mortality
Comparison National & RLH
199
3
200
7
200
9
201
1
201
3
201
5
Nationa
l
14% 10% N/A N/A N/A N/A
RLH 5% 3% 0% 0% 0% 0%

44. For more details please contact:
Royal Liverpool and
Broadgreen University
Hospitals NHS Trust
T:
M:
E:
Thank you.
0151 706 2800
07342073613
Darren.mcguiness@rlbuht.nhs.uk
Darren McGuinness
Directorate Administrator
Acknowledgements
Dr Sanchoy Sarkar PhD. FRCP
Endoscopy Lead & CD of BCSP- Royal Liverpool
Hospital

45. Seven Day Services In
Radiology

46. Patient safety
 Mortality rate
 ED at front door , inner city trust Trauma team, stroke service,
Improved access to diagnostics
 Reduce delays
 Prompt diagnostics aide decision making
Improved clinical outcomes
 Right thing to do for acutely ill patients
 Reduces peaks and troughs and batching
Improved Patient experience
 Reduce frustration anxiety
 Support working population
Improved efficiencies
 Equipment fully utilised
The Case for Change

47. Informatics metrics
Radiology demand and year on year largest growth within NHS Trusts
over four years:-
• X-Ray 8%
• CT 38%
• MR 41%
• USS 19%

48. Effective job planning.
 Radiologist/radiographer flexibility skill mix/impact of MDT/ on call
 Creative approach retention /recruitment
 Focus on robust training programmes
Organisational change processes
 HR - Business change leads
 Understanding of contractual obligations and AFC rules/overtimes
 Support for work life balance
Leadership challenges
 Engagement and buy in
 Communication to teams
 Communication across the Trust /business units.
Workforce challenges

49. Effective business planning
 Resource implications
 Impact of other care groups
 Business cases – board support
Improved efficiencies
 Improved scheduling
 Reduce DNA- Text reminder – patients choice
 On line vetting
Accurate data - remodelling of service
 Demand and capacity
Create enhanced inpatient services
 Prioritising care – KPI
 Expedite discharges
Service delivery

50. • Inpatient Liaison nurse within IR
• On line vetting
• Radiologist Clinic
• Manager of the day
• USS reporting directly
New initiatives

51. For more details please contact:
Royal Liverpool and
Broadgreen University
Hospitals NHS Trust
T:
M:
E:
Thank you.
0151 706 2909
Nicky.taggart@rlbuht.nhs.uk
Nicola Taggart
General manager Radiology and Imaging

52. www.england.nhs.uk
Any Questions?

53. www.england.nhs.uk
The next #NHS7DS webinar is:
The importance of Clinical
leadership in establishing Seven
Day Services
It will be held on 7th February 2017, 13:00 – 14:00.
Please email england.si-7ds-support@nhs.net for details
of how to register or register here http://bit.ly/2k7ZIFM
The Next Webinar