Improving access to seven day services - Taunton 4th March 2015 The first of the regional events for the south took place in Taunton on 4 March. Over 100 delegates from local health and social care organisations came together with patient, public and voluntary sector representatives to hear about the expectations, opportunities and challenges of delivering seven day services and to review and further develop plans for their local communities. Interactions between the delegates in their local health and social care communities, supported by the NHS Improving Quality team, made this a vibrant event with everyone contributing to the table discussions during the day. Key themes emerging during the day included: • The need for system resilience group members to fully understand the skills and “offer” that each of them can bring to the table to improve health and social care seven days a week. This was highlighted in discussions around clinical standard 9, which many groups focussed on as their top priority. • The need to have an effective system of information sharing between all parts of the health and social care system. • The huge role that patients and public groups have to play in planning services.

1. 2015
Training and Up-skilling the
Workforce to Deliver Effective 7-Day
Services – Improving Access and
Quality Across the NHS
- Patrick Mitchell
Director of National Programmes

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HEE exists:
To improve the quality of care delivered to patients. Through our
Local Education and Training Boards (LETBs), we ensure that our
workforce has the right skills, values and behaviours, in the right
numbers, at the right time and in the right place.
HEE promises:
to oversee that education contracts include consultant availability to
provide adequate supervision of doctors in training 7 days a week.
Health Education England

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Our business

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How it all fits together –
our key documents
Informed by
local plans
15 year strategic framework (F-15)
Revised Mandate
2015/16
Business Plan 15/16
Workforce Planning
Guidance
Workforce Plan for England 15/16

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Local
Planning
National
Planning
Provider
Forecasts
LETB
Aggregate
provider
Forecasts
LETB
Investment
Plans
England
Wide
Forecasts
Workforce
Investment
Plan for
England
LETB 5
Years Skills
Strategies
Call for
Evidence
Local
Challenge,
triangulation
and
moderation
HEE Workforce Planning
Process 2015/16
ALBs,
HEEAGs, and
PAF
National
Challenge,
triangulation
and
moderation
Commissioners
HEIs, and Other
Partners
Strategic Intent
Document and
Mandate

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Workforce plan for England extract

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Which Doctor do we require?
Reproduced under licence from bbc.co.uk- 2013

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Competency frameworks
• Workforce competency review and skill mix planning should be clinically led
and supported by HR and workforce planners.
• Yorkshire and Humber LETB have adopted the “Calderdale framework”
across their geography with all 16 trusts signed up to its use.
• Provides a single language and way of working thus providing opportunities
for shared education and training across multi-professional groups.
• Provides a shared understanding of roles, skills and professional
accountabilities.
• Supported development of the alternative workforce – right skills and
competencies for a given clinical workload.

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Advanced clinical practitioners
• Advanced clinical practitioners across a range of nursing, science and AHP.
• ACP in EM - development group have defined a core minimum set of
competences for ACPs based on the Membership examination for the
College of Emergency Medicine - first time there is a national minimum
standard for ACPs.
• Maps to Calderdale framework.
• Next steps are to:
o Describe and agree educational preparation
o Define the assessment framework
o Develop a national growth plan by geography
o Disseminate the work

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Physician Associates
• About 250 physician associates working across UK and over 100 in
training.
• Mostly Science graduates that undertake a further 2 years training.
• Work in many areas of secondary and primary care.
• Barrier to their employment – not able to prescribe medication/request
x-rays.
• HEE supporting Royal College of Physicians to create a Faculty for
PAs.
• Faculty will manage voluntary register, re-accreditation examinations
and CPD.
• HEE and RCP Faculty will lobby for form of statutory registration -lead
to work to enable prescribing for PAs.
• 6 programme in England - at least 12 more opening between 2015/17.
• HEE in discussion with DH on options for ongoing funding.

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Pharmacists
• Very likely surplus of pharmacists in the system.
• The role of community pharmacists is emphasised within the Urgent and
Emergency Care review.
• New programme for developing community pharmacists’ clinical
consultation skills.
• Some GP practices employing clinical pharmacists as part of team.
• National pilot roll-out - pharmacists in the Emergency Department staffing:
o Managing minor ailments at front door of ED
o As a specialist pharmacist supporting the wider clinical team and
reducing poly-pharmacy

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Paramedics
• The Paramedic Education and Training Steering Group to make
recommendations with respect to the conclusions from the Paramedic
Evidence-Based Education Project (PEEP).
• Review of scope of practice and education entry level, careers structure,
financing education and training.
• Close work with College of Paramedics and Ambulance services in UK.
• The Urgent and Emergency Care Review recommends using paramedics
to manage the “hear and treat” and “see and treat” initiatives.
• The group will also consider the use of paramedics within ED and primary
care.
• National shortage appearing – need to increase training commissions
substantially.

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Workforce support –
Better Training Better Care
Aims to improve the quality of training and learning for the benefit of
patient care
Professor Sir John Temple: Time for Training
• ‘Making every moment count’
• ‘Appropriate supervision’ and/or ‘Consultant present service’
• ‘Service delivery must explicitly support training’
Published evaluation and tools on HEE website for anyone to use and adopt/adapt

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East Kent Hospitals NHS Foundation Trust–
Hot and Cold Teams: Enhancing Trainee Experience, Improving Patient Care
Reduced
length of stay
for patients at
weekends
Increased
attendance at
clinics by
training
doctors
Improved
handover
(Friday) and
support for/
supervision
of trainees
Increased
number of
safe,
appropriate
discharges at
weekends
Redesigned the service model in medicine in
order to:
1. Improve patient care/safety out-of-hours
and at weekends
2. Improve supervision/support for trainees
3. Provide improved/increased educational
opportunities for trainees.

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BTBC
Training Outcomes
1.Improved Handover
2.Increased opportunities for clinic
attendance.
3.Improved supervision.
4.Improved opportunities for practical
procedures.
Patient outcomes
•1.Reduction of length at weekends
•2.Increase in weekend discharges c. 30%
•3. Reduction in weekend mortality.
•4. Reduction in SUIs involving juniors at
weekends.
7 day working
Through the creation of a weekend multi-professional (doctors, nurses, HCAs,
medical students and managers), ward-based, cold team, we have helped move
towards 7 day working.

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Mid-Cheshire Hospitals NHS Foundation Trust –
Enhanced Training & Education in Handover & Supporting Electronic Solution
Demonstrated an
82.6%
improvement in
‘out of hours’
tasks being
handed over and
completed after
the interventions
Statistically
significant 10%
increase in ‘out of
hours’ discharge
rates, without any
negative effects on
length of stay
Video observation
results revealed
that 60% of
handovers
adhered to the
‘Think FIRST’
technique
Estimated
£156,200 savings
over 3 months
1. Provide training to develop key handover
skills such as leadership, task prioritisation
and time management
2. Support handover
3. Modify the structure, standardise the handover
process and utilise the good practice
guidelines.
Pilot project

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Enabling 7 day Care &
Hospital at Night
Supports 7 day care
• Rota redesign and out of hours care
• Provision of dedicated learning time at weekends
• Improvement in out of hours tasks being completed
• There has been a statistically significant increase in out of hours discharges and
reduction in length of patient stay.
Supports Hospital at Night
• Pilots have encouraged managers to look at what happens in their hospital night
• Supports HaN as the means to raise awareness of patient safety and maximise
efficiency of staff at night
• Places the patient in the centre of any change process

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Trainees as change agents
Trainees demonstrated outstanding leadership skills championing their pilot
projects during implementation and outside of the pilot environment.
Mid Cheshire –
Handover
Trainees moved to other
trusts and requested the
pilot initiative to be
implemented in their new
roles.
East Kent – EM rota
Trainees displayed
strong leadership and
enthusiasm for the pilots
and trainers reported
strong leadership of FP
doctors and registrars in
handovers.
Leeds and York –
Decision making in
psychiatry
Trainees championed the
system and took on a
strong leadership role
from the outset.
Trainees felt better
supervision and support
allowing them further
development
Clear leadership in the
handover process was
clear in 100% of meetings
100% trainees higher
confidence, 83% felt
benefitted by the change

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Integration of training
in care
Trainees became more integrated in the delivery of care and in the wider multi-
disciplinary team. This has had a positive effect on patient care and improved
communications and multi-disciplinary team working.
King’s – RAT+
Increased consultancy
support, improved patient
time to treat and
presented opportunities
for nurses to develop.
Mid Cheshire –
Handover
Greater consultant input
at handover meetings,
with registrars taking on
leadership roles in their
absence.
Dudley – Prescribing
Better working relations
and understanding
between pharmacist and
trainees, with improved
knowledge by trainees in
prescribing and in
national guidelines.
82.6% improvement in
‘out of hours’ tasks
handed over and increase
in staff satisfaction
Significant improvements
in time to treatment and
time to referral
Improved relationships in
pharmacy department

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Impacting on culture,
efficiency and effectiveness
Leeds and York –
Decision-making in
psychiatry
Rota change allowed
more trainees to come on
day duty and have
greater exposure to
training and support, this
improved productivity,
communications and
MDT working
Mid Cheshire –
Handover
Greater degree of
efficiency in performing
handovers , better quality
information recorded and
an increase in the
number of tasks
completed.
South Manchester –
Surgery
Reconfiguring theatre
lists exposed trainees to
concentrated training in
specific areas, trainees
developed better skills
and gained confidence in
performing simple
procedures across
specialities
Several of the pilots have had a positive impact on culture, efficiency and
effectiveness in the implementation of their pilots.
82.6% improvement in ‘out
of hours’ handover and 10%
increase ‘out of hours’
discharge
Increases of 37.7%
weekday, 29.1% weekend
and 22.1% night shift
activity
12.7% increase in
supervised operative
training

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Summary
Supports 7 day care
• This is not just about doctors
• It takes time to produce the future workforce!
• Competency frameworks can support clinical workforce planning
• Don’t throw doctors and nurses at this without looking at the alternatives
on offer
• Work with local workforce planners and the LETB to develop what you
require
• Don’t forget the current workforce needs
• Think Human Factors
• By reviewing medical education organisation and delivery (Temple) you
might solutions closer and cheaper to home!