Embracing ChangeDonna Poole, Acting Head of TransformationHealth Education England Kent Surrey and Sussex

Long Term Plan and Interim People plan

• All the workforce formal and informal

• Flexible working and build career pathways

• Multidisciplinary teams

• Value and enable all the workforce

• New roles, new ways of working, upskilling, leadership at all levels and in all

workforce

• Innovation, technology, digital

• Equip the workforce with the skills to operate at advanced levels of practice

• Enable level of practice to be identified and valued

• Expand multi-professional credentialing to enable clinicians to develop new

capabilities

• Making the most of the skills mix and expertise will form a critical component

of building the flexibility of the workforce to better meet needs of populations

• Evidence consistently shows that multi-professional team working delivers better outcomes for patients and more effective and satisfying work for clinicians.

• Multi-professional work requires flexibility in attitude and behaviour and for professionals to value and respect the distinct contribution each professional makes

http://www.aomrc.org.uk/wp-content/uploads/2017/10/JOINT-PROFESSIONS-STATEMENT-

111018.pdf

• New ways of working and delivering healthcare requires employers to ensure that clinicians have the professional development they need to adapt to changing circumstances

• New solutions are required to deliver healthcare to meet the changing needs of the population. This will need new ways of working, new roles and new behaviours.

http://www.aomrc.org.uk/wp-content/uploads/2017/10/JOINT-PROFESSIONS-STATEMENT-

111018.pdf

Transformation

Drivers for transformation of the workforce:

• offering careers and not just jobs, so that people can see a self actualising and supported career path

• a mid career upskilling moment to build skills in person centred approaches, population health understanding, mental health skills, drive digital literacy and innovation.

• maximising rehabilitation, prevention and addressing health inequalities, supported self management and paying more attention to bio-psycho-social approaches to care

• to support the rethinking of modern teams, build the team around the patient and family, redistribute workload to meet the needs of populations, support the whole workforce and better utilise the skills of all, within a place

Key enablers of workforce transformation

LeadershipUp-skilling

Identifying current

and future

workforce

availability in terms

of skills,

capabilities and

numbers, in order

to identify the

appropriate

workforce

interventions.

Supply

Emphasis on

developing an

integrated

workforce culture

that empowers it

to break through

system barriers

and deliver a

practical

response to

support and

enable person-

centred care

across a system.

To improve the

aptitude for work of (a

person) by additional

training *

the aim of which is to

create:

• A competent

workforce working

to its maximum

potential

• An agile workforce

that may be flexibly

deployed

• A capable

workforce with

future-facing

knowledge and

skills

*Collins English

Dictionary, 2014

Health and care roles

designed to meet a

defined workforce

requirement, warranting

a new job title; the likely

ingredients including

additionality to the

workforce, a formal

education and training

requirement (whether

that be vocational or

academic), an agreed

scope within the

established Career

Framework, and national

recognition (although not

necessarily regulatory)

by clinical governing

bodies.

New roles

The support of

individuals,

organisations and

systems in their

leadership

development –

ranging from

individual

behaviours and

skills, to

organisational

development of

systems through

partnerships.

New ways of

working

• Purpose- what issue are you trying to approach and resolve? for whom and what

• Start with the patient/service user/population need

Structure to thinking

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• STOP! • Define the issue

• ALL the right

people involved?

• Common language

• Patient pathway

Particular

area of

practice on

journey

Population

health need

Impact

Transformational

impact

Quality and

safety impact

Patient

group

impact

Population health risk stratification• TIER 4 complex, high need, case

management

• TIER 3 rising risk, multiple conditions care management

• TIER 2 supported self care/ disease management

• TIER 1 self care, health and

well being

what does the population need from health and social care services?

A SMALLER GROUP OF PEOPLE THAT

may need specific expert clinical knowledge and skills capability for people living with conditions requiring particular nutritional

support and input

• regular focus and contact

A RANGE OF PEOPLE THAT NEED GREATER KNOWLEDGE AND UNDERSTANDING AND

SKILLS

• a range of specific knowledge and skill in relation to people living with nutritional

support needs

• in contact with people living with conditions that require nutritional support

A LOT OF PEOPLE WITH SOME KNOWLEDGE AND SKILL

• a broad general understanding and awareness with some use of knowledge and skills relating to nutritional needs

• Public health and prevention and awareness of nutritional needs

What do we need to know and be able to do?

WORKFORCE- who?

Patient Journey

• is a conceptual map

• Its use is intended to help enable visualisation of the patients journey across services and systems

• The patients’ needs come first- what does the patient need from the service? What skills, knowledge and behaviours do they need? What does their journey look like?

• The patients’ pathway can be mapped so that their care needs can be seen holistically rather than in a fragmented way.

• It enables the “zoom out” view of what that journey may be like in an integrated way across primary, community and secondary care, and what impact it has on the patients needs and experience.

Transition zones• There are zones of transition in this journey (blue arrows)

where it may be crucial to, for example:

» change the direction of the journey or location of

intervention and care e.g. frailty,

» think about the skills, knowledge, behaviours and

capabilities of the workforce in those zones e.g.

ACP, NA,

» and the relationship with the patient and family and

their experience e.g. care navigation or co ordination

Learner Journey

• Who is our workforce now?

• Who is our workforce of the future?

• What do they have in terms of knowledge skills and behaviours already?

• How do we/they assess gaps in knowledge?

• How do we top them up?

• How do we build it into learning pathways and development plans?

• Where to learn? How to learn? What to learn? Who helps me learn?

• Service users essential

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• Not skills buckets

• Increasing Capabilities to manage complexity, uncertainty, risk, responsibility and accountability for decisions made

• Build team around patient/ person

Levels of practice

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Spectrum of development and levels of practice

for each step of the patient journey there is a whole

workforce of learners at all stages and levels…..• What are the core capabilities,

skills and knowledge that are needed for each part of the patient journey?

• What do you offer already that could tie it together and be built in to a solution? I.e. undergraduate support and development, induction and preceptorship programmes, ongoing education, coaching, mentoring, shadowing, rotation opportunities.

• Same roles but enabled to

work in a different part of the

pathway?

• Think about using the

workforce in a different way in

a different place to enable that

journey to change it for the

better, e.g. not into acute but

treat in community at home?

HPN

• What would that learner need to be able to work in a different zone of the journey? would you like to develop more generic capabilities and skills and knowledge or specific ones to work in specialities?

• How could potential to work in and across different parts of the patient journey be built in along the learners’ journey of development in a career pathway?

• Development of career pathways to attract high quality staff, this may include research opportunities and evaluation of service?

• What technology and shared learning tools can you utilise in your solutions?

• technology advances that may affect new ways of working E.g. simulations-could that be used/ offered more broadly/widely across professions?

• What about genomics?

• How to build confidence to work in a different system across different systems? i.e. acute to community or primary care based on the patients’ needs. What would help enable that?

• Consider analysis of education and training required to support the workforce with new ways of working, impact on undergraduate and postgraduate formal education and training pathways, any requirements for change in curriculum, educational placements –maybe experiences following the patients’ pathway instead throughout training etc. Thoughts about future workforce required may be substantially different from current capability.

Pathways to Train 2022

Apprenticeships and national procurement frameworks

across professions

Employer/HEE Workforce development/Self funded route

(Modular)

Equivalence route (Masters Level ACP).

• Quality Assured programmes for ACP that meet the national

standards held by the HEE Academy of Advanced Practice.

• Nationally recognised specialty specific/bespoke routes

@NHS_HealthEdEng @BeverleyHarden #ACPfit4thefuture

Ways to Train 2022

• Clinically specific components are driven by patient safety

and service transformation, portfolios evidence effective

clinical learning and progression.

• Work-based learning, capability development and

educational/ clinical supervision have revolutionised clinical

skills acquisition in the work place.

• Trust, respect and mutual understanding is built training

side by side in service.

@NHS_HealthEdEng @BeverleyHarden #ACPfit4thefuture

Advancing Clinical Practice in 2022

How we optimise the opportunity and safety:

• The mid career upskilling is exploited to modernise skills,

focus on population health and prevention, person centred

communication, supporting the digital revolution.

• The education pillar is positively exploited to build learner

capacity in the work place at every level.

• There is equality of opportunity across the workforce.

• Patient safety remains central to the work.

@NHS_HealthEdEng @BeverleyHarden #ACPfit4thefuture

Advanced Clinical Practice Defined

‘Advanced clinical practice is delivered by experienced, registered health and care practitioners. It is a level of practice characterised by a high degree of autonomy and complex decision making. This is underpinned by a master’s level award or equivalent that encompasses the four pillars of clinical practice, leadership and management, education and research, with demonstration of core capabilities and area specific clinical competence.

Advanced clinical practice embodies the ability to manage clinical care in partnership with individuals, families and carers. It includes the analysis and synthesis of complex problems across a range of settings, enabling innovative solutions to enhance people’s experience and improve outcomes.

This definition therefore requires that health and care professionals working at the level of advanced clinical practice will exercise autonomy and decision making in a context of complexity, uncertainty and varying levels of risk, holding accountability for decisions made’ (Health Education England, 2017)

A level of practice not a role:

• ACP manifests itself in different types of role, dependent upon the needs of service, characterised by the level of practice

• Spectrum of roles

– furthering existing area of expertise with a broad base e.g. paediatric dietician ACP

– or broadening existing expertise e.g. learning disability ACP

– or building upon and developing new knowledge and skills e.g. surgical ACP

• Each requires different approaches to education, support and development leading to the same outcome

Advanced Clinical Practice in 2022

How we make this work at scale:

• We have moved beyond ‘one trusted’ individual.

• There is now a supply of nationally transferable

meaningful qualifications across the specialities.

• People are supported to ‘work to the top of their

licence’ and pathways rely on their integrated skills

• The workforce can see a career of valued, supported

progression as opposed to ‘just a job’

@NHS_HealthEdEng @BeverleyHarden #ACPfit4thefuture

Advanced Clinical Practice • The work is being coproduced across

the system to ensure that all solutions are appropriate and focussed relentlessly upon safety, the supported development of the workforce and system confidence.

• Working with NHSI, NHSE, AoMRC, Council of Deans for Health, the Regulators, NHS Employers, NHS Partners plus a variety of key stakeholders. All professions, all specialties, all sectors.

• The work supports all regulated healthcare professions e.g. Healthcare Science, Midwifery, Allied Health Professions, Nurses, Psychology, Physicians Associates, Pharmacy, Dental Nurses.

Keeping it safe

• The co-production of the ‘Academy of Advancing Practice for oversight

and support

• HEE Quality Standards Frame work- learning environment, supervision,

culture

• The wicked issues discussed

• Regulators

• All have a role to play:

• patient safety,

• research and evaluation,

• impact and outcomes,

• leadership,

• articulate value,

• share learning and support others,

• co production with citizens for citizens

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