OTs should be placed in multi-disciplinary teams in GP practices

Report offers solutions to workforce problems in the NHS

Published on 25th March 2019

Staffing is the make-or-break issue for the NHS in England, according to a joint report by The King's Fund, the Nuffield Trust and the Health Foundation.

The report 'Closing the Gap' states that workforce shortages are already having a direct impact on patient care and staff experience.

"Urgent action is now required to avoid a vicious cycle of growing shortages and declining quality," said the report. "The workforce implementation plan to be published later this year presents a pivotal opportunity to do this."

The report, which focuses on nursing and general practice where the workforce problems are particularly severe, warns that there "are no silver bullets". However, the report makes recommendations with high-impact policy actions which, if properly funded and well implemented across the NHS would over time create a sustainable model for general practice and help to eliminate nursing shortages.

The measures would require investment of an extra £900 million per year by 2023/24 into the budget of Health Education England.

The report suggests that, on current trends, in 10 years’ time the NHS will have a shortfall of 108,000 full-time equivalent nurses. Furthermore, even with a major focus on increasing the number of GPs in training, the report projects that the numbers of GPs in the NHS will fall substantially short of demand and of the government’s target of an additional 5,000 GPs.

Recommendations include:

- The government should significantly increases the financial support to nursing students with ‘cost of living’ grants of around £5,200 a year on top of the means-tested loan system.

- Further action, including covering the costs of tuition fees, should be taken to triple the number of nurses training as postgraduates.

- Substantial progress towards a new model of general practice with an expanded multidisciplinary team drawing on the skills of other health care professionals.

- The workforce implementation plan must focus on how the NHS can become a better employer and a place where staff want to build a career.

- The current Agenda for Change pay deal runs until 2021. Beyond then pay in the NHS will need to continue to rise in real terms in line with wider economy earnings.

- A fourfold increase in the current workforce development budget is required to accelerate change and support people to adapt and enhance their skills, particularly in line with technological advancements.

- A sector-specific route for international migration that works for social care post-Brexit, as current proposals will not be adequate.

"The workforce has not been a policy priority: responsibility for it is fragmented nationally and locally, the information the NHS needs to understand and plan its workforce remains poor, and the NHS has not invested in the leadership capability and skills needed to manage the workforce effectively," said the report.

"The government cannot continue to view education and training as an overhead cost to be minimised. The forthcoming NHS workforce implementation plan needs to address not just specific policy areas but also the roles, responsibilities, skills and capabilities needed across the system for more effective workforce planning. But above all, it is a plan that needs to be properly funded," it added.

Julia Skelton, Director of Professional Operations at the Royal College of Occupational Therapists, said: “We agree that multidisciplinary teams are essential to making the most of resources while delivering the best care for patients. Occupational therapists should be at the heart of these teams, equipped as we are with all the right tools to deliver tailored physical, mental and social care.

“As we said in our report Living, not Existing: Putting prevention at the heart of care for older people in England, more occupational therapists should be based within GP practices and local care hubs to empower people to manage their health and independence. Our role and interventions are key to providing greater prevention and personalisation of care through assessment of frailty needs, home modifications and developing self-management skills for long-term conditions, including mental health ones.

“To make this happen, the shortfalls in recruitment of the occupational therapy workforce need also to be addressed as a priority," she concluded.

Glen Garrod, President of the Association of Directors of Adult Social Services, added: "Adult social care derives its strength from the many people who work in it.

“Our valued, dedicated and skilled workforce, which includes care workers, activities coordinators, personal care assistants, social workers and occupational therapists, perform essential everyday tasks to help look after those who rely on them.

“This report rightly highlights that a comprehensive overhaul of social care funding is needed immediately to stop staff leaving the sector due to lower pay and conditions. This runs the risk of being exacerbated by pay policies for NHS staff such as increased training and bursaries, potentially attracting people with some of the same skills and qualities needed in social care.

“In the last year, social care has shown how vulnerable it is with both national and local providers struggling to run a viable business and retain essential staff. Social care is fragile and critically needs the people working in it to want to continue and for others to be able to join.

“Given the number of people working in social care that come from the EU, it is likely that the sector will struggle to cope unless there is an absolute guarantee from government that our colleagues from EU countries can continue to come to work here, without disruption.

“The government also needs to provide the same assurance and guarantees as it has done for the NHS and produce a sustainable, long-term funding settlement for social care in its imminent green paper," he concluded.

Closing the Gap

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