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Workforce design

Workforce redesign

In 2016 the Nuffield Trust identified 10 important lessons for organisations seeking to redesign their workforce.

  • Be realistic about the time and capacity needed to support change
  • Create a receptive culture for change
  • Support transformation with a strong communication and change management strategy
  • Build roles on a detailed understanding of the work, staff skills and patient needs
  • Invest in the team, not just the role
  • Ensure robust triage mechanisms
  • Develop and invest in a training capability
  • Build sustainability for new and extended roles
  • Evaluate change
  • Adopt a systematic approach to workforce development and change
  • Complex / continuity

Skills for Care provides a practical guide to workforce planning to take you through the whole workforce planning process using a practical analyse-plan-do-review method.

The principles of workforce redesign include:

  • Take a whole system view of organisational change
  • Recognise the different ways people, organisations and partnerships respond to change
  • Nurture champions, innovators and leaders; encourage and support organisational learning
  • Engage and empower people in the process; acknowledge value and utilise their experience
  • The different ways that people learn should influence how change is introduced and the workforce supported
  • Encourage and utilise the understanding of values, behaviours and practice to shape innovation
  • Engage with your patient participation group and your community to understand its cultures and strengths; work with the community to develop inclusive and creative workforce planning.

Some other key information that will help you plan includes:

  • Staff overview: for how many staff members you employ, the roles they fill and absence rates
  • Recruitment and retention: for turnover and retention issues
  • Workforce demographics: for age, gender, ethnicity and nationality
  • Pay: for annual and hourly pay rates (you can compare your pay rates against others locally, regionally and nationally). The practice accountant may be able to help you benchmark your staff costs
  • Qualifications and training: to see how qualified and well trained your workforce are and to help with training plans
  • The workload demand and demographics: Comparing your population projections and any new housing and care home developments in your area. This is particularly helpful in looking ahead and future proofing your business.

New clinical roles

Over the next five years in England, there will be some new roles created within primary care but also several existing roles will begin to work in new ways:

  • Network Clinical Director
  • Clinical pharmacists
  • Social prescribers (also known as Link Workers)
  • First contact physiotherapists
  • Primary care paramedics
  • Physicians associates

Given these are emerging roles, it is important to for practices to set clear expectations of the functions that they would like the person to carry out. There are opportunities to exchange ideas or materials such as template job descriptions through forums locally and nationally.

It is vital to help the whole team to understand any new role that has been allocated. This helps to ensure appropriate work is assigned to the new role and so that other team members can explain the role to patients and families. This is also a good opportunity to explore boundaries of the work a new role will handle and the words they would use to describe their unique skills.

These new team members will need to be supported to develop the specific skills needed to work within primary care. This may be through:

  • Encouraging individuals to network with others, perhaps in terms of supporting exchange or in seeking professional support and training from others in the community
  • Developing a clinical peer network can help to expand the range of functions, teach additional skills, sometimes shortcut innovation by swapping tools and templates

Resources have been produced by several organisations which explain in more detail the roles and responsibilities that the expanded primary care team may have and develop.

Professional bodies:

The role of the GP in expanding skill mix team and supervision

Those team members who have not worked in general practice before would, as part of an induction programme, require training in several areas including:

  • use of the clinical computer systems
  • Quality and Outcomes Framework (QOF)
  • clinical coding
  • clinical and information governance
  • safeguarding adults and children

GPs can expect to become more involved with supervision of the expanding primary care team and will need to review the systems and processes in place within the practice setting to support the skill mix. 

GPs need management and leadership skills to supervise an effective team of nurse practitioners, paramedics, pharmacists, nurses, medical students and HCAs. In addition to seeing patients, updating medication and dealing with routine enquiries.

Not only will supervision by GPs be important but mentoring and coaching skills will become increasingly needed as we work to inspire, educate and nurture those working in the wider team within general practice.

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