JOINT PRIMARY CARE COMMISSIONING COMMITTEES TITLE: General Practice Forward View (GPFV) International GP Recruitment DATE OF MEETING: 11th May 2017 PAPER REF: JPC/17/25 AUTHOR: Charlotte Lawson PRESENTER: Charlotte Lawson PURPOSE OF REPORT: The purpose of this paper is to brief the Primary Care Commissioning Committee members on the General Practice Forward View (GPFV) International GP Recruitment scheme. EXECUTIVE SUMMARY: In Mid-Notts we are building our workforce intelligence across Primary Care to understand current and future gaps. We know that in the preceding four years we have under recruited to the Mansfield GP training scheme which is having an impact on the supply of qualified GPs. We are undertaking a range of initiatives to reverse this trend however given the scale of the problem we need to be more radical in our thinking. NHSE has published details of a 20M, 3 year International GP Recruitment scheme. The scheme funds the recruitment, training, relocation and accommodation costs of the GPs. Mid-Notts received the support of the local NHSE team to submit a bid for 25 GPs to be recruited to work in general practice in Mid-Notts. The bid with a financial value of £890,000, was developed in partnership with Primary Care People. A decision on the bid will be communicated by NHSE by the end of May. RECOMMENDATION:

To note to approve To agree the recommendation (see details below) REPORT: KEY IMPLICATIONS: FINANCIAL If successful the bid will provide financial support to help general

practice recruit GPs. VALUE FOR MONEY - RISK - LEGAL - WORKFORCE This project will support the recruitment of GPs into Mid-Notts PATIENT AND PUBLIC INVOLVEMENT

There is a draft communication and engagement plan appended to the bid.

CLINICAL ENGAGEMENT There is a provision for one session of clinical lead time to support year 1 implementation. The bid was developed with clinical input from the CCGs, NEMS, HEE and the PCSET.

COMMITTEES CONSULTED PRIOR TO GOVERNING BODY

HOW DOES THIS CONTRIBUTE TO THE OUTCOMES AND OBJECTIVES OF THE CCG:

Quality Health Financial xClinical Performance (tick as appropriate)

CONFLICTS OF INTEREST:

This is a recommended action to be agreed by the Chair at the beginning of the item. No conflict identified Conflict noted, conflicted party can participate in discussion but not decision (see below) Conflict noted, conflicted party can remain but not participate (see below) Conflicted party is excluded from discussion (see below)

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Is the information in this paper confidential? x No Yes If the paper is considered confidential, please tick the relevant box. Does it contain personal information e.g. regarding a patient, member of staff or another individual?

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Does the report contain information which has been provided to the CCG in confidence by a third party and is there a risk that the third party could take legal action for a breach of confidence if it was disclosed?

Does the discussion relate to policy development not yet formalised by the organisation and if the discussion were made public would this hamper full and frank discussion and therefore adequate consideration and development of proposal? This is intended for matters that are considered at a Board meeting early in the process to obtain initial thoughts and to give officers a steer in developing the policy. It would not be appropriate to use this argument where the governing body is being asked to approve a policy or initiative as this would be too late to argue that policy development was still on-going.

Has the document/report been produced by another public body which has chosen not to make the document publicly available and would not wish the CCG to do so?

Is the document in draft form which will publically available at a future date?

Note: Upon request for the release of a paper deemed confidential, under Section 36 of the Freedom of Information Act 2000, parts or all of the paper will be considered for release by the CCG’s ‘Qualified Person’ based on the circumstances at that time. ANNEXES: List annexes

General Practice Forward View (GPFV) International GP Recruitment

Detailed Proposal for Scheme in Mid-Nottinghamshire

Lead Organisation Name: Mansfield and Ashfield and Newark and Sherwood CCGs

Contact details for lead organisation

Charlotte Lawson

Programme Manager – Workforce Transformation Direct Dial: 01623 673719 Mobile: 07500 783221 Charlotte.lawson@mansfieldandashfieldccg.nhs.uk Charlotte.lawson1@nhs.net

Other Stakeholders

Dr Thilan Bartholomuez Clinical Lead, N&S CCG

Dr Gavin Lunn Clinical Lead M&A CCG

David Ainsworth Director of Primary Care

Dr Nigel Marshall Clinical Advisor, Newark & Sherwood and Mansfield and Ashfield CCGs

Michael Wright Local Medical Committee

Dr Helen Mead GP Dean, HEE

Dr Christine Johnson Chair, Primary Care Staff Education and Training

Dr Simon Browes Clinical Director, NEMS CBS

Lyn Bacon STP Exec Sponsor for workforce

Chris Locke Primary Care Development Centre

Dawn Atkinson Head of Business Change & Implementation Mid-Notts

Date of your Submission: 18th April 2017

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Executive Summary

Mid Nottinghamshire CCGs have been developing proposals for an EU recruitment scheme for some time, identified as part of our GP Forward View Plan.

In response to the demonstrable difficulties recruiting, high average patient numbers per GP, planned retirements and the anticipated increase in patient population the scheme aims to recruit 25 GPs under the international recruitment scheme to work in Mid-Nottinghamshire GP Practices. There will be a number of benefits as a result of the scheme such as a move towards the national average of patients per GP, improving access for the population. The increased pipeline of GPs will ensure the CCGs are proactively positioned to respond to anticipated turnover and population increase, and a fully managed process, with robust performance measures, will ensure delivery and quality.

Increased GPs will support the resources necessary to achieve maximum coverage of primary care services to the population including hard to reach and high deprivation areas. This allows for a focus on public health to combat the deprivation and life expectancy inequalities within the area.

The proposal seeks funding of £890,000 to deliver the scheme and provides a robust plan for recruiting and retaining GPs. There is significant ongoing support that will continue for the 3 years of the contract, and targeted development for GP’s identified to aid the smooth transition through key points of the process and minimise attrition.

Across the STP footprint we have a maturing workforce governance structure, within which the scheme will fall. The Primary Care Staff Education and Training Group will monitor the progress and quality of the scheme providing ongoing assurance of quality and success to our stakeholders.

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General Practice Forward View (GPFV) International GP Recruitment

Detailed Proposal for Scheme in Mid-Nottinghamshire

Contents

1. Introduction 4 2. Current approach to primary care development 5

Vision 5 Workforce supply work to date 5

3. Primary Care Landscape 6 4. Planned Approach 8 5. The localities: Newark and Sherwood 9 6. The localities: Mansfield an Ashfield 9 7. Stakeholder Engagement 10 8. Funding 11 9. Abortive Costs 12 10. National Principles 12 11. Incentives 12 12. Relocation 12 13. Ongoing Support 13 14. Welcome, Induction and Orientation 13 15. Continuing Professional Development 13 16. Recruitment 14

Recruitment Partner 14 GP Scholarship Scheme 15

17. Benefits Realisation 15 18. Governance 16 19. Further Deployment 17

Appendix 1: Initial Communication and Engagement Plan

Appendix 2: Initial brief to practices

Appendix 3: Recruitment Implementation Plan

Appendix 4: CCGs Plan for the Delivery of the GP Forward View 2017-2019.

Appendix 5: Stakeholder involvement map

Appendix 6: Relocation Policy

Appendix 7: Candidate Brochure

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General Practice Forward View (GPFV) International GP Recruitment

Detailed Proposal for Scheme in Mid Nottinghamshire

1. Introduction 1.1 Mansfield and Ashfield Clinical Commissioning Group (M&A CCG) and

Newark and Sherwood Clinical Commissioning Group (N&S CCG) are collectively known as Mid Nottinghamshire CCG’s.

1.2 The GP forward view (April 2016) identified that there has been a steady rise in patient expectations, a target driven culture and a growing requirement for GPs to accommodate work previously undertaken in hospitals, or in social care. This has resulted in unprecedented pressure on practices, which impacts on staff and patients. Small changes in general practice capacity have a big impact on demand for hospital care, so the need to support general practice in underpinning the whole NHS has never been greater.

1.3 General practice is the bedrock of the NHS, over 90% of patient consultations with the NHS happening in general practice. Our plans need to be ambitious and transformational as well as strategically sound and locally sensitive. We are cognisant of the ranging levels of deprivation, socio-economic, geographical and political drivers that exist in our communities.

1.4 In Mid-Nottinghamshire, increasing demand and constricted supply of GPs is creating pressure on the system as patients seek access to Primary Care in inappropriate settings. It is therefore essential that we take action to address the supply and retention of GPs.

1.5 The following proposal outlines our vision for primary care and our current landscape. We also describe our current initiatives to address supply and retention of the workforce. Finally we detail how we will deliver a successful international GP recruitment scheme, in partnership with Primary Care People (PCP) a leading primary care recruitment consultancy.

1.6 The proposal supports the ambition of the Nottinghamshire Sustainability and Transformation Plans (STP) to build capacity, capability and resilience in the Primary Care Workforce.

1.7 This proposal is detailed in the Mid Nottinghamshire CCGs Plan for the Delivery of the GP Forward View 2017-2019. (Appendix 4).

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2. Current approach to Primary Care development

Vision

2.1 Over the next decade the CCGs have a vision to ‘build a system that places GPs central to a model of provision supported and surrounded by a skilled multi-disciplinary team.’

2.2 Strengthening of the Primary Care workforce will ensure GP’s are free to provide personalised care face to face for people with complex needs and through supervisory expertise, providing support to junior teams dealing with the increasing demands on primary care.

2.3 Our health optimisation plan aligns with the prevention agenda to reduce the future burden of demand on health services. There is a need to improve healthy life expectancy through reductions in diabetes, heart disease and respiratory disease.

2.4 We have health inequalities associated with deprivation and problems such as isolation and loneliness, with mental health featuring in one in every four consultations. Prevention and community activation (self-care) are therefore included in the CCGs operational plan in relation to key areas of health impact.

2.5 We are developing four localities made up of groups of practices with each locality having an average 80K population. The model provides the infrastructure for GPs to come together and co-design future services, basing their priorities on shared goals, aligned to the STP and wider community. This approach allows the CCGs to achieve full population coverage on key areas such as diabetes and supports the mobilisation of our international GP recruitment scheme across the locality.

2.6 In 2017/18 we are moving towards full population coverage for Extended GP Access.

Workforce supply work to date

2.7 Health Education England (HEE) has been allocated a small number of bursaries in Sherwood Forest as part of the Targeted Enhanced Recruitment Scheme (TERS) and this may attract GP trainees for the August 2017 intake. There are 12 bursary placements for the Mansfield scheme. Whilst this is positive, there is no guarantee that these recruits will choose to stay in the Mid-Notts area upon qualifying.

2.8 Two schemes have been established by Health Education England and these are open to GP’s within our locality;

2.8.1 Preparation for Specialty Training, PST (GP) The aim of this scheme is to

provide applicants who do not meet the admission requirements of GP training an opportunity to work in one area of England while receiving teaching and clinical exposure. The intended outcome is to improve the skills required for admission to specialty training.

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2.8.2 General Practice Foundation Year 2 (GP FY2) Pilot. The aim of this scheme

is to support and assist future applications to GP training for any applicants who experience difficulty in demonstrating suitable evidence of Foundation Competences.

2.9 In March 2015 the return to practice scheme was revised and relaunched, providing an opportunity for GPs who have previously been on the GMC Register and on the NHS England National Performers List (NPL), to safely return to General Practice after a career break, raising a family or time spent working abroad. It also supports the safe introduction of overseas GPs who have qualified outside the UK and have no previous NHS experience. The CCGs has embraced the scheme however the area still faces challenges when recruiting GPs.

2.10 The GP retainer scheme is intended to ensure that doctors who may be

thinking of leaving practice or those who can only undertake a small amount of paid professional work can keep in touch with general practice and retain their skills. Our workforce intelligence suggests that the use of this scheme will be greater in the future, with a number of GPs wishing to work part time.

2.11 We have developed 2 Clinical Fellows post for Mid-Notts, for newly qualified GPs to retain them in the area these are currently out to advert.

2.12 Whilst this work is positive, baseline data and local intelligence highlight that we urgently need to act more radically to address the immediate shortages. To this end, Mid-Notts are making this bid for a GPFV International GP Recruitment Scheme Scheme.

3. Primary Care Landscape

3.1 There are 41 GP practices that service the four localities in Mid Nottinghamshire (27 in M&A, 14 N&S) with a total registered population of 323,790. The smallest list size is 2,726 the largest is 18,816.

3.2 There are challenges recruiting and replacing Primary Care staff in many areas. 20% (30) of the GPs are over 54, greater than the average for the East Midlands area. In addition the % of GPs under 40 is less than the national average (M&A CCG).

GP Demographics Mansfield & Ashfield CCG

Newark & Sherwood CCG

East Midlands England

% of GPs aged under 35 10.30% 13.20% 12.30% 13.40% % of GPs aged 35 - 54 67.90% 69.10% 69.70% 65.20% % of GPs aged 55 and over 21.80% 17.70% 18.00% 21.40%

3.3 Total sum of practitioners (exc Registrars, Retainers, Locum) M&A 87, N&S 68. (Source NHSDigital 2016)

3.4 N&S CCG average patients per GP is within the national average, however M&A CCG has significantly higher numbers of patients per GP, putting pressure on the primary care system.

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3.5 When comparing the local data with available data for East Midlands, the high volume of patients within M&A CCG as demonstrated in the table below. Whilst N&S CCG have patient numbers within the national average, the ratios are high when compared to the neighbouring CCG areas.

3.6 For the CCGs that have a ratio greater than the East Midlands average, it would take 4% increase on the current workforce to reduce their ratio down to the current average. (HEE: General Practice Workforce Analysis – East Midlands.)

3.7 In addition the region is expecting a 3% increase in population over the next 5 years, exacerbating pressure on already challenged primary care services.

3.8 The CCG has carried out a recent survey of practices to seek intelligence in regards to the GP workforce. The results demonstrate a high vacancy rate across our practices with 8 out of the first 21 responding practices outlining that they are carrying 11 vacancies that on average they have tried to fill on three occasions.

3.9 The same 21 practices reported 15 members of staff were actively considering reducing their working hours. Only 1 GP partner was considering increasing their hours. 5 GP Partners were planning to retire in the next 5 years.

3.10 The practices were asked whether they had any concerns regarding recruitment and responses included GP shortages, no interest from GPs for vacancies, with no foreseeable change in the next few years.

1,800 1,900 2,000 2,100 2,200 2,300

Mansfield & Ashfield CCGNewark & Sherwood CCG

East MidlandsEngland

Rushcliffe (Notts) 1:1621 Nottingham City (Notts) 1:2014North Derbyshire (Derbys) 1:1682 Nene (Northants) 1:2039East Leicestershire and Rutland (LLR) 1:1691 Lincolnshire West (Lincs) 1:2067Nottingham West (Notts) 1:1795 Hardwick (Derbys) 1:2095South Lincolnshire (Lincs) 1:1819 Corby (Northants) 1:2112Nottingham North and East (Notts) 1:1830 Erewash (Derbys) 1:2120.Southern Derbyshire (Derbys) 1:1899 Mansfield and Ashfield (Notts) 1:2211West Leicestershire (LLR) 1:1945 Lincolnshire East (Lincs) 1:2240Newark and Sherwood (Notts) 1:1954 Leicester City (LLR) 1:2527

South West Lincolnshire (Lincs) 1:2549

East Midlands average 1:1980 National Average 1:1952

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3.11 Difficulties recruiting can also be seen when considering the two GP training

schemes in Nottingham and Mansfield. Historically Nottingham has been oversubscribed and Mansfield undersubscribed.

Mansfield Scheme Nottingham Scheme Year Vacancies Recruited Vacancies Recruited 2016/17 24 13 45 48 2015/16 24 16 45 35 2014/15 21 13 44 30 2013/14 21 18 40 40

3.12 Under recruitment impacts on both Primary and Secondary Care as hospital rotations are an element of the training. For example, Sherwood Forest Hospitals is currently facing a shortfall in its junior doctor workforce in A&E due to the failure to recruit to the GP scheme.

4. Planned Approach

4.1 Primary Care People (PCP) are leading recruitment consultants within the Primary Care sector (https://primarycarepeople.co.uk/).

4.2 PCP are on the NHS Employers recruitment agency list (South Central). They are our bidding partner, and preferred provider. We have experience of working with the company and they have successfully placed a GP at Bilsthorpe Surgery in Newark & Sherwood filling a long term vacancy.

4.3 PCP have developed a vast European network of Medical Practitioners, specifically GPs and adhere to the UK code of practice for international recruitment. PCP offer a comprehensive and robust training package for EU GPs wanting to relocate and work in UK General Practice and gain entry onto The National Medical Performers List (NPL).

4.4 For the past 18 months, PCP has been putting together the infrastructure needed to support the EU GP Programme. By partnering with PCP will establish a stable and sustainable approach to the workforce challenge.

4.4.1 PCP has been chosen as our recruitment partner as they have a proven history of success: o PCP has 48 GPs who qualified in mainland Europe who work for PCP full

time o PCP has supported 17 EU GPs to secure inclusion onto the NPL o PCP have been recruiting and building a pipeline of GPs in Europe for 18

months, and currently have 600 who have expressed an interest o PCP has their own indemnity scheme for the GPs o PCP are the only provider to have a clinical training team to support GPs o PCPs legal advisors are DAC Beachcroft who are the No 1 ranked NHS legal

advisors with specific expertise in international recruitment o PCP are the only recruitment consultancy to be endorsed by the RCGP. o PCP have over 400 GPs working in long term interim roles throughout the

country o PCP can provide an interim GP for 6-12 months whilst clients IMG GP is in

training and on the NPL

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4.5 In response to the demonstrable difficulties recruiting, high average patient

numbers per GP, planned retirements and the anticipated increase in patient population the scheme aims to recruit 25 international GPs to work in Mid-Nottinghamshire GP Practices.

4.6 There will be a number of benefits as a result of the scheme:

4.6.1 We can increase our ability to support navigation to alternative health and

social care services. 4.6.2 The area will move towards the national average of patients per GP,

improving access for the population. 4.6.3 A fully managed process, with robust performance measures, will ensure

delivery and quality. 4.6.4 The increased pipeline of GPs ensures the CCGs are proactively positioned

to respond to anticipated turnover and population increase. 4.6.5 Increased GPs support the resources necessary to achieve maximum

coverage of the population, including hard to reach and high deprivation areas. This allows for a focus on public health to combat deprivation and life expectancy inequalities within the area.

4.6.6 The scheme supports the acute junior doctor workforce through the hospital rotations.

5. The Localities: Newark and Sherwood (N&S)

5.1 Newark and Sherwood is the largest geographical district in Nottinghamshire – covering one third of the County. The combined district has a population of 115,761 maximising the benefits of the scheme in this area.

5.2 Almost 20,000 are aged under 15. In Newark and Sherwood people of retirement age make up nearly a fifth of the total population. Life expectancy is almost eight years lower for men and more than four years lower for women in the most deprived areas of Newark and Sherwood compared to the least deprived areas.

5.3 It is also a growth region with short-term and long-term population change both well above the average for Nottinghamshire and Great Britain. The significant growth in population presents local services with a challenge, both in providing services in new communities, and in resourcing already established communities.

6. The Localities: Mansfield and Ashfield (M&A)

6.1 The Mansfield and Ashfield area comprises Mansfield, Sutton in Ashfield, Kirkby in Ashfield and Mansfield Woodhouse. The area’s combined population is around 172,000 making it amongst the most populated urban areas in England.

6.2 The health of the populations of Mansfield and Ashfield is generally worse than the average for England - with deprivation above the average at around 23 per cent of the resident population.

6.3 In Mansfield and Ashfield’s district population there are around 9500 children living in poverty. Life expectancy for both men and women is lower than the national average with high levels of obesity in some school aged children.

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http://www.neighbourhood.statistics.gov.uk

7. Stakeholder Engagement

7.1 The initial stage of the process focused on ensuring engagement with

relevant parties. This proposal has been prepared with support and agreement from a number of stakeholders including the Nottingham City Urgent Care Training Partnership, the Local Medical Committee (LMC), Health Education England (HEE), General Practice, Our Primary Care Staff, Education and Training Group (PCSET) and the Primary Care Development Centre (PCDC).

7.2 We have made contact with Dr Kieran Sharrock, Medical Director at Lincolnshire Local Medical Committee which is a wave one site. We are hoping to share the immediate learning from their experiences as we further develop our local implementation plans.

7.3 To date we have had a number of conversations with practices that we know are vulnerable due to staff shortages. We have been surveying all our practices so we have a robust baseline of vacancies and an understanding of attempts made to fill those vacancies. As a result we can ensure that the international GP recruitment scheme targets placement of GPs to maximise the positive impact on the patient population.

7.4 In order that all our practices have an opportunity to partake in the programme we will hold a launch event for all practices. One of the outcomes of which will be a memorandum of understanding with our General Practice partners who wish to employ an international GP.

7.5 As part of this process an initial communication and engagement plan has been developed to ensure that the programme is clearly promoted within the GP locality, to the local population, and the stakeholders. This includes clear and effective communications on the quality and effectiveness of the programme and how success and progress will be monitored. Please see attached Appendix 1 and 2 for a copy of the communication and engagement plan and the initial brief to practices.

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8. Funding

8.1 The system is proposing to recruit 25 GPs and is requesting a total of

£890,000 from the NHS England GPFV International Recruitment fund to deliver the scheme.

8.2 The breakdown of the costs are as follows: Element Cost per

GP Total cost

1 Recruitment Process International English Language Testing System (IELTS) General Medical Council registration and license to practice

£7,000 £175,000

2 Relocation Package £8,000 £200, 000 3 UK GP Practice integration and familiarisation

(Practice observation) £4,000 £100,000

4 GPs pay when in the UK pre National Performers List (NPL) Inclusion

£5000 £125,000

5 Training for chosen route onto NPL £4,000 £100,000 6 Pastoral care pre NPL £2500 £62,500 7 Pastoral care to improve retention and for 36 months

post NPL inclusion. £1,000 £25,000

8 Clinical support to ensure integration for 36 months post NPL inclusion

£2,500 £62,500

Total £34,000 £850,000 Communication & Engagement Launch event, public

engagement, materials, £20,000

CCG Clinical Lead Session per week £15,000 Other Travel/sessions/misc £5,000 Total Cost of scheme £890,000 Cost per GP £35,600

8.3 If it is a requirement that the recruits need to go through the I&R process the following alternative costings would replace items 3,4 and 5 from the above list. We would however look to bring in the totality of the scheme within the per doctor cap of £36,000.

Element Cost Per GP Induction & Refresher (I&R) Salary

£21,000

I& R training costs Variable

8.4 Annual Salary (post NPL inclusion) payable by the employing practice to the GP, £75,000-£80,000 pa +NI, Pension, Indemnity

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9. Abortive costs

9.1 We are working with PCP to develop some principles around the abortive costs of the project. This will form part of the detailed specification.

9.2 It is not yet known how the triggering of Article 50 will impact on the rights of EU citizens to work in the UK. It is anticipated that this will not impact on the life of this project. However a provision for this will be built into the proposed abortive costs.

10. National Principles

10.1 The proposal embraces the national principles and recognises these as essential in recruiting and retaining GPs in a fair and effective manner. The proposed process is outlined in detail below and presented in the appendices.

10.2 When the funding is agreed we will deliver a robust and effective recruitment scheme, with clear and ongoing support mechanisms in place to maximise retention of international GPs and ensure the benefits are realised.

11. Incentives

11.1 In order to attract and retain GPs, material on the community has been

produced. PCP has developed detailed information including details of local amenities, education, restaurants, transport links, networking opportunities and other local attractions which gives an insight into the environment and allows the presentation of the locality at an early stage in the process.

11.2 The contract of employment for recruited GPs will outline appropriate terms of employment, including a provision for providing Extended Access, salary commitment, and a mutual obligation to commit to 3 years minimum employment, to provide stability and certainty for GPs recruited as part of this process.

12 Relocation

12.1 A relocation package will be utilised for recruited GPs and used when advertising the positions. PCP have a comprehensive door to door relocation service working with HCR is one of the UK's largest and most successful independent companies providing UK and International Employee Relocation and property related services. HCR have an enviable reputation for providing innovative accommodation solutions in the UK and throughout the world relocating on average around 8000 employees per year. HCR hold ISO9001:2015, have won numerous awards, care about our environment and are certified to Cyber Essentials. (See Appendix 6).

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12.2 PCP provide an option for the GP to take UK driving lessons to familiarise themselves with the UK road system if they wish, as part of an overall relocation package.

13 Ongoing Support

13.1 As part of the ongoing management of the scheme, and to ensure the programme remains on schedule and is efficiently and fully delivered, dedicated Project Management support is identified within PCP. This will be supported by CCG Clinical Lead sessions.

13.2 PCP will ensure that the recruited GPs have a consistent and identified single point of contact for any queries that they have in regards to the process, their relocation and engagement with the community. They are also available to signpost the GPs to resources that may aid them in their transition.

13.3 All support identified will be available for the 3 years of the GPs contract, to maximise retention and the quality of the scheme.

13.4 The CCG will continually engage with the practices involved in the scheme,

and will seek feedback on their experience. .

14 Welcome, Induction and Orientation

14.1 Candidates will be fully supported by experienced GPs; clinicians, trainers and local system leaders with a clear vision and a proven track record of achieving positive change in the current challenging national climate.

14.2 GP-S is a peer mentoring service for General Practice, offering coaching and signposting service for General Practice based in Nottinghamshire, Derbyshire and Lincolnshire. Our recruited GP’s will be able to access this service once in post http://www.gp-s.org/

14.3 The CCGs will tailor a robust local induction programme for the recruits, including input from the local NHS England Medical Director, the Primary Care Development Centre and the Urgent Care Training Partnership.

14.4 We have made a provision for a session a week of clinical leadership for the first 12 months of the programme to support the implementation of the programme.

15 Continuing Professional Development 15.1 In addition to the training above, and to support the ongoing retention of the

GP, PCP have a training hub which has a rolling programme suitable to the needs of the GPs and the specific needs identified from an individual learning needs analysis.

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15.2 The educational programme delivered will involve a combination of in house

and external speakers, modelling UK GP specialty training schemes. Currently we have 6 GP educators who will deliver this teaching from Oxford.

15.3 The programme will include peer group reflection and learning, educator led sessions, role play, online learning and pastoral support including resilience, working under pressure, where to seek help both during the Induction & Refresher (I&R) training and when working as NHS GPs, for the full 3 years of the contract.

15.4 The curriculum includes NHS systems, primary and secondary care interface, roles of allied professionals in primary care, other sources of support beyond the GP Practice e.g. drug and alcohol support, MIND, IAPT. The programme also includes development of professional behaviours including GMC expectations, ethics and ensures high level communication and consultation skills framed in the UK NHS patient centred model. Practical support is also provided in regards to appraisal and revalidation, and governance within the NHS.

15.5 The assessment and training programme identified above demonstrates a clear commitment to ensuring high quality and effective recruitment and training. The training package is developed to include both a varied curriculum and methods of training. Wherever appropriate we will localise the training.

15.6 The recruited GPs will be invited to attend the CCGs Protected Learning Time clinical education events (PLTs). We will also facilitate links into the local education establishments to support their CPD.

16 Recruitment Recruitment Partner

16.1 PCP will be sourcing and screening GPs from various EU Countries. The

screening process ensures the quality of candidate recruited, ensuring international recruitment standards and CQC requirements are met. Appendix 3 outlines the recruitment implementation plan.

16.2 Alongside a robust and quality recruitment process, is an ongoing and targeted programme of training to ensure that candidates achieve access to the NPL.

16.3 The screening process will incorporate a values based assessment to ensure the candidates fit with the NHS values. Where appropriate will include both the CCG Clinical Advisor and our local NHSE medical director in the recruitment process.

16.4 Further to the initial screening process, in-country assessment days will be undertaken with the potential candidates. This includes a number of elements:

16.4.1 An introduction to the locality being recruited to – PCP embraces the process of supporting the candidates to feel welcomed to the UK and provides as much information on the area as possible throughout the process.

16.4.2 A written and oral test, designed by PCP’s clinical director. This is a test to ascertain clinical ability as well as the level of English knowledge across the four

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elements assessed; listening, speaking, reading and writing. Candidates will be clinically assessed by NHS Assessors/Trainers.

16.4.3 A PCP management interview to understand the candidate’s motivations for working in the UK.

16.5 PCP places high value on supporting successful candidates with English language training to ensure they have adequate knowledge of English for application to the GMC for a licence to practice, and to ensure they have sufficient English language knowledge for General Practice consultation styles in the UK. GPs will have access to PCP’s online medical english training as well as online IELTS training course.

16.6 Once selected, the GPs will be prepared for, and begin, GMC registration.

GP Scholarship Scheme

16.7 Once GMC registration with a licence to practice is achieved the PCP EU GP

Scholarship Programme will begin, a combination of both online and classroom lead training. PCP places great value on preparation for (Multiple Choice Question) MCQ and Simulated Surgery Assessments, to maximise successful outcomes and the efficiency of progression through the recruitment process.

16.8 The GPs will have access to a clinical mentor throughout their training; the mentorship will continue even after entry onto the National Medical Performers List. This preparation and training will run alongside the Induction & Refresher Scheme to support pass rates of our candidates, and the delivery of GPs to the area.

16.9 Once the GP has passed both MCQ and Simulated Surgery Assessments, they will complete a work based placement.

16.10 We will assist in the process of helping candidates to find placements in practices within the CCG area, supported by the 15 training practices within the area the HEE I&R lead and the Nottingham City Training Hub for which we are a spoke.

16.11 Once this is complete the GP will be signed off by through the national I&R scheme to gain entry onto the National Medical Performers List and placed in a practice.

17 Benefits Realisation 17.1 Return on investment will be measured for the life of the project. The programme team will finalise the success criteria. PCP provide the following performance measures to provide assurance on the quality and effectiveness of the services offered.

17.1.1 Interview to offer: Time frame from interview to offer letter is 1 week (as long

as the clinical and linguistic exams have been passed) we aim to offer 65% of applicants a role on our scholarship programme.

17.1.2 Day 1 of scholarship to completed NPL and in practice. We know that this process will take 3-12 months depending on the applicant and the pathways time

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frame set out on the GP recruitment office website. We will expect to see 20% of our GPs complete the registration within 3 months and the remaining 80% within 6-12 months.

17.1.3 Performers list – 3 years in post. PCP understand the complexities and realities of overseas recruitment and recognise the reality of attrition. In year one we expect to lose 5% of GPs and in year 2 a 10% attrition rate. Recruitment will be based on a contingency of a 10% loss, so there will be sufficient supply to the CCGs.

17.1.4 Engagement interviews - PCP have an engagement team that will conduct interviews in months 3, 6 and 12 to make sure the GP and the Practice are happy with how the placement is going and that all expectations from both side are being met.

17.2 As part of the process, the attrition rate will be monitored. Any exits from the scheme will be explored, with robust exit interviews undertaken with all leavers.

17.3 The key stakeholders identified as part of the engagement process will form the programme team for the scheme and will meet on a regular basis to review progress against the implementation plan.

17.4 The draft recruitment implementation plan (attached as Appendix 3) will be used to develop clear project documentation to ensure that key milestones are met and the project timeframe remains on track.

17.5 Patient surveys will be reviewed to understand the impact upon service delivery and provide assurance of quality care.

17.6 The GPs will receive an annual appraisal, providing assurance on performance, quality and integration within the system.

17.7 Complaints and compliments will be monitored to ensure quality and learning.

17.8 Retention will be paramount and we will seek qualitative feedback interviews with the GPs at check points within the process to understand issues, successes and areas for improvement, as well as feedback from Practices on how they have found the programme, and support provided to them

18 Governance

18.1 Across the STP footprint we have a maturing workforce governance structure Fig 1.

18.2 The Group (formally General Practice Education and Training Group) are a well-established element of the structure. The PCSET have developed a PID around supporting international recruitment. We will use the expertise of the PCSET to help develop local training and support for the international recruits ad monitor the progress and quality of the scheme.

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Fig 1

19 Further deployment 19.1 Whilst we have presented a Mid-Notts specific bid, it is the intention that the

learning will be shared across the STP Footprint to ensure benefit to a greater patient population.

19.2 We will make provision within the scheme that, in the unlikely scenario that the 25 recruits are not placed in Mid-Notts, we will offer an opportunity to the wider system based on local assessment of need and evidence of difficulty recruiting.

19.3 This will be facilitated by the Mid-Notts and Greater Notts Workforce Transformation Programme Managers

19.4 As the scheme reaches maturity we will explore a range of options to develop ongoing opportunities for the recruits. This may involve roles in urgent care settings, for example ED or the Out of Hours service. Locally we are developing a GP Chambers and this may also present an opportunity.

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Appendices

Appendix 1 - Communication and engagement plan

Appendix 1 Communication and En

Appendix 2 - Initial brief to practices

Appendix 2 Initial Brief to Practices.docx

Appendix 3 – Recruitment Implementation Plan

Recruitment Implementation Plan

Appendix 4 – GPFV Strategy

Appendix 4 GPFV Strategy.docx

Appendix 5 – Stakeholder involvement map

stakeholder involvement map

Appendix 6 –Relocation Policy

Relocation Policy

Appendix 7 – Candidate Brochure

Candidate Brochure

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