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.

1. The CfWI produces quality intelligence to inform better workforce
planning that improves people’s lives
Planning your workforce for future
uncertainty
Primary Care & Public Health Conference
22 May 2013
Greg Allen, COO CfWI

2. 2
The new healthcare system in England

3. Our Mission
To become the
primary source of
workforce
intelligence for health
and social care
We produce quality
intelligence to inform
better workforce
planning that improves
people’s lives

4. Our vision
To be the national
authority on workforce
planning and
development,
providing advice and
information
to the NHS and social
care system.
Our values
 Everyone working
together
 Quality counts
 Respect
 Improving lives
 Dignity
 Compassion
 Care

5. The care and health workforce in
England 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
Demands on the healthcare sector...
... will evolve with changing demographics and societal shifts. How can we
plan for and develop the healthcare workforce to meet these demands?

7. 7
The future of primary care & general
practice
 Those starting training now will still be in
practice in 2050
 The pace of change is increasing
 The NHS is facing unprecedented
challenges
 We will be working differently in the
future

8. 8
Some statistics about primary care
• 90% of all patient contact is in primary
care
• The NHS Budget is expected to be
under significant pressure despite being
“ring-fenced”
• Spending on primary care rose by 1.3%
last year compared to 5.1% for
secondary care
• 22% of GPs are aged over 55
• 20% of Practice Nurses are aged over
55
• 10,000 GPs intend to retire in the next 5
years
• Doubling in demand for consultations in
the next ten years

9. 9
GPs as a proportion of all NHS doctors
(England)

10. 10
Our workforce planning framework
Improving the quality of workforce intelligence

11. 11
Macro-level
research
Horizon
scanning
Scenario
workshops
Parameters
defining
possible futures
Workforce
model
Forecast
supply and
demand
Sensitivity
analysis to
identify critical
parameters
Workforce
data and
assumptions
Delphi
Micro-level
research
Policy
interventions
Our horizon scanning work aligns with
wider scenario generation and
workforce modelling. Our outputs
inform later research activities to
produce workforce intelligence.
From horizon scanning to final report...

12. 12
Scenario generation workshop

13. 13
Our medical workforce supply model
medical
school
Foundation
1
Career post
Foundation
2
Core
training
Run-
through
training
GP training GP
Higher
specialty
training
Hospital
consultant
Consultant
to GP
training
Not shown but modelled
• Attrition from stocks
• Exits out of system
• Inflows from overseas and re-
joiners
• Re-sits
1. Highly configurable
2. Ageing in one-year bands
3. Migration can be modelled (but
we lack data)
4. SAS doctors data and modelling
need improving

14. 14
What is our review seeking to
address...
Considering the likely changes to service delivery
and the role of GPs over the next 20 years, how do
we ensure sufficient supply for the future general
practitioner workforce?

15. 15
How are we addressing this?
 Review current workforce capacity issues in general practice
 Assess the current GP recruitment target for England and review
options for GP training and recruitment targets beyond 2015
 Understand the likely impact of possible future shifts in care in the
medium and long term
 Develop and refine the CfWI’s GP system dynamics model
 Make recommendations, if appropriate, on GP service delivery models
and affordability of different options

16. 16
Sources: NHS HSCIC 2006a, 2006b and 2012a
GPs (excluding retainers and
registrars)
Practice nurses 0
1
2
3
4
5
6
7
8
0
5,000
10,000
15,000
20,000
25,000
1995 1997 1999 2001 2003 2005 2007 2009 2011
RatioGP:practicenurse
Numberofpracticenurses
Practice nurses headcount (left axis)
Practice nurses FTE (left axis)
Ratio GP: practice nurse (right axis)
The general practice workforce

17. 17
0
20
40
60
80
100
120
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
1995 1997 1999 2001 2003 2005 2007 2009 2011
GPsper100000population
NumberofGPs
GPs 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 retainers
The GP workforce 1995-2011

18. 18
Source: NHS HSCIC 2011
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
Under 25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70 and
over
Unknown
Headcount
Age band
Men Women
GPs by age band and gender

19. 19
Source: GP National Recruitment Office (2012), Health Education England (2013a)
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
0
1,000
2,000
3,000
4,000
5,000
6,000
2009-2010 2010-2011 2011-2012 2012-2013 2013-2014
Competitionratio
GPtraineenumbers
Recruitment year
Applicants (right axis)
Vacancies (right axis)
Accepted offers (right
axis)
Competition ratio (left
axis)
GP postgraduate trainee recruitment
(left axis)
(left axis)
(left axis)
(right axis)

20. 20
• CfWI’s analysis points to a GP workforce under strain. GP
workforce numbers need to be lifted to more sustainable levels
• If the recruitment target of 3,250 GP trainees per year in England
is achieved by 2015 and maintained it will result in an increase
of about 15,300 GPs by 2030 compared with 2011 levels
• If this boost in GP training is coupled with other measures to
improve supply and manage demand, it may be sufficient to meet
expected patient demand to 2030
Preliminary findings I

21. 21
• By 2030, we expect women to be the majority of the GP
workforce
• Our projections suggest the average age of GPs will be
lower, and the number of GPs in their thirties will have
doubled
• There are fewer ‘single-handed’ practices; very large
practices now see around one in seven patients and are
growing rapidly
• There has been a shift towards more salaried GPs and fewer
GP partners, which is likely to continue
Preliminary findings II

22. 22
30,000
35,000
40,000
45,000
50,000
55,000
2010 2015 2020 2025 2030
Full-timeequivalent
Demand - baseline GPs
Supply - baseline GPs
Source: CfWI system dynamics medical workforce model for England
GP supply and demand baselines

23. 23
30,000
35,000
40,000
45,000
50,000
55,000
2010 2015 2020 2025 2030
Full-timeequivalent
Demand - baseline GPs
Supply - baseline GPs
Demand - scenario 1 - 6
Source: CfWI system dynamics medical workforce model for England
With demand scenarios added...

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
30,000
35,000
40,000
45,000
50,000
55,000
2010 2015 2020 2025 2030
Full-timeequivalent
Demand - baseline GPs
Supply - baseline GPs
Demand - scenario 1 - 6
Supply - scenario 1 - 6
Source: CfWI system dynamics medical workforce model for England
and supply scenarios

26. 26
• Work to achieve the recruitment target for England of 3,250 GP
trainee places per year by 2015 and maintain training at that level
• A substantial share of this workforce increase should go towards
improving support for under-doctored areas
• Other measures to improve workforce supply and manage
demand
• Regular reviews of the GP workforce at least every 3-5 years
• More frequent data on GP activity and consultation rates
Emerging recommendations I

27. 27
Source: NHS HSCIC (2011) and the CfWI system dynamics medical workforce model for England
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 79
NumberofGPs
2000 2010 2020 2030
Age of GPs - 2000 to 2030

28. 28
• Action needed to improve the attractiveness of general practice
and to retain the existing workforce
• More flexible and open ended medical career pathways
• NHS commissioners to encourage more innovative and
collaborative approaches to primary care delivery
Emerging recommendations II

29. Preliminary
findings
http://www.cfwi.org.uk/publications/gp-in-depth-review-preliminary-
findings
• We look forward to hearing the views
of GPs, other health
professionals, professional
bodies, employers, patients and the
public
• Please email your views or
evidence, or contribute to our
LinkedIn online forum:
• http://www.linkedin.com/groups/Friends-
Centre-Workforce-Intelligence-CfWI-
4274008
• The Preliminary findings report can
be downloaded from:

30. Centre for Workforce
Intelligence