CONTENTS

PAGE

Acknowledgements

Statistical Information

Executive Summary

1. Introduction

1.2 Methodology

1.3 Grampian Trends

1.4 Local Delivery Plan

2. Drivers for Change

2.1 Pay Moderinsation

2.2 Current Workforce Profiles

2.3 Workforce Trends

3. Service Change

3.1 Change & Innovation Programme

3.2 Workforce in the Sectors and Community Health Partnerships

3.3 Regional Projects

4. Workforce Projections

4.1 Scenario 1 – Historical Projections

4.2 Scenario 2 – Redesigning Our Services

4.3 Key Workforce Changes

4.4 Notes

5. NHS Grampian Workforce Action Plan 2007

6. Education, Redesign and Regulatory Requirements

1

2

3

4 – 11

12 – 21

22 - 29

30 – 53

54 – 55

56 - 63

TABLES

1. Scottish & Grampian Population by Age, 2005 and projected changes

over time

2. Breakdown of the Ethnic Origin of those recruited during 2005/06

3. Age Distribution of staff aged 65 and over by Staff Group

4. WTE Consultant Vacancies as at 30 September 2006

5. WTE Nursing & Midwifery Vacancies as at 31 March 2006

6. WTE Allied Health Professional Vacancies as at 31 March 2006

7. Medical Projections based on current trends in WTE by Grade 2006 -

2016

8. Primary Care Dental Services Projections based on current trends in

WTE 2006 - 2016

9. GP Projections based on current trends in Headcount 2006 - 2011

10. Nursing & Midwifery projections based on current trends by Specialty in

WTE 2006 - 2011

11. Allied Health Professional Staff projections based on current trends by

Specialty in WTE 2006 – 2009

12. Psychology projections based on current trends in WTE 2006 – 2009

13. All other staff projections based on current trends in WTE 2006 – 2009

14. Medical Projections based on Service Redesign WTE 2006 – 2016

15. Primary Care Dental Services Projections based on Service Redesign

in WTE 2006 – 2016

16. Nursing & Midwifery Projections based on Service Redesign in WTE

2006 – 2011

17. GP Headcount Projections based on Service Redesign in Headcount

2006 – 2011

18. Allied Health Professions Projections based on Service Redesign in

WTE 2006 – 2009

19. Psychology Projections based on Service Redesign in WTE 2006 –

2009

20. All other staff categories projections based on service redesign in WTE

2006 - 2009

CHARTS

1. Age Profile by Staff Group

2. Profile of Headcount by Staff Group

3. Profile of WTE by Staff Group

4. Percentage of Staff Group by Gender

5. Percentage Split of Whole-time/Part-Time

6. Percentage of Turnover by Staff Group

7. Redeployment – Staff Movements

8. Medical WTE - 2006

9. Medical Projections – 2016

10. Primary Care Dental Services WTE - 2006

11. Primary Care Dental Services Projections – 2016

12. GP Headcount

13. GP Projections – 2011

14. Nursing & Midwifery WTE – 2006

15. Nursing & Midwifery Projections – 2016

16. Allied Health Professions WTE – 2006

17. Allied Health Professions Projections – 2009

18. Psychology WTE – 2006

19. Psychology Projections – 2009

20. All Other Staff WTE – 2006

21. All Other Staff WTE – 2006

22. Medical WTE Redesign – 2006

23. Medical Projections Redesign – 2016

24. Primary Care Dental WTE Redesign – 2006

25. Primary Care Dental Projections Redesign – 2016

26. Nursing & Midwifery WTE Redesign – 2006

27. Nursing & Midwifery Projections Redesign – 2011

28. GP Headcount Redesign – 2006

29. GP Projections Redesign – 2011

30. Allied Health Professions WTE Redesign – 2006

31. Allied Health Professions Projections Redesign – 2009

32. Psychology WTE Redesign – 2006

33. Psychology Projections Redesign – 2009

34. All Other Staff Categories WTE Redesign – 2006

35. All Other Staff Categories Projections Redesign - 2009

APPENDICES

1. Workforce Planning Model

2. Staff Group Glossary

3. NHS Grampian Policies

4. Workforce Redesign

5. CIP Workforce Map

REFERENCE DOCUMENTS 1. Staff Governance

WORKFORCE PLAN 2007

Acknowledgements

The following document has been developed in conjunction with a number of individuals and groups

from throughout NHS Grampian. Contributions have come from all areas within the system. The

authors, Gerry Lawrie, Workforce Development & Redesign Manager, Patrina Jordan-Bain, HR

Workforce Manager and Anne Millar, Workforce Information Analyst would like to thank Eleanor

Morrison, Fran Harkness and Frances Taylor for their commitment and support in producing this

document. This year contributions from the CHPs/Sectors and their HR Managers have been crucial.

Thanks are also due to the Staff Governance Committee and the Workforce Planning Advisory Group.

This year input has been received from the Sectors, Community Health Partnership’s and Grampian

Area Partnership Forum who have all provided helpful feedback and suggestions about the Plan.

Final thanks to Finance colleagues Alan Sharp, Clark Paterson and Alan Gall for their input to the

Plan and in particular the projections.

Please note that a number of hyperlinks are provided within the Plan for referenced documents.

These are available to NHS Grampian staff only through the internal intranet. Please contact the

authors for details if not available on our website nhsgrampian.org

1

Statistical Information

Statistical information has been provided from a number of sources including the Scottish Workforce

Information Standard System (SWISS), General Register Office of Scotland (GROS) and ISD

Scotland. A staff group glossary is attached as Appendix 3. The introduction of Agenda for Change,

(the new national NHS pay system) has meant that a phased approach to assimilation of staff to the

new pay bands has been taken by NHS Boards throughout Scotland although full assimilation has to

been achieved. As a consequence the figures from ISD Scotland are presented in the same

groupings as for previous years and the details for employees who have been assimilated to Agenda

for change have been “mapped back” as far as possible to the coding used under the previous

Whitley pay scales to ensure consistency in trend data. However it is not possible to report fully on

staff grades at present due to the non-direct match between old grades and new Agenda for Change

pay bands.

2

Executive Summary

This year’s NHS Grampian Workforce Plan is provided in a more compact version and readers should

consult the 2006 NHS Grampian Workforce Plan. This is to eradicate significant repetition with regard

to the context, the introduction and the drivers for change:-

Workforce Plan 2006 As required by the Workforce Unit, projections this year are provided for ten years for medical staff

and dentists, five years for GP’s and nurses and three years for all other staff groups. NHS Grampian

has provided projections in two different scenarios based on the criteria of affordability, availability

and adaptability.

Although there is recognition why this variance of timescales is required for different staff group

projections, this has caused some difficulty. Planning for 10 years for one staff group does not reflect

the impact on other staff groups and reinforces Workforce Planning in silos, rather than workforce

planning based on patient pathways and the service needs. Planning should be in a singular

timeframe, multi-professional and based on service groups so the whole system is considered.

In recognition of the three criteria, the projections for Scenario 2 – Redesign of Services does not

show overall significant increase in staffing numbers. Generally, increases in staffing numbers, if any,

are small and relate to specific projects or developments. Key changes include:

o Small increases for some Nurses and AHPs but not for all specialties.

o Some small decreases in staff numbers reflecting the needs of the service e.g. in Learning

Disabilities.

o The introduction of new or enhanced roles specifically for Nurses and Allied Health

Professionals but also new roles such as Physicians Assistants.

o The enhancement of Assistant/Support Worker type roles, both as generic workers and

specific to a specialty or profession.

o Some redeployment and retraining issues relating to ward closures.

o Continued problem areas where we have both an ageing workforce in an area which has

recruitment difficulties e.g. Old Age Psychiatry and Trades/Works staff.

o A large increase in Dentist and Dental staff to support the requirements of the service and the

opening of new practices and the Dental Institute.

The first scenario uses historic information for the projected changes to the Workforce. These

projections are unrealistic in terms of affordability, redesign and service needs and priorities. The

second set of projections utilises information known within the services and is based on agreed

redesign and service improvement as highlighted in the NHS Grampian Health Plan

We have included an Action Plan in Section 5 of this year’s Workforce Plan. This Action Plan

identifies key issues which NHS Grampian intends to address over the coming years in relation to the

development, redesign and planning of the Workforce. Some of these are significant projects in terms

3

of size but all are crucial in determining an effective and suitable Workforce for the future in NHS

Grampian.

Within the NHS Grampian Health Plan – Update on Progress, we have stated that “We will develop

new roles for staff, recognising the need to make best use of existing skills and the scarcity of other

skills. This may mean introducing enhanced roles for our current staff. We will extend and support the

contribution that nurses, pharmacists, physiotherapists (to name a few) can make to treatment and

care. This may mean that you will see an appropriate practitioner rather than a doctor when you

receive treatment and care. We will involve the education and training organisations in Grampian and

the North of Scotland in supporting these new ways of working. To support these changes there will

also need to be cultural changes within the Workforce.”

The most effective means to taking forward workforce redesign, improved productivity, cost savings

and utilising pay modernisation tools appears to be through one cohesive group. In order to remove

duplication and ambiguity in relation to various corporate groups involved in workforce redesign and

management, irrespective of whether this was to achieve improved service quality and/or financial

balance through redesign, NHS Grampian has established a Workforce Steering Group to provide an

overview and give strategic direction on workforce management issues. Its remit will include:-

Workforce Planning and Redesign The NHS Grampian Workforce Plan as required by the Executive and the workforce development and

redesign required within the Change & Innovation Programme.

Workforce Utilisation The meeting of key national performance targets, e.g. nurse bank and agency usage, sickness

absence, consultant related productivity, workforce productivity, junior doctor’s hours of work and local

targets, e.g. nurse and AHP benchmarking exercise and vacancy control.

Pay Modernisation The alignment of key contractual changes – Consultant, GMS, Agenda for Change, Pharmacy etc to

support the achievement of service redesign and performance targets.

4

Section 1 - Introduction

Workforce planning is an interactive process, which is built on information and ideas from a wide

variety of sources. It identifies the needs and aspirations of a system regarding the shape of its

workforce in the short, medium and long term. Consideration needs to be given to the organisation

priorities within the NHS Grampian Health Plan as well as Health Policy.

Since the publication of the Workforce Plan 2006 there has been progress within the organisation

relating to Workforce Planning. Organisational thinking has started to evolve. “Buy In” and

understanding of the Workforce Plan and Workforce Planning have improved as individuals

throughout the organisation recognise their role in the process. This change has been instrumental in

the development of the NHS Grampian Workforce Planning Action Plan which is detailed in Section 5.

NHS Grampian continues to implement new ways of working driven by the implementation of

Delivering for Health (Scottish Executive 2005). Through the NHS Grampian Health Plan and the

Change and Innovation Programme Action Plan numerous projects are working to improve the care

offered and where it is offered. We are supporting self care and strengthening local preventative

services. The Acute services will focus on providing complex care.

The vision of the future as described in Delivering for Health requires significant workforce redesign in

the coming years. It underpins every aspect of redesign and services will be required to establish

Workforce Planning as an integral part of their Service Planning and Redesign process.

“Workforce development has a key role to play in the reform of NHS Scotland to improve healthcare

services for patients. It is about getting the right people with the right skills to be in the right places at

the right time."

Working for Health, The Workforce Development Action Plan for NHS Scotland 1.2 Methodology

Workforce planning is more an art than a science. Providing projected figures for individual

professions is not a simple task. The methodology does not consider the impact on other members of

the ‘care’ team. In these circumstances Workforce Planning can become one dimensional and

confused.

In order to try and counteract this potential flaw, NHS Grampian has built its Workforce Plan up from

the local plans within the Community Health Partnership’s (CHPs) and Sectors.

This method has tried to ensure that all the Workforce Planning processes consider the impact of

changes on all members of the team. Although the methods used within the Sectors and CHPs have

5

varied they have all considered a multi-professional approach. Workforce Plans are based on agreed

and funded projects and the key shifts identified using the Workforce Redesign model. (See

Appendix 1. This is based on Carol Brooks’ and Tineke Bosma’s Planning Model).

1.3 Grampian Trends 1.3.1 Population Between 1991 and 2005, the population of Grampian rose to 525,930, an increase of 11,950 (+2.3%).

During that period, the population total reached a peak of 533,820 in 1995. The population of

Aberdeen City also peaked at 219,880 in 1995, before declining gradually each year from 1996

onwards. Aberdeenshire’s population has however risen steadily over the period by 9.1%. In a

similar way, Moray’s population has increased by 4,130 over the period (4.9%). Scotland has

remained at a similar level.

In 2005, 15.8% of the Grampian population was aged 65 and over. Grampian accounts for 10.3% of

the total Scottish population.

Table 1 - Scottish Population by Age, 2005 and projected changes over time Aberdeen City Aberdeenshire Moray Scotland No

(000s) % No

(000s) % No

(000s) % No

(000s) %

Total Population 2005 Below Working Age Of Working Age Above Working age

202 32

133 37

100% 16% 66% 18%

235 47

146 42

100% 20% 62% 18%

88 17 54 18

100% 19% 61% 20%

5095 929

3191 975

100% 18% 63% 19%

Changes in population, 2024 Total Population Below Working Age Of Working Age Above Working age

-23% -42% -32% 25%

7% -15% -7% 77%

3% -14% -5% 43%

0% -12% -8% 38%

Between 2005 and 2024, the Scottish total population is expected to remain relatively stable.

Population change will be unevenly spread across the various age groups, with a rise of 38% in the

population above working age.

During the same period, the population of Aberdeen City is projected to decline by 23%. There will be

significant decreases in working age, and below working age population, along with a 25% rise in

those above working age. Natural change (births minus deaths) is expected to be quite low, with

most of the decline in population in Aberdeen City due to net migration loss. It is interesting to note

that during 2006 births outweighed deaths in Scotland for the first time in over 10 years.

Within Aberdeenshire, there is a projected population increase of 7% between 2005 and 2024, and a

projected increase of 77% in the population over statutory retirement age. The projections for Moray

reflect the Scottish population forecasts, with the exception of a small predicted increase (3%) in the

Moray population by 2024.

6

1.3.2 Ethnic Origin and Migrant Workers

During 2005/2006 NHS Grampian employed 91% of staff from a UK origin with 8% of non-UK origin.

This compares favourably with the size of the local ethnic communities in Grampian (7%). However

since 2004 there has been a large influx of migrant workers and their families from Eastern

European countries. This section of the population is under represented in the NHS Grampian

workforce who are now estimated to make up around 2.9% of the population in the area but only

represent 0.75% of the workforce. The main reason for this anomaly is that the overwhelming

majority of Eastern European workers coming to Grampian since 1 May 2004 have been recruited

from their country of origin by local Grampian based firms to a specific post. Hence the scope for

NHS Grampian to recruit from this group of workers is limited. However, this situation is changing.

From April 2006 onwards, there has been an influx of workers from Eastern Europe, primarily

Poland, who have come to Grampian on their own initiative, looking for work. In addition, a

number of Eastern European workers recruited by companies in Grampian are now looking to move

on to get better terms and conditions. NHS Grampian is alert to this recruitment opportunity. In

co-operation with Grampian Racial Equality Council, we are actively encouraging suitably skilled

craft persons to apply for long standing vacancies in the Estates Department. In addition,

information on a wide range of NHS Grampian vacancies is being made available to the Grampian

Racial Equality Council, on a regular basis.

These opportunities for the workforce however also influence the level of services required in

Grampian and the increased ethnic population is estimated at around 39,000 in the last two years.

This level of increase is already putting pressure on the requirement for health services. For example,

in one Grampian GP practice 30% of pregnant mothers did not have English as their first language.

7

Table 2 - Breakdown of the Ethnic Origin of those recruited during 2005/06

Description Number PercentageAsian Scottish 1 0.1% Chinese 2 0.2% UK Scottish 699 82.4% English 72 8.5% Welsh 2 0.2% Indian 14 1.7% Irish 18 2.1% Mixed Background 4 0.5% Other African Background 9 1.1% Other Asian Background 5 0.6% Other Ethnic Background 2 0.2% Other European Background 8 0.9% Pakistani 1 0.1% Polish 1 0.1% Estonia 1 0.1% Latvia 3 0.4% Slovakia 1 0.1% Declined to disclose 6 0.7% Total Number of Vacancies Filled 849 100%

1.3.3 EarningsIn 2006, the average gross full-time weekly wage in Grampian was £551.60; well above the Scottish

average of £503.70 and also higher than the equivalent UK average of £539.20. At £606.30, average

full-time wages in Aberdeen City were among the highest in Britain. In the period from 2003 to

2006, average weekly earnings in Grampian rose by 13.4%. This was higher than the rest of Scotland

(+7.2%) and above the rest of the UK (+5.9%). The increase in wages between 2003 and 2006 was

higher in Moray (13.5%) than Aberdeenshire (10.4%) or Aberdeen City (7.5%).

The weekly mid-point salary for Band 5 (Agenda for Change) is £415.23 and for Band 6 is £512.56.

Obviously this does not compare favourably with the rest of Grampian’s salaries and therefore puts

further pressure on the workforce availability and the competition for recruitment.

1.3.4 Employment/UnemploymentThe employment forecasts for the region are encouraging. Total employment is expected to remain at

its current level for a number of years, despite the anticipated downturn in energy sector employment.

The post-2011 decline will be gradual and concentrated in a small number of industrial sectors.

Energy employment passed its peak several years ago and the downward trend will continue. Oil

production is declining; however the North Sea remains an important producer of hydrocarbons with

substantial remaining reserves. Employment in the Non-Energy sector is forecast to rise from

176,050 in 2003 to over 179,000 in 2011, before declining to 175,500 in 2021. Some significant

8

infrastructure projects, e.g. the Western Peripheral Route, will result in a sharp increase in

construction employment in the period to 2011.

Self employment has been rising in recent years and a further increase is anticipated in the period to

2021. By 2021, there will be over 30,000 people in self-employment in Grampian.

The annual average claimant count unemployment rate in Grampian has fallen from 4.1% in 1996 to

1.6% in 2006. Between the 12 months January - December 2006 the number of claimants has

declined by 10,152 to 4,284 persons, or a 70.3% reduction. Scotland, too, has experienced

decreasing levels of unemployment since 1996 - the annual rate falling from 6.1% to 2.8%. Over the

past year claimant count unemployment has decreased by 17% in Aberdeenshire, 7% in Moray and

10% in Aberdeen.

1.3.5 The Health Needs Grampian does well when its health statistics are compared with Scotland. However we must

remember that Scotland compares particularly badly with the rest of Western Europe and we

therefore have room for improvement.

•

•

•

•

The Grampian death rate is lower than the rate for Scotland; however there are variations within

the region. The commonest causes of death in Grampian reflect the national picture. Thirty eight

percent of all deaths were in people under 75 years old (known as premature death) with the

three main causes cancers (38.3%), ischaemic heart disease (15%) and diseases of the

respiratory system (7%).

Within the Grampian population, a gradient is seen in premature deaths from cancer and

ischaemic heart disease, in suicide rates and in lifestyle choices (including smoking and teenage

pregnancy). This means that these conditions occur least frequently in the most affluent sections

of the population and most frequently in the most deprived sections of the community. For

example premature deaths from ischaemic heart disease (‘heart attacks’) are almost double the

Scottish average in deprived areas and 30% below the average in affluent areas.

Three areas of great public health concern are the number of premature deaths, the extent of

illness and disability and the wider social harms that they cause include obesity, alcohol misuse

and diabetes.

Overweight and obesity are steadily increasing (65% of adult males and 60% of adult females in

Grampian are overweight or obese) and are the result of societal and environmental influences,

life circumstances and individual lifestyle. In Grampian around 35% of boys and 30% of girls

aged 2-15 years can be classified as overweight or obese. Obesity has an impact on physical

and mental health and is a significant contributory risk factor for a range of chronic conditions.

9

•

•

About 3.4% of the people of Grampian are known to have diabetes and there will be others with

undiagnosed diabetes. Some diabetes could be prevented by lifestyle measures such as

avoiding becoming overweight and/or obese, and by undertaking physical activity. People living

in the least affluent fifth of the area have roughly a 50% greater risk of diabetes than those people

in the most affluent.

In Grampian the percentage of adults aged 16 and above consuming more than the

recommended weekly amounts (21 units for men and 14 units for women) was 22% of men and

15% of women. In a national survey of school-aged children, 20% of 13-year old boys and girls

report drinking alcohol in the week before the survey, rising to 40% of boys and 46% of 15 year

old girls. Grampian adolescent drinking patterns are similar to Scottish youths. Two drinking

patterns are particularly likely to increase the risk of harm due to alcohol misuse – binge drinking

(consuming at least 8 units of alcohol for men and at least 6 units for women during one drinking

session) and chronic drinking (drinking large amounts of alcohol regularly).

Director of Public Health Annual Report (2007)

1.4 Local Delivery Plan The Grampian Local Delivery Plan highlights the importance of the development and redesign of the

Workforce in its achievement. There are a number of Workforce issues associated with delivering the

levels and types of services identified. There are themes of increasing staff knowledge and educating

others, of enhancing roles, and of recruiting and re-skilling staff to be able to support the achievement

of the key targets. Other issues include the changing profile of the Workforce and the differing

locations for services that may be necessary to ensure that care is provided as locally as possible.

These are represented in appendix 2 – The NHS Grampian Rightfit Model

Examples of initiatives relating to the Local Delivery Plan include:

Suicide Rates The NHS Grampian training team have co-ordinated ASIST training across Grampian. Nine courses

have been run in Aberdeenshire and Aberdeen City with 191 participants from a range of partnership

agencies (voluntary and statutory). This training includes targeted efforts in the most deprived

communities. In addition 12 people are trained to provide suicide talks. Self-harm training has

already been provided to staff within our main A&E facility and further training needs in order to

deliver Commitment 7 of the Mental Health Delivery Plan will be identified.

Absences NHS Grampian is committed to minimising staff absence rates and already experiences a low rate of

absence when compared to elsewhere, although an increase has been experienced during 2006/07.

10

A number of initiatives are planned or in place as detailed in the NHS Grampian Staff Governance

Audit Action Plan 2007-2008 (Reference Document 1).

• Proactive Support for Sickness Absence Project (PSSA) has been implemented across the

Facilities Directorate and intention is to roll-out gradually across NHS Grampian

• Managing Attendance at Work Policy is being reviewed by a joint group for implementation in

April 2007

• Continued development of work/life balance policies.

A & E Waits – 4 Hour Targets Whole system redesign actions are being supplemented by the measures outlined below. These

actions will, however, contribute to the creation of sustainable capacity and systems to meet the 4

hour targets:

• Commitment to the funding of Extended Role Practitioners within Medicine (Similar posts to that

of Night Nurse Practitioners)

• Operational Support working Sunday shifts from January 2007

• Acute Medical Assessment Unit (AMAU) Senior Nursing staff will hold the Medical Admissions

Bleep 7 days a week, in order to free up Senior House Officers’ time. Previously this was on a

Monday to Friday basis 7am to 7pm.

Cataract Surgery Good progress continues to be made towards delivering an 18 week total patient journey from referral

to cataract surgery across Grampian. A second consultant ophthalmologist at Dr Gray’s in Elgin has

helped reduce demand on the Aberdeen service. Additional optometry support has also been put in

place to support the service and cover staff absence. Additional operating sessions are in place.

Endoscopy A Locum Consultant has been employed to support local medical staff in delivering the procedures.

The sustainability of the 9 week target will be achieved by extra workforce capacity from a Nurse

Endoscopist beginning upper endoscopy procedures independently from February 2007. In addition

two Nurse Endoscopists are currently undergoing training for colonoscopy and will complete and be

able to practice from September 2007. Within Aberdeenshire CHP there are 3 GP’s trained to carry

out endoscopy and they will enable a service to be provided more locally where appropriate.

11

Section 2 – Drivers for Change

The future NHS Grampian workforce is hugely influenced by internal and external drivers. Some of

these are national policy and initiatives, others relate to the population (see section 1.3), and others

are influenced by the local economy. There are also a number of initiatives which influence the

workforce which often require quick action and are supported by short term funding. This type of

initiative is difficult to legislate for in terms of Workforce Planning and Redesign. This is exacerbated

when the initiatives are in areas where there are existing Workforce issues e.g. recruitment problems

or large percentages of staff in a pre-retirement phase.

2.1 Pay Modernisation Pay Modernisation is normally identified as the Consultant Contract, the GMS Contract and Agenda

for Change. However NHS Grampian believe they are only part of the picture and would include the

Pharmacy Contract, Managing Medical Careers and the new Dental Contract as part of the suite of

Pay Modernisation as key modernisation initiatives. As each of these strands have a significant

impact on the future NHS Grampian Workforce they must be considered individually to identify their

impact. Pay Modernisation Delivery Plan Progress Report

2.1.1 Consultant Contract The introduction of the new consultant contract in April 2004 promoted the better planning of

consultant workload and a reduction in working hours for Consultants, moving to 48 hours or less.

During the Job planning year 2006-2007, NHS Grampian saw an overall reduction in 48 hour working

with service planning and redesign taking priority in supporting this objective.

2.1.2 Staff and Associate Specialist Doctors New national terms & conditions are currently being negotiated for this key group of medical staff. The

intention is to support their needs and maximise the valuable contribution they make to the delivery of

services. In the meantime, all Staff and Associate Specialist Grades continue on current Terms and

Conditions with ongoing updates being provided through the NHS Grampian Local Negotiating

Committee.

2.1.3 Junior Doctors Modernising Medical Careers (MMC) introduces a programme based, competency assessed training

programme to ensure that training arrangements are more effective and that time to train is used

more efficiently, thereby ensuring future doctors are able to meet patient and service needs.

Specialty Training is a key commitment, with NHS Grampian taking the lead on recruitment to Mental

Health Services and Diagnostics in Scotland.

UK-wide recruitment to Specialty training is intended to encourage a fair and equitable recruitment

system to training programmes. This could however see a deluge of applicants from English

Deaneries applying to Scottish training programmes – which will inevitably affect the recruitment and

12

retention of our ‘own’ trainees. The impact of trainees now focusing more on their educational needs

is likely to be a shift the workload to others in the service. This, coupled with the reduction in working

hours from 56 to 48, will put significant pressure on the system.

Vignette 2 - Foundation Doctors This new process for providing medical training has streamlined the process for Foundation year doctors. It has provided clarity on career paths and allowed junior doctors to choose the focus of their training. There are significant benefits to this new system to the Service, the doctor and to the patient. These include explicit standards of competence, a fully accredited (trained) workforce, opportunity for redesign of others roles e.g. nurses, more flexible approaches to training for the trainees and service redesign based around the patients needs.

2.1.4 Agenda for Change Agenda for Change is a tool to assist the planning, recruitment, development and retention of our

workforce. It enables and supports the development of new ways of working, ensuring the workforce

is effective, efficient and developed to meet current and future needs of the service.

Job Evaluation is important in assessing new and enhanced roles, for planning service improvement,

through appropriate reward. In addition, the modernisation and harmonisation of terms and

conditions should assist service redesign.

The use of the Knowledge and Skills Framework (KSF) in clarifying required competencies and

developing new roles will be crucial and ensure that we recruit, retain and develop a quality workforce

that is fit for purpose. KSF can be used to identify skill gaps, develop the core and specific knowledge

and skills required for the new roles and

providing a system that supports staff to achieve them. It will be instrumental in facilitating changes to

work practice and roles and used to support measurable targets and improved patient care.

2.1.5 General Medical Services (GMS) Contract There is recognition that the GMS contract has impacted on the whole Primary Care Team and for

Out of Hours on the whole system. The contract promotes the development of enhanced services

within Primary and Intermediate Care, and the development of Anticipatory Care. NHS Grampian is a

leader in negotiating and implementing revised Terms and Conditions of Employment for Salaried

General Practitioners and a cohort of associated grades e.g. GP with Special Interests (GPwSI),

Career Start GP’s, GP’s in Management etc. During the next year NHS Grampian will be faced with

national negotiations on Salaried GP’s as well as ongoing pressure for parity between GP’s and

Consultants/GMS colleagues.

13

2.1.6 Pharmacy Contract The new Pharmacy Contract which focuses on improving patient care has already begun to secure

better integration between pharmacy staff and the wider health care team. As it is implemented it will

have a significant effect on the breadth of services the pharmacy team will provide. The development

of services such as Minor Ailments has meant that 126 pharmacists have signed up for this service

and 40,000 patients have registered for the Service. This along with other initiatives, such as the

introduction of Pharmacists as independent prescribers, has implications for registration and

development of skills. The future focus for the Pharmacy team will be patient focused clinical services

using medicines expertise of pharmacists to provide care, support and information.

2.2 Current Workforce Profiles The following charts/tables provide information about the current Workforce within NHS Grampian.

Information is included on age profile, headcount, staff groups profile, turnover, gender split,

whole/time part, vacancies, redeployment and ethnicity (see 1.3.2). Each of these charts/tables helps

to build the overall picture and allow NHS Grampian to consider the actions required to ensure a

suitable Workforce for our future. Some narrative is provided after charts/tables to highlight any

Workforce issues we have currently and to highlight significant changes from last years Workforce

Plan. A staff group glossary is attached as Appendix 3.

Chart 1 - Age Profile by Staff Group

Age Profile by Staff Group as at 30 September 2006

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

%ag

e

60+ 3.4% 1.3% 2.8% 1.8% 1.8% 3.0% 2.4% 5.0% 5.0% 16.9% 14.1%

55-59 6.5% 4.0% 9.7% 7.5% 12.5% 8.1% 3.0% 15.2% 17.5% 20.1% 15.5%

50-54 9.6% 8.0% 12.5% 11.6% 15.8% 10.0% 11.8% 14.5% 35.0% 13.0% 12.1%

45-49 10.5% 20.0% 16.2% 12.0% 16.1% 13.9% 14.2% 16.8% 20.0% 14.9% 11.3%

40-44 11.5% 18.7% 17.4% 14.6% 16.1% 16.7% 17.8% 14.3% 17.5% 7.8% 11.8%

35-39 11.7% 12.0% 14.0% 15.3% 8.6% 15.5% 13.6% 13.5% 5.0% 7.1% 7.6%

30-34 16.1% 21.3% 10.8% 15.3% 6.1% 11.8% 15.4% 10.0% 0.0% 7.8% 6.3%

25-29 21.1% 13.3% 10.7% 14.3% 15.4% 12.0% 14.2% 6.8% 0.0% 4.5% 5.5%

20-24 9.6% 1.3% 5.6% 7.6% 7.5% 6.7% 7.1% 3.1% 0.0% 3.2% 6.1%

Under 20 0.0% 0.0% 0.3% 0.0% 0.0% 2.3% 0.6% 0.7% 0.0% 4.5% 9.6%

M edical DentalNursing & Nursing Therapeut ic

Healthcare Science Technical Pharmacy

Admin & Clerical/Senior

M anagersWorks Trades Ancillary

Data Source: ISD

14

Vignette 2 – Mature Apprentices A proposal which is currently being considered is to introduce a scheme for Mature Modern Apprenticeships targeted towards appropriate non-craft / unqualified staff who have aspirations of developing their experience, formal skills, qualifications and role within NHS Grampian Estates. Given the target group the initiative would not be age limited. NHS Grampian has already employed one individual under this initiative in Moray. Vignette 2 – Mature Apprentices

Table 3 - Age Distribution of staff aged 65 and over by Staff Group

Staff Category 65 66 67 68 69 70 71 72 73 75 76 Grand Total

Admin & Clerical/Senior Managers 11 5 4 1 - - - - 1 - 1 23 AHP Incl. Psychology, Optometrists 1 - - - 1 - - - - - - 2 Ancillary 23 10 9 7 6 5 2 2 1 - - 65 Maintenance 2 - - - - - - - - - - 2 Medical & Dental 3 1 2 1 1 - - - - 1 - 9 Nursing & Midwifery Trained 7 3 2 - - - - - - - - 12 Nursing & Midwifery Untrained 16 1 1 - - - - - - - - 18 Other - - 1 - - - - - - - - 1 Technical 1 - - - - - - - - - - 1 Grand Total 64 20 19 9 8 5 2 2 2 1 1 133

Data Source: SWISS

2.2.1 Age ProfileThe age profile for NHS Grampian has not changed significantly since the 2006 Workforce Plan. The

most significant change in profile has been within Dentistry in the 25 – 35 age groupings. This is as a

direct result of new staff being employed for the Aberdeen Dental Institute and new Dental Practices.

Over the last 12 months, the number of staff employed beyond their 65th birthday has nearly doubled,

continuing the increasing trend indicated from last year. The largest rises have been in Medical &

Dental and Nursing & Midwifery. Within NHS Grampian, 28.2% of the total workforce is aged over

50. The number of Consultants and senior Nursing and Midwifery Staff reaching retirement age has

also continued to increase with 8% of consultants, 1.6% of Qualified and 6.4% of Unqualified

Nurses/Midwives now over 60. AHP staff are entitled to retire at 55, this gives some concern as some

of the projected changes include small increases with this workforce category. For scientists (another

group with a significant percentage of staff over 50) an initiative by NHS Education Scotland and the

Higher Education Institutes to promote this profession and improve recruitment has focused on

changing education for this group. We will continue to consider flexible work patterns to utilise this

section of the labour market.

With an ageing workforce and predicted population trends of significantly less young people coming

into the labour market, it is clear that this will begin to have a huge impact on the pool from which we

15

as an employer are able to recruit new employees. Retention of our older workforce will bring benefits

of retained corporate knowledge, lower recruitment costs and increased retention on investment in

staff. Such a diverse workforce will bring a wider mix of talents, and there is clear evidence that both

staff turnover and absenteeism are reduced and that motivation and commitment are improved by a

mixture of ages within the Workforce.

Chart 2 - Profile of Headcount by Staff Group

Profile of Headcount by Staff Group as at 30 September 2006

8%

1%

46%

8%

3%

17%0% 13%1%

2%

1%

Medical (1192) Dental (75) Nursing & Midw ifery (6387)

Therapeutic (1167) Healthcare Science (279) Technical (432)

Pharmacy (169) Admin & Clerical/Senior Managers (2279) Works (40)

Trades (154) Ancilary (1896)

Data Source: ISD

2.2.2 Headcount The total headcount of staff has increased by 2.95% (403) to 14,070, over the past 12 months, but

with no significant changes to the profile. There has been a 92% Headcount increase in the Dental

category, which was predicted last year as a result of opening the Aberdeen Dental Institute, 3 new

Dental Practices and the transfer of employment for receptionists at our salaried practices. There is

predicted to be a slower, albeit continuing increase in this category throughout 2007 and beyond, as

new practices are opened. Rises were also seen of between 12 – 14% in Pharmacy and Ancillary.

The increase in Ancillary was as a result of the TUPE transfer of 229 Initial Services staff to NHS

Grampian in November 2005. The increase in Pharmacy staff is not a rise in actual staff numbers, but

a consequence of the non-direct match between old Whitley grades and new Agenda for Change pay

bands.

16

Chart 3 - Profile of WTE by Staff Group

Profile of WTE by Staff Group as at 30 September 2006

10%1%

47%

8%2%

3%1%

16%

11%1%0%

Medical (1080.2) Dental (61.7) Nursing & Midw ifery (5150.9)

Therapeutic (899.6) Healthcare Science (247.4) Technical (359.5)

Pharmacy (144.8) Admin & Clerical/Senior Managers (1809.1) Works (38.6)

Trades (150.7) Ancilary (1262.8)

Data Source: ISD

Chart 4 - Percentage Split of Gender

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

%age

Percentage Split by Gender as at 30 September 2006

Female 43.4% 61.3% 94.1% 92.6% 67.4% 75.0% 85.8% 86.7% 2.5% 5.8% 70.7% 82.7%

M ale 56.6% 38.7% 5.9% 7.4% 32.6% 25.0% 14.2% 13.3% 97.5% 94.2% 29.3% 17.3%

M edical DentalNursing & M idwifery

Therapeut ic

Healthcare Science Technical Pharmacy

Admin & Clerical/Se

nior Works Trades Ancillary Total

Data Source: ISD

17

Chart 5 - Percentage Split of Whole-time/Part-time

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Medical

Dental

Nursing & Midwifery

Therapeutic

Healthcare Science

Technical

Pharmacy

Admin & Clerical/Senior Managers

Works

Trades

Ancillary

Percentage Split of Whole-time/Part-time by Staff Group as at 30 September 2006

Whole-time Part-time

Data Source: ISD

2.2.3 Part Time/Full time Split and Feminisation The majority of the workforce continues to be female, and this percentage is rising in the majority of

staff groups. The number of part-time posts has also increased across all staff groups. Our policies

in Grampian aim to support staff in a number of ways including a raft of family friendly policies

including Parental Leave, Special and Carers Leave, Redeployment, Secondments, Phased

Retirement, Learning and Development, Work Experience and organisational change. Arguably

most, if not all NHS Grampian policies support the recruitment, retention, planning and development

of the Workforce. Reference Appendix 4 - NHS Grampian Policies

The increase in the dental headcount since 2005 has had an impact on this category, whereby the

percentage of males has increased from 26% to 38.7%. However the number of part-time posts has

increased.

2.2.4 Vacancies The following tables provide information on live vacancies within the system at a given date. (Note

that the dates vary dependent on when the ISD figures are collated). Vacancies which are being

managed within the system and are not being processed are not included.

Over the last 12 months the number of live vacancies within the organisation has varied from month to

month from 143 to 343 with an average of 230 per month.

18

Table 4 - WTE Consultant Vacancies as at 30 September 2006

Vacant for: Vacancies as a percentage

of establishment

EST Staff in

post

Posts under review

Total vacancies

Less than 6 months

Over 6 month vacancies Unknown Total 6 months or over

Consultants 393.4 376.3 0.0 17.1 11.1 6.0 0.0 4.3% 1.5%

Data Source: ISD

The number of Consultants has increased as predicted in last year’s workforce plan. There is an

increase in the number of vacancies, although a larger number of these have been vacant for less

than 6 months. The overall vacancy rate has however increased to 4.3%.

Table 5 - WTE Nursing & Midwifery Vacancies as at 31 March 2006

Vacant for:

Vacancies as a percentage of establishment

EST Staff in

post Posts under

review Total

vacancies Less than 3

months

Over 3 months

vacancies Unknown Total 3 months or

over Nursing & Midwifery 5460.5 5188.2 18.0 272.3 175.0 89.9 7.4 5.0% 1.6% Data Source: ISD

The number of overall nursing vacancies has increased by 19.2%. The Specialties with the greatest

increases in the number of vacancies are registered Hospital Mental Health nurses (104%) and non-

registered Care of the Elderly nurses (189%). However, Care of the Elderly began a targeted

recruitment drive in April 2006 and filled 17.5 WTE vacancies.

Table 6 - WTE Allied Health Professional Vacancies as at 31 March 2006

Vacant for:

Vacancies as a percentage of establishment

EST Staff in

post

Posts under review

Total vacancies

Less than 3 months

Over 3 months

vacancies Unknown Total 3 months or

over Allied Health Professional 866.6 817.6 0.1 49.0 15.5 33.5 - 5.7% 3.9% Data Source: ISD

The total number of AHP vacancies has decreased significantly since March 2005 from 74.3 to 49.0

WTE. The largest decrease is in short-term vacancies i.e. those posts vacant for less than 3 months.

This is in part due to vacancy management in that most managers are ensuring their documentation is

accurate and the recruitment process is therefore slicker.

19

National initiatives which encourage AHPs back into the workplace are likely to have had an impact

on recent increases to vacancies. Also, anecdotally, vacancies in this staff group have sometimes not

been formalised due to known difficulties in the labour supply.

Chart 6 - Percentage of Turnover by Staff Group

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

%age

Percentage Turnover by Staff Group October 2005 - September 2006

Data Source: ISD and SWISS

2.2.5 TurnoverBetween 30 September 2005 and 20 September 2006 turnover was 12.6% across all staff groups.

The highest rate was 24.7% for Ancillary and the lowest 8.3% for Pharmacy.

Chart 7 - Redeployment - Staff Movements

0

10

20

30

40

50

60

70

No.

of S

taff

New Posts Ill Health Funded Extended Resignations Terminations Total

Reason

Redeployment Staff MovementsSeptember 2006 - March 2007

20

2.2.6 Redeployment Staff MovementBetween September 2006 and March 2007 there were 84 staff on the NHS Grampian redeployment

register. A large number of current staff on the register are due to planned closures of wards. This

Register and our Redeployment Policy are to support staff to find new or alternative employment

within the organisation. Reasons for redeployment include TUPE, ill health, organisational change,

matters of capability, resolution of grievances, employee conduct, ward and hospital closure.

Redeployment provides individuals with an opportunity to develop new skills in order to take up a new

role.

2.3 Workforce TrendsWithin NHS Grampian there are a number of trends which are emerging regarding the workforce,

including

o The feminisation of traditionally male roles e.g. GPs. This results in the increase in the

workforce headcount as the number of females working part time are greater than the number

of males working part time.

o Current information is highlighting that 70% of the medical student population is female. This

has obvious connotations for the future medical workforce given current trends regarding

feminisation and part time working.

o There are indications of individuals consciously choosing a work life balance. This could have

an impact on overall organisational headcount. Examples can be seen within nursing and

through the Consultant job planning process.

21

Section 3 - Service Changes

3.1 CHANGE & INNOVATION PROGRAMME

Context The Change & Innovation Programme (CIP) is key to delivering both the Grampian Health Plan and

National Strategy for NHS Scotland and as such is closely aligned to the objectives laid out in

‘Delivering for Heath’.

It is the means by which NHS Grampian’s service strategy and redesign agenda will be taken forward

and reflects the activity of the various National Improvement Programmes such as Planned Care.

It is agreed and understood within the CIP that redesign of services cannot only be considered in

terms of the type, level and location of activity but must also include ensuring the most appropriate

workforce to deliver services to patients. Workforce planning and redesign is therefore viewed as a

vital component in shaping services fit for the future

Process To ensure consistency and to facilitate integration between activity and workforce planning NHS

Grampian have adapted and utilised the existing Workforce Planning Tool . The agreed process

allows a dynamic interaction between individual redesign projects, the sectors with planning

responsibility for the CIP and the NHS Grampian Workforce Plan.

This is highlighted in the accompanying example. See appendix 5

Each project and sector work to predetermined templates to ensure compatibility of information. This

is being taken forward on a multidisciplinary basis involving the management team including planning

leads, HR Managers and Managers from Learning and Development.

Discussion is ongoing in relation to projection modelling of future resource requirement at an

organisational level. Any scenario planning for the following projects will include workforce redesign.

o Unscheduled Care o Integrated Care o Intermediate Care o Self Care o Planned Care

22

Vignette 3 - Physicians Assistants NHS Grampian is currently employing 3 Physicians Assistants as part of a Scottish pilot. To date the feedback has been very positive. A full evaluation conducted locally by the University of Aberdeen will be due for completion in 2008. There will also be national evaluation by the University of Highlands and Islands. Two postholders are employed within Woodend Hospital and the other within the out of hours GMED service. These individuals have been trained in a “medical model” which concentrates on judgement and risk management. The work ethos is service and patient focused. Although there may have been some tension at the outset of this pilot, to date the impact of these posts has been significant and their contribution to the clinical care and the clinical team has been recognised to be of value.

3.2 Workforce in the Sectors and Community Health Partnerships (CHPs)

3.2.1 Aberdeen City Community Health Partnership Within the Aberdeen City CHP there are number of workforce changes which will result from the

implementation of the CIP and other redesign work. As with all Community Health Partnerships they

are reliant on the Local Authority and their symbiotic relationship of health and social care. Any

changes to the agreed level of care provided by the Local Authority will have an impact on the

demand for health care services.

In general there will be a need to reskill and reshape the Workforce within this Community Health

Partnership to support changes in the ethos of care as required by the implementation of integrated,

planned and intermediate care. Within the present financial climate there is a belief that the

Community Health Partnership will continue with a similar number of staff as currently exists. Any

changes will be in marginal numbers and are likely to focus on nursing, support worker and AHP

roles. Changes may include a small increase in the number of assistant/support worker roles and for

those with a multiple specialty. This however is based on upskilling and reskilling staff and not

increasing nursing and AHP workforce numbers. There may be marginal increases in Occupational

Therapy and Physiotherapy staff as services are provided over extended hours. However details of

these changes have yet to be agreed.

Some examples of workforce initiatives within this Community Health Partnership include

o Redesign of the nursing liaison team to support early planned discharge

o Possible creation of community based specialist rehabilitation teams to facilitate early

discharge and prevent hospital admission e.g. for Stroke

o Development of leaders for a Nurse/AHP led intermediate care/rehabilitation service

o Commissioning research from the University of Aberdeen to look at future primary care

services in Grampian

o Changing roles of GPs, Practice & Community Nurses and Pharmacists in chronic disease

management and complex case management

23

Vignette 4 - Aberdeen City Community Health Partnership Delivery Teams Within the City work has begun which will cluster GP surgeries together. Within these clusters the clinical workforce will be re-designed to support patient needs. Each cluster will align with local Nursing Care Homes and the design of the team will be based around the most efficient use of the skills from the multi-disciplinary members.

3.2.2 Aberdeenshire Community Health Partnership (CHP) Aberdeenshire CHP serves a wide geographic area in the north-east corner of Scotland. Primary

Health Care Services are provided throughout this rural area in a variety of settings including

community hospitals, health centres, clinics, care homes, schools and of course in the patient’s own

home.

The population profile of Aberdeenshire is predicted to alter dramatically over the next ten years. The

population of over 85 year olds is anticipated to grow by 40% during this period. This is accompanied

by a predicted 15% decrease in the working age population. Given that the over 85’s are highly

dependant upon NHS services, there is a need to rethink how services will be delivered in the future,

as it is not sustainable to continue to provide the care in the current way. Coupled with this is the

desire to deliver as much care as possible in the primary care setting as close to the patient’s home

as is reasonably practical and feasible. There is also a need to further develop measures to prevent

unnecessary admissions to an acute hospital; supported by promotion of self care and local

accessibility to services.

Joint working with the Local Authority is crucial to the success of how care will be delivered in the

future and through this joint working and planning of services, community based alternatives to long

stay care will be developed.

The CIP supports the closure of long stay elderly and old age psychiatry beds and the development of

rehabilitation beds and community support services. It will develop Diagnostic and Treatment

Services and redesign maternity services, with the emphasis shifting from interpartum care, to

enhancing the role of the community midwife in both ante-natal and post-natal care. It will also

enhance the provision of AHPs with consideration being given to develop some services to seven

days. The role of the generic therapies assistant will also be reviewed and developed. The North of

Scotland Workforce Group commissioned research by Robert Gordon University into this area which

was reported during 2005. This Report could be used to inform future development of these roles.

Aberdeenshire CHP has already introduced, or is in the process of introducing, a number of enhanced

services throughout the region. These are mainly provided by local GP’s with special interests

(GpwSI) who have received training in the specialties below. Additional training for nursing staff and

AHP’s will also be considered in the future.

24

These include:

o Shifting diabetic care to GP Practices

o Establishing cardiac assessment clinics

o Establishing endoscopy clinics

o Development of Ultrasound services

o Development of Dermatology Clinics

o Development of a network of GP’s and other health professionals with an interest in

Orthopaedics

o Development of ENT clinics

Current staff will receive assessment and training of competency in new and redesigned roles, to

enable the CHP to support these changes utilising current staff numbers. It is planned within the CHP

to redesign services using approximately the same number of staff, but acknowledging a likely

increase in AHP staff and in GPwSI’s. Ideally any area requiring less staff will be met through natural

wastage, turnover and retraining and redeployment.

3.2.3 Moray Community Health and Social Care Partnership

Moray continues to develop its single system organisational arrangements with its Local Authority

partner –Moray Council. The workforce implications over the next few years are quite significant for

this model. The acute hub of the system (Dr Gray's Hospital), is moving towards a service led model

of care, with more emphasis on advanced competencies for both medical and non medical health

professionals. Increasingly, the demands of MMC, New Deal and EWTD, has helped determine that

patient care pathways are best delivered by experienced health care professionals with more

protected training and learning time for inexperienced health care staff/doctors.

Dr Gray’s current nursing workforce is being addressed in terms of more effective utilisation of

existing resources. The recent skill mix review on nursing (using the Telford Model) illustrates that the

issue may potentially be about shifting the balance of resource within some areas. There are plans to

roll out this approach into other staffing areas. A Planned Care Development Plan is being produced

to address the pertinent issues around maximum waits for specific conditions including the effective

management of day case and pre-admission assessment rates. Particular areas are being identified

for practitioner and/or specialist support.

Moray CHSCP has consistently high stability and low turnover and the focus is about redesign within

existing resources, with innovation coming from the single system. (For example please see last years

Plan). The overall projected staffing changes for the next few years are minimal with some

developments in AHP areas as a result of growth within specialisms particularly in support of

integrated and self care.

25

Unscheduled Care is a particular pressure for the system and the workforce implications are

significant in terms of how the system is supported in the future. This will involve some additional

resource albeit marginal, in that GMED and acute hospital staff will address the unscheduled care

activity in a more optimal manner through service redesign, streamlining triage, admission and

discharging processes and working together in a unified team.

The Community Matron Project piloted in a Locality is still very much a crucial aspect of future

workforce planning for the system, using the successes of this project to deliver more effective care

within chronic and complex disease management. Current workforce plans from staffing groups areas

(Nursing and AHPs in particular), suggest that the resource allocation is changing, with more now

being moved from Acute to Primary care.

Recent scoping work undertaken by Highlands and Islands Enterprise - Moray in liaison with Moray

CHSCP has provided for a focussed strategy on future growth and sustainability, moving away from

the historical dependency on the two local RAF bases for Moray CHSCP’s staffing. This provides for

opportunities to further develop Moray’s capability and capacity with regards to telemedicine and

Integrated Rural Health Care, Women’s Health, Bariatric/Obesity Care and training expertise within

General Medicine and Rural Health Care. The workforce implications are currently being addressed

but the theme continues to be one of innovation and effective utilisation of existing staffing resource.

Further examples of some current workforce initiatives in support of the workforce plan are:

Hospital at Night Project, Medical Redesign (Virtual Medical Ward) Project, Diagnostic and Treatment

Centre Project and Moray 20/20 Project.

3.2.4 Acute Hospital and Interface GroupThis sector covers a diverse number of services all with differing drivers, priorities and workforce

needs. There are however a number of common themes which are emerging from this Sector.

These include the waiting time targets and other performance targets such as new to return ratio,

development of new improved clinical practice, some less invasive surgically and some more

invasive, development of new and improved drug therapies, the move to more community service

provision particularly in the management of chronic disease, financial targets, development of new

technology/equipment, the increasing elderly and very elderly population, the reduction in the younger

population, the introduction of a Core and Pool bed model and MMC. This is not an exhaustive list

and only highlights some of the issues impacting on the future workforce needs.

These drivers will mean changes to the workforce in terms of numbers, locations and

skills/competence. Below are some examples of these predicted changes.

o More focus on specialist practitioners providing care for chronic disease out in the community,

information regarding the number of Practitioners with a Specialist Interest (PwSI) is being

collated.

26

o Upskilling of healthcare assistants to allow them to undertake the roles of more qualified staff

e.g. nurses and nurse practitioners who in turn are taking on extended roles due to the

implementation of MMC and also the move to Core and Pool beds within Acute Sector

o Increasing and developing the role of Community Geriatricians to support patients in their own

communities by providing specialist input

o Development of nurses, midwives and AHPs to support the shift in the balance of care. There

is also likely to be an increase in the number of AHPs and an enrichment of the skill mix to

support projects such as Intermediate Care

o Increase in the number of patients seen by Optometrists in the community to reduce referrals

to the Ophthalmology Service

o Unavailability in the labour market of certain skills e.g. Neurophysiology

o Some redesign work which will require an increase in administrative and portering staff to

support the clinical services and free up clinical capacity

Vignette 5 - Acute Restructuring The new Acute structure within NHS Grampian has at its core a Unit Operational Manager and a Clinical Director as its leaders. These individuals are currently working towards ensuring that job planning is completely integrated into the service planning process. They are using this opportunity to ensure that the process is joined up and reflects the future Workforce needs not just of medical staff but all of the Workforce team.

3.2.5. Mental Health Services The Mental Health Delivery Plan was published by the Scottish Executive at the end of 2006. The

Plan builds upon the Mental Health (Care and Treatment) Act 2003 and the earlier Framework for

Mental Health Services. There are 3 targets supported by 14 National commitments which will impact

upon Design of Mental Health Teams, Development of Peer Support Workers, Integrated Care

Pathways, Evidence-based Psychological Therapies, Physical Health of patients with severe and

enduring mental illness, Design of Crisis Services, Design of Services for Children and Young People,

Reduction in Re-admissions, Development of Dementia Services.

o A key driver has been the Mental Health Act which led to the creation of a Mother and Baby

unit within Royal Cornhill Hospital, with an associated post for a Perinatal Nurse which was

appointed to recently.

o The service is currently drawing up plans to look at the feasibility of a Nurse Consultant within

Learning Disabilities. This links into the Rights, Recovery, and Responsibilities (RRR) which

interfaces to the Mental Health Delivery Plan. If progressed, this post will interface across

NHS Grampian.

o There is a significantly high level of vacancies for qualified nurses in Mental Health entwined

with a difficulty in recruiting suitable staff. Executive money ring-fenced for an enhanced

Substance Misuse service on an annual basis has caused a bit of a recruitment issue, not

only within Substance Misuse but within Mental Health. However, NHS Grampian is now

27

looking nationally to attract people from elsewhere and formulating an action plan to support a

national recruitment drive.

o The Mental Health sector is in the process of closing one ward and this will be concluded by

the end of June 2007. Staff are being appointed from the mix of 2 wards, whereby we have

increased the nursing staff within the new existing ward and any displaced staff will be

redeployed within Mental Health. At this time there are no further definite decisions about

closing any other wards.

With regard to developments Mental Health are expecting to open a new in-patient service for

Eating Disorders in the next 18 months or so, which will result in the recruitment of multi-

profession posts. For example Nursing, OT, Psychology, Medical, etc.

3.2.6 Facilities DirectorateAround 2,500 staff are employed in this sector covering the whole of Grampian. They provide support

services to NHS Grampian in Acute and Primary Care settings. Services include Procurement and

Logistics (Transport, Portering and Commodities), Catering encompasses a Cook Chill Production

unit based in Aberdeen, Domestic Services, Estates and Technical Support Services (Linen Services,

Sterile Services, De-contamination).

The key issues impacting currently and for the future are:

o The age profile of Estates staff, with around 52% of staff over 50 years of age. NHS

Grampian is currently experiencing difficulties in recruiting and retaining appropriately

qualified staff given the competitive labour market for these skills

o Efficient Government – Procurement Modernisation Programme, this initiative is based on the

redesign of Procurement and Logistics arrangements across Health Boards, which will impact

on the numbers of staff and the skills required within these services. With current banding

from Agenda for Change and the mismatch with private sector market rates for professional

procurement staff this will challenge access to upskilled resource requirements. Access to

and recruitment of Graduate trainees or Students undergoing appropriate courses of study

with a view to bringing them into the organisation under a procurement skills development

programme is currently being considered.

o There are also ancillary staff recruitment issues, across Portering, Laundry, Catering,

Domestic and other ancillary staff requirements in Facilities. The recruitment of European

nationals to fill vacancy requirements is becoming more prevalent. In accordance with NHS

Grampian equality and diversity policies, suitable and practical methods of providing

translation and language learning support are being considered.

o Facilities will make links with our local authority partners which will also impact on both of

these workforces through efficient government and Shared Support Services.

28

3.3 Regional Projects

The North of Scotland has a number of regional projects being implemented. These projects are at

varying stages of development with some not yet reaching the stage of producing Workforce Plans.

However key Workforce issues have been progressed. Examples of these include

o Diagnostics and Radiology – where work has been done to consider the level of vacancies

and the aging workforce. This project has also looked at the need for role development and

the “4 tier” career structure. Follow on issues from this work include learning and development

plans.

o Medium Secure unit – the workforce subgroup have agreed a process for the development of

the workforce plan. This includes looking at competencies for mental health, utilising the KSF

and profiling the current and future workforce.

o Cardiology Network – to date this project has to date appointed two regional posts; Clinical

Lead and Service Improvement Manager. Future objectives include

Further defining the future vision in the North for cardiac service provision

Performing a census on current workforce for cardiac services across the Northern

health boards

Holding a workforce planning workshop at the end of June 2007 to look at how the

workforce will affect the future service provision and the vision and how to plan for

this effectively

Developing and agreeing the North of Scotland Cardiac Workforce Plan for Sept 2007

o Care of Older People in Rural Areas – this research project in partnership with NES,

Aberdeen University and Skills for Health is looking at the skills required by the rural care

team and what impact rurality has on the level of care provided. A significant aspect of this

work relates to competencies.

o Child Health – whose workforce objectives include developing a regional post for Workforce

Planning and regional appointments. A project objective is to empower local teams to support

complex care locally using the development of new and extended roles e.g. consultant nurses

in the community

o Maternity Services – have developed a work plan based on a collaborative seminar. Specific

workforce objectives include exploring capacity shortages in Obstetrics and Neonatology and

the need to look at new and different roles for midwives in the future. Work has begun on

developing a regional educational strategy to support the new networks.

29

Section 4 – Workforce Projections

4.1 Scenario 1 – Historical Projections These projected workforce figures are based on trends over the last 10 years; these trends have been

extrapolated to show what would happen over the next 1,2,3, 5 & 10 years as required. As with the

2006 Plan these projections are unaffordable as most groups are projecting an increase in staffing

numbers and this would not be feasible given the current labour market and financial climate. Those

areas where a decrease is predicted do not reflect the reality service needs. Realistically we have no

choice but to redesign our services to provide an affordable workforce.

Table 7 - Medical Projections based on current trends in WTE by Grade 2006 – 2016

WTE Staff in Post

30/09/2006

Year 1 2007 WTE

Expected

Year 2 2008 WTE

Expected

Year 3 2009 WTE

Expected

Year 5 2011 WTE

Expected

Year 10 2016 WTE

Expected Clinical Laboratory Specialties Consultant 30.8 31.5 32.2 33.0 34.5 38.5 Staff Grade 3.0 2.8 2.7 2.5 2.2 1.7 Doctors in Training 28.0 29.0 30.1 31.1 33.4 39.4 Medical Specialties Consultant 124.1 127.6 131.1 134.8 142.4 162.3 Staff Grade 18.7 20.4 22.2 24.2 28.6 41.4 Doctors in Training 287.7 288.0 288.3 288.6 289.1 290.6 Psychiatric Specialties Consultant 46.1 47.3 48.4 49.6 52.1 58.6 Staff Grade 10.5 12.1 13.8 15.9 20.6 35.8 Doctors in Training 48.6 51.7 55.0 58.5 66.0 87.2 Radiology Consultant 20.4 20.4 20.4 20.5 20.5 20.6 Staff Grade 0.0 0.0 0.0 0.0 0.0 0.0 Doctors in Training 13.6 13.6 13.6 13.6 13.7 13.7 Surgical Specialties Consultant 137.9 141.5 145.2 148.9 156.7 177.1 Staff Grade 11.1 10.5 10.0 9.5 8.5 6.7 Doctors in Training 216.8 224.0 231.3 239.0 254.8 296.8 Community Medical Specialties Consultant 15.9 16.5 17.2 17.8 19.2 23.0 Staff Grade 11.4 10.2 9.2 8.3 6.7 4.3 Doctors in Training 19.6 35.6 51.6 67.6 99.6 179.6 Total Consultant 375.2 384.8 394.6 404.7 425.4 480.0 Staff Grade 54.7 56.0 57.9 60.3 66.6 89.9 Doctors in Training 614.3 641.9 669.9 698.5 756.6 907.3

Data Source : ISD

Notes: Medical Specialties also include A&E, OHS and Obstetrics & Gynaecology Surgical Specialties also include Anaesthetics and Hospital Dental Specialties Community Medical Specialties also include Public Health

30

The significant increase in Community Medical Specialties is a direct consequence of using historic

trends from the period of the introduction of the new Foundation Year Programme.

Chart 8 - Medical WTE – 2006

Scenario 1 Medical - WTE by Grade as at 30 September 2006

375.2, 36%

54.7, 5%

614.3, 59%

Consultant Staff Grade Doctors in Training

Data Source: ISD

Chart 9 - Medical Projections – 2016

Scenario 1 Medical Projections based on current trends - WTE by

Grade in 2016

480.0, 32%

89.9, 6%907.3, 62%

Consultant Staff Grade Doctors in Training

Data Source: ISD

31

Table 8 - Primary Care Dental Services Projections based on current trends in WTE 2006 – 2016

ISD Baseline Data Year 1 Year 2 Year 3 Year 5 Year 10 2006 2007 2008 2009 2011 2016

WTE Staff in Post

(at 30th Sept) WTE

Expected WTE

Expected WTE

Expected WTE

Expected WTE

Expected

Primary Care Dental Services 117.4 133.2 151.2 171.5 217.8 365.0 Dentists 43.1 48.3 54.1 60.6 75.1 120.2 Dental Nurses 68.1 78.0 89.3 102.2 131.9 227.5 Others 6.2 6.9 7.8 8.7 10.8 17.3

Chart 10 - Primary Care Dental Services WTE – 2006

Primary Care Dental Services WTE as at 30 September 2006

43.1, 37%

68.1, 58%

6.2, 5%

Dentists Dental Nurses Others

Data Source : ISD

Chart 11 - Primary Care Dental Services Projections – 2016

Primary Care Dental Services based on current trends in 2016

120.2, 33%

227.5, 62%

17.3, 5%

Dentists Dental Nurses Others

Data Source : ISD

32

Table 9 - GP Projections based on current trends in Headcount 2006 – 2011

ISD Baseline Data Year 1 Year 2 Year 3 Year 5 2006 2007 2008 2009 2011

Headcount Staff in Post (at 30th Sept) WTE Expected WTE

Expected WTE

Expected WTE

Expected

General medical service 531 551 575 603 673 Performer 394 396 399 401 406 Performer registrar 36 38 40 42 47 Performer salaried 79 96 117 143 205 Performer retainee 22 20 19 17 15

Chart 12 - GP Headcount – 2006

Scenario 1 GP Headcount as at 2006

394, 74%

36, 7%

79, 15%22, 4%

Performer Performer registrar Performer salaried Performer retainee

Data Source : ISD

Chart 13 - GP Projections – 2011

Scenario 1 GP Projections based on current trends - Headcount in 2011

406, 61%47, 7%

205, 30%

15, 2%

Performer Performer registrar Performer salaried Performer retainee

Data Source : ISD

33

4.1.1 GPsIn general there are now more part-time GP's. From the recent collection of data via the Primary Care

Practice Workforce Survey there are areas where the GP workforce is more female than male.

Although this survey did not receive returns from all practices there are a number of useful indicators

including a reasonable age profile with only a few practices highlighting concerns regarding retirals of

GPs. There are also indications that there are likely to be significant retirals for administrative staff

and managers within the primary care workforce within the next 5 years. The increase in the

Performer Salaried group is due to the fact that initially fewer GP's wish a partnership within a

Practice. The reduction in the number of Retainees relates to the Career Start scheme within

Grampian. As there is already flexibility in the system with regards to employment, hours etc,

there is less need to employ individuals under the retainee scheme.

Table 10 Nursing & Midwifery projections based on current trends by Specialty in WTE 2006 – 2011

ISD Baseline Data Year 1 Year 2 Year 3 Year 5 2006 2007 2008 2009 2011

WTE Staff in Post (at 30th Sept)

WTE Vacancies

(at 31st Mar) WTE

Expected WTE

Expected WTE

Expected WTE

Expected

All Specialties 5,150.9 270.3 5,159.4 5,169.3 5,180.7 5,199.6 All Specialties – Registered 3,834.9 181.5 3,863.8 3,893.6 3,924.4 3,980.1 All Specialties - Non-Registered 1,316.0 88.8 1,295.7 1,275.8 1,256.4 1,219.5

Adult 3,605.8 192.4 3,603.9 3,602.2 3,600.5 3,589.6 Registered 2,690.4 121.3 2,698.5 2,706.6 2,714.7 2,722.8 Non-Registered 915.4 71.1 905.4 895.6 885.8 866.8

Children 261.4 10.5 270.5 279.9 289.7 310.4 Registered 210.7 8.7 220.2 230.1 240.4 262.1 Non-Registered 50.8 1.8 50.3 49.8 49.3 48.3

Mental Health 838.0 48.8 842.6 847.6 852.8 864.2 Registered 573.5 38.4 583.8 594.3 605.0 626.8 Non-Registered 264.5 10.4 258.8 253.2 247.8 237.3

Learning Disabilities 99.7 3.0 92.8 86.3 80.3 70.0 Registered 68.2 3.0 64.2 60.5 56.9 50.7 Non-Registered 31.5 - 28.5 25.8 23.4 19.4

Midwifery 346.0 15.6 349.7 353.4 357.3 365.4 Registered 292.1 10.1 297.1 302.1 307.3 317.7 Non-Registered 53.9 5.5 52.6 51.3 50.1 47.7

34

Chart 14 Nursing & Midwifery WTE – 2006

Scenario 1 Nursing & Midwifery WTE as at 30 September

2006

3,834.9, 74%

1,316.0, 26%

All Specialties - Registered All Specialities - Non-Registered

Chart 15 Nursing & Midwifery Projections – 2016

Scenario 1 Nursing & Midwifery projections based on

current trends WTE in 2016

3,980.1, 77%

1,219.5, 23%

All Specialties - Registered All Specialities - Non-Registered

35

Table 11 - Allied Health Professional Staff projections based on current trends by Specialty WTE 2006 – 2009

ISD Baseline Data Year 1 Year 2 Year 3 2006 2007 2008 2009

WTE Staff in Post(at 30th Sept)

WTE Vacancies

(at 31st Mar) WTE

Expected WTE

Expected

All disciplines 833.3 49.0 872.3 914.1 All disciplines - Qualified 726.2 42.8 755.5 786.2 All disciplines - Assistant 107.1 6.2 116.8 127.8

Arts Therapy (art/music/drama) 4.1 - 4.4 4.7 Qualified 4.1 - 4.4 4.7 Arts Therapist Assistant - - - -

Podiatry 66.8 0.8 69.3 72.0 Qualified 64.0 0.8 66.7 69.5 Podiatry/Foot care Assistant 2.8 - 2.7 2.5

Dietetics 56.7 0.3 60.6 64.7 Qualified 56.7 0.3 60.6 64.7 Dietetic Assistant - -

Occupational Therapy 164.6 11.2 171.5 178.8 Qualified 150.0 9.5 156.5 163.2 Occupational Therapy Assistant 14.6 1.7 15.1 15.6

Orthoptics 7.0 - 7.1 7.2 Qualified 7.0 - 7.1 7.2

Physiotherapy 198.9 10.6 205.0 211.3 Qualified 192.5 6.4 198.9 205.4 Physiotherapy Assistant 6.4 4.2 6.2 5.9

Radiography 158.2 11.4 166.8 176.1 Qualified 141.5 11.3 146.9 152.5 Radiography Assistant 16.7 0.1 19.9 23.6

-

Sonography 10.3 - 11.2 12.1 Qualified 10.3 - 11.2 12.1 In Training - -

Speech and Language Therapy 97.2 14.7 101.1 105.2 Qualified 91.6 14.5 94.8 98.1 Speech and Language Therapy Assistant 5.6 0.2 6.3 7.0

Orthotics and Prosthetics 8.4 - 8.6 8.8 Qualified 8.4 - 8.6 8.8 Orthotist and Prosthetist Assistant - - - -

Other (incl. Health Promotion, Sexual Health) 60.9 - 66.7 73.1 Qualified - - - - Technical Instructor and handicraft teacher 54.8 - 59.8 65.2 Play staff 6.1 - 6.9 7.9

36

Chart 16 - Allied Health Professions WTE – 2006

Allied Health Professions WTE as at 30 September 2006

726.2, 87%

107.1, 13%

All disciplines - Qualif ied All disciplines - Assistant

Chart 17 - Allied Health Professions Projections – 2009

Allied Health Professions WTE in 2009

818.3, 85%

140.4, 15%

All disciplines - Qualif ied All disciplines - Assistant

Table 12 Psychology projections based on current trends in WTE 2006 – 2009

ISD Baseline Data Year 1 Year 2 Year 3 2006 2007 2008 2009

WTE Staff in Post

(at 30th Sept) WTE

Expected WTE

Expected WTE

Expected

Clinical & Applied Psychologists, Clinical Associates, Counsellors and Therapists 64.3 68.7 73.4 78.4

Qualified 50.2 53.8 57.6 61.7 In Training 4.0 4.5 5.1 5.8 Assistant 10.1 10.4 10.7 11.0

Child Psychotherapy 2.0 2.0 2.1 2.1 Qualified 2.0 2.0 2.1 2.1 In Training - - - - Assistant - - - -

37

Chart 18 - Psychology WTE – 2006

Scenario 2 Psychology - WTE as at 30 September 2006

52.2, 79%

4.0, 6%

10.1, 15%

Qualif ied In Training Assistant

Chart 19 - Psychology Projections – 2009

Scenario 2 Psychology Projections based on Service Redesign - WTE in

2009

63.8, 79%

5.8, 7%11.0, 14%

Qualif ied In Training Assistant

38

Table 13 All other staff projections based on current trends in WTE 2006 – 2009

ISD Baseline Data Year 1 Year 2 Year 3 2006 2007 2008 2009

WTE Staff in Post(at 30th Sept)

WTE Expected

WTE Expected

WTE Expected

Healthcare Science staff 247.4 261.5 278.3 299.2 Qualified 193.3 199.3 205.5 211.8 In Training 12.0 17.5 25.6 37.3 Assistant 42.2 44.6 47.2 50.0

Technical staff 359.5 394.0 435.3 485.9 Qualified 251.5 264.6 278.3 292.8 In Training 15.0 22.9 35.0 53.5 Assistant 93.0 106.5 121.9 139.6

Pharmacy staff 144.8 171.3 219.2 309.8 Qualified 120.6 126.1 132.0 138.0 In Training 4.0 4.4 4.8 5.3 Assistant 20.2 40.8 82.4 166.5

Administrative & Clerical staff 1,809.1 1,821.8 1,834.5 1,847.4 Works 38.6 38.6 38.6 38.6 Trades 150.7 149.2 147.7 146.3 Ancillary 1,262.8 1,256.5 1,250.3 1,244.0

Chart 20 All Other Staff WTE – 2006

Scenario 1 All Other Staff

WTE as at 30 September 2006

247.4, 6%359.5, 9%

144.8, 4%

1,809.1, 45%

1,262.8, 31%

38.6, 1%

150.7, 4%

Healthcare Science staff Technical staff Pharmacy staff Administrative & Clerical staff Works Trades Ancillary

39

Chart 21 All Other Staff projections based on current trends in WTE - 2009

Scenario 1 All Other Staff projections based on current trends - WTE in 2009

299.2, 7%

485.9, 11%

309.8, 7%

1,847.4, 43%

146.3, 3%

1,244.0, 28%

38.6, 1%

Healthcare Science staff Technical staff Pharmacy staff Administrative & Clerical staff Works Trades Ancillary

4.1.2 Impact of Historical TrendsThese projections, based on continuation of current trends experienced over previous years, would

mean

• a decrease of 7.3% in unqualified nurses

• an increase of 3.8% in qualified nurses

• an increase of 15.0% in AHPs

• an increase of 21.4% in Psychology Profession

• an increase of 8.9% in the remaining “all other staff” groups.

As stated previously, these projections are unaffordable and not feasible given the current labour

market and financial climate. They do not meet the needs of our future workforce.

4.2 Scenario 2 – Redesigning Our Services

This scenario is based on Workforce Redesign as provided by the Sectors and the CHPs within NHS

Grampian. The projections indicate that there require to be a number of changes within the

Workforce and that these changes have consequences for varying staff groups.

4.2.1 Affordability These projections and scenarios have been assessed for their robustness in relation to affordability by the Financial Director and have been accepted. Projections given are based on

current agreed funding levels, however, any funding changes, new targets or new national policies

are likely to have an impact on workforce numbers. This is the case even with small initiatives or

40

changes to policy or targets. These cannot be predicted with any accuracy until development funding

is agreed.

Affordability is also about value for money and as an organisation we are responsible for ensuring

this is attained through any Workforce changes. NHS Grampian promotes the development of roles

through good practice, however, even when evidenced as providing the best care for patients this

may not also mean that the care is value for money. We are currently developing a Role

Development Framework which ensures that any role development meets the needs of the service, is

supported by best evidence, is in line with national and local policy and ensures the delivery of quality

patient care.

An example of how we are ensuring affordability is through the use of extended role practitioners to

support the reduction of hours for doctors in training.

4.2.2 Availability The availability of a suitable future workforce is likely to become increasingly difficult given the

changing demography of both the Grampian population in general but also our potential future

Workforce. Initiatives such as working closely with the Grampian Racial Equality Commission creates

one opportunity to tap into our expanding immigrant labour market.

The impact of Agenda for Change (AfC) Bandings for some groups of staff is likely to make

recruitment more difficult in the short term. More worryingly is the retention of our current staff who

often have years of experience and are competent in their roles. Replacing this loss in the

organisation will be costly in terms of recruitment and development and will take time to rebuild to a

similar level of competence. Based on anecdotal evidence the impact of AfC bandings is likely to be

reflected in increased turnover in the short term.

More work will be required to consider new labour supply opportunities. These will include initiatives

such as Job Jump Start, and utilising the Conditions Management Programme which is being piloted

in Grampian. We will also need to be aware of the returners and how we support them as they

resume their careers through initiatives such as the Return to Practice programme.

Further work, with the educational institutions promoting careers in health is also essential.

4.2.3 AdaptabilityThe projections given do not indicate the level of adaptability i.e. the development and cultural

change that the organisation will be required to achieve through redesign to meet the future health

needs of Grampian. Given that we can expect changes in levels, types and numbers of competences

the use of the Knowledge and Skills Framework and our Learning and Development Plans will help to

identify our current and future competence needs throughout the organisation. This will allow us to

inform our Learning and Development strategy for future years. However the process of enhancing

skills and introducing new roles could incur costs in terms of time, courses and opportunity costs. It is

crucial that any competence development is married into redesign plans at an appropriate time. If it is

too early we risk losing the individuals who are developed; too late and we will not be able to

41

introduce the change. In the future there is likely to be an increase in the number of patients who are

seen by a healthcare professional other than a doctor.

To date there are around 200 individuals who could be identifies as Practitioners with a Special

Interest (PwSI) within NHS Grampian across all professional groups. There are however difficulties

as to how we to ascertain exact numbers PwSI because there is a lack of an agreed definition for

PwSI and the required levels of competence, qualification and CPD are unclear.

Table 14 - Medical Projections based on Service Redesign WTE 2006 – 2016

2006 2007 2008 2009 2011 2016

Clinical Laboratory Specialties Consultant 30.8 30.9 31.0 31.2 31.4 32.0 Staff Grade 3.0 3.0 3.0 3.0 3.0 3.0 Doctors in Training 28.0 28.0 28.0 28.0 28.0 28.0 Medical Specialties Consultant 124.1 124.1 124.1 124.1 124.1 124.1 Staff Grade 18.7 19.7 20.7 21.7 23.9 28.3 Doctors in Training 287.7 289.9 292.2 294.5 299.1 310.0 Psychiatric Specialties Consultant 46.1 46.1 46.8 46.8 46.8 46.8 Staff Grade 10.5 10.5 10.5 12.5 12.5 12.5 Doctors in Training 48.6 48.1 47.7 47.2 46.4 44.0 Radiology Consultant 20.4 21.7 21.7 22.7 22.7 22.7 Staff Grade 0.0 0.0 0.0 0.0 0.0 0.0 Doctors in Training 13.6 13.5 13.5 13.4 13.3 13.0 Surgical Specialties Consultant 137.9 137.9 137.9 137.9 137.9 137.9 Staff Grade 11.1 12.2 13.2 14.3 16.4 21.5 Doctors in Training 216.8 215.8 214.9 213.9 212.0 207.0 Community Medical Specialties Consultant 15.9 15.9 16.9 16.9 16.9 16.9 Staff Grade 11.4 11.5 11.5 11.6 11.7 12.0 Doctors in Training 19.6 19.6 19.7 19.7 19.8 20.0 Total Consultant 375.2 376.6 378.4 379.6 379.8 380.4 Staff Grade 54.7 56.8 58.9 63.1 67.5 77.3 Doctors in Training 614.3 615.1 615.9 616.8 618.5 622.0

42

Chart 22 - Medical WTE Redesign – 2006

Scenario 2Medical WTE as at 30 September 2006

375.2, 36%

54.7, 5%

614.3, 59%

Consultant Staff Grade Doctors in Training

Chart 23 - Medical Projections Redesign – 2016

Scenario 2Medical Projections based on Service Redesign WTE in

2016

380.4, 35%

77.3, 7%

622.0, 58%

Consultant Staff Grade Doctors in Training

Table 15 - Primary Care Dental Services Projections based on Service Redesign in WTE 2006 – 2016

ISD Baseline Data Year 1 Year 2 Year 3 Year 5 Year 10 2006 2007 2008 2009 2011 2016

WTE Staff in Post(at 30th Sept)

WTE Expected

WTE Expected

WTE Expected

WTE Expected

WTE Expected

Primary Care Dental Services 117.4 159.5 188.5 200.5 213.5 235.5 Primary Care Dental Management 3.0 3.0 4.0 4.0 4.0 4.0 Community Dentists 17.4 17.4 17.4 17.4 17.4 17.4 Salaried Dentists 22.7 43.8 54.8 58.8 66.8 71.8 Community Dental Nurses 27.3 27.3 27.3 27.3 27.3 27.3 Salaried Dental Nurses 29.8 45.8 69.8 74.8 83.8 90.8 Dental Nurses Trainees * 11.0 16.0 9.0 12.0 4.0 8.0 Therapists/Hygienists 3.4 3.4 3.4 3.4 6.4 12.4

Dental Triage Nurses 2.8 2.8 2.8 2.8 3.8 3.8

43

* Dental Trainees from 2006 will qualify as Dental nurses and in 2008 therefore the figures have been reduced to reflect this. An estimate has been given for the numbers in training for the 2011 and 2016 years.

There are no details of additional staff that will be included within the Dental Service from 2007.

The Salaried and Community based Primary Care Dental services will be merged by 2008 and will be known as the public Dental Service. There is therefore a question mark over whether they should be shown separately as all the data from then on will be merged.

Chart 24 - Primary Care Dental WTE Redesign – 2006

Scenario 2Primary Care Dental WTE as at 30 September 2006

3.0, 3% 17.4, 15%

22.7, 19%

27.3, 23%

29.8, 26%

11.0, 9%

3.4, 3%

2.8, 2%

Primary Care Dental Management Community Dentists

Salaried Dentists Community Dental Nurses

Salaried Dental Nurses Dental Nurses Trainees *

Therapists/Hygienists Dental Triage Nurses

Chart 25 - Primary Care Dental Projections Redesign – 2016

Scenario 2Primary Care Dental Projections based on Service

Redesign WTE in 2016

4.0, 2% 17.4, 7%

71.8, 30%

27.3, 12%

90.8, 39%

8.0, 3%

12.4, 5%

3.8, 2%

Primary Care Dental Management Community Dentists

Salaried Dentists Community Dental Nurses

Salaried Dental Nurses Dental Nurses Trainees *

Therapists/Hygienists Dental Triage Nurses

44

Table 16 - Nursing & Midwifery Projections based on Service Redesign in WTE 2006 – 2011

ISD Baseline Data Year 1 Year 2 Year 3 Year 5 2006 2007 2008 2009 2011

WTE Staff in

Post WTE

Vacancies

(at 30th Sept)

(at 31st Mar)

WTE Expected

WTE Expected

WTE Expected

WTE Expected

All Specialties 5151.0 270.3 4859.0 4859.2 4859.4 5161.7 All Specialties - Registered 3834.9 181.5 3542.2 3541.7 3541.2 3842.1 All Specialties - Non-Registered 1316.1 88.8 1316.8 1317.5 1318.2 1319.6 Adult 3605.8 192.4 3610.3 3614.8 3619.4 3628.5 Registered 2690.4 121.3 2693.1 2695.8 2698.5 2703.9 Non-Registered 915.4 71.1 917.2 919.1 920.9 924.6 Children 261.5 10.5 262.5 263.6 264.7 266.7 Registered 210.7 8.7 211.5 212.4 213.2 214.9 Non-Registered 50.8 1.8 51.0 51.2 51.4 51.8 Mental Health 838.0 48.8 833.0 828.0 823.1 822.9 Registered 573.5 38.4 570.1 566.7 563.3 566.3 Non-Registered 264.5 10.4 262.9 261.4 259.8 256.6 Learning Disabilities 99.7 3.0 98.7 97.7 96.8 94.9 Registered 68.2 3.0 67.5 66.9 66.2 64.9 Non-Registered 31.5 0.0 31.2 30.9 30.6 30.0 Midwifery 346.0 15.6 54.4 55.0 55.5 348.7 Registered 292.1 10.1 0.0 292.1 Non-Registered 53.9 5.5 54.4 55.0 55.5 56.6

Chart 26 - Nursing & Midwifery WTE Redesign – 2006

Scenario 2Nursing & Midwifery WTE as at 30 September 2006

3834.9, 74%

1316.1, 26%

All Specialties - Registered All Specialities - Non-Registered

45

Chart 27 - Nursing & Midwifery Projections Redesign – 2011

Scenario 2Nursing & Midwifery Projections based on Service Redesign

WTE in 2011

3842.1, 74%

1319.6, 26%

All Specialties - Registered All Specialities - Non-Registered

Table 17 - GP Headcount Projections based on Service Redesign in Headcount 2006 – 2011

ISD Baseline

Data Year 1 Year 2 Year 3 Year 5 2006 2007 2008 2009 2011

Headcount Staff in Post (at 30th Sept)

HC HC HC HC

General medical service 531 530 530 531 531 Performer 394 386 378 370 353 Performer registrar 36 37 38 39 41 Performer salaried 79 86 94 103 122 Performer retainee 22 21 20 19 15

Note these figures are based on current knowledge and cannot legislate impact of feminisation full-time/part-time splits

Chart 28 - GP Headcount Redesign – 2006

Scenario 2GP Headcount as at 30 September 2006

394, 74%

36, 7%

79, 15%22, 4%

Performer Performer registrar Performer salaried Performer retainee

46

Chart 29 - GP Projections Redesign – 2011

Scenario 2GP Projections based on Service Redesign Headcount in

2011

353, 66%41, 8%

122, 23%15, 3%

Performer Performer registrar Performer salaried Performer retainee

Vignette 6 - Academic GPs In Partnership with the University of Aberdeen, NHS Grampian City Community Health Partnership has developed a new post for an Academic GP within salaried practices. This post which receives 50% funding form each organisation has been established for 4 years. The focus of the role is teaching and research and General Practice. To date there has been specific benefits including the positive links with education and the opportunity to look at succession planning. It has also strengthened the links between education and clinical practice and created valuable research opportunities. The success to date has led the partnership to look at creating a second post.

47

Table 18 - Allied Health Professions Projections based on Service Redesign in WTE 2006 – 2009

ISD Baseline Data Year 1 Year 2 Year 3 2006 2007 2008 2009

WTE Staff in

Post (at 30th Sept)

WTE Vacancies

(at 31st Mar)

WTE Expected

WTE Expected

WTE Expected

All disciplines 833.1 49.0 835.8 838.5 845.8 All disciplines - Qualified 726.1 42.8 728.2 730.3 732.4 All disciplines - In Training - - - - - All disciplines - Assistant 107.0 6.2 107.6 108.2 113.4

Arts Therapy (art/music/drama) 4.1 - 4.1 4.1 4.1 Qualified 4.1 - 4.1 4.1 4.1 Arts Therapist Assistant - - - - -

Podiatry 66.8 0.8 66.8 66.9 66.9 Qualified 64.0 0.8 64.0 64.0 64.0 Podiatry/Foot care Assistant 2.8 - 2.8 2.9 2.9

Dietetics 56.7 0.3 56.9 57.1 61.8 Qualified 56.7 0.3 56.9 57.1 57.3 Dietetic Assistant - - - - 4.5

Occupational Therapy 164.6 11.2 165.3 166.1 166.8 Qualified 150.0 9.5 150.5 151.0 151.5 Occupational Therapy Assistant 14.6 1.7 14.8 15.1 15.3

Orthoptics 7.0 - 7.0 7.0 7.0 Qualified 7.0 - 7.0 7.0 7.0

Physiotherapy 198.9 10.6 199.6 200.3 201.1 Qualified 192.5 6.4 193.1 193.8 194.4 Physiotherapy Assistant 6.4 4.2 6.5 6.6 6.7

Radiography 158.2 11.4 158.7 159.2 159.8 Qualified 141.5 11.3 142.0 142.4 142.9

Diagnostic Therapeutic

Radiography Assistant 16.7 0.1 16.8 16.8 16.9

Sonography 10.3 - 10.3 10.3 10.3 Qualified 10.3 - 10.3 10.3 10.3 In Training - - - - -

Speech and Language Therapy 97.2 14.7 97.7 98.2 98.7 Qualified 91.6 14.5 91.9 92.2 92.5 Speech and Language Therapy Assistant 5.6 0.2 5.8 6.0 6.2

Orthotics and Prosthetics 8.4 - 8.4 8.4 8.4 Qualified 8.4 - 8.4 8.4 8.4 Orthotist and Prosthetist Assistant - - - - -

Other (incl. Health Promotion, Sexual Health) 60.9 - 60.9 60.9 60.9 Qualified - - - - - Technical Instructor and handicraft teacher 54.8 - 54.8 54.8 54.8 Play staff 6.1 - 6.1 6.1 6.1 Rehabilitation/Clinical support Assistant - - - - -

48

Chart 30 - Allied Health Professions WTE Redesign – 2006

Scenario 2Allied Health Professions WTE as at 30 September 2006

726.1, 87%

107.0, 13%

All disciplines - Qualif ied All disciplines - Assistant

Chart 31 - Allied Health Professions Projections Redesign – 2009

Scenario 2Allied Health Professions Projections based on Service

Redesign WTE in 2009

732.4, 87%

113.4, 13%

All disciplines - Qualif ied All disciplines - Assistant

Table 19 - Psychology Projections based on Service Redesign in WTE 2006 – 2009

ISD Baseline Data Year 1 Year 2 Year 3 2006 2007 2008 2009

WTE Staff in Post(at 30th Sept)

WTE Expected

WTE Expected

WTE Expected

Clinical & Applied Psychologists, Clinical Associates, Counselors and Therapists 64.3 64.3 64.3 64.3

Qualified 50.2 50.2 50.2 50.2 In Training 4.0 4.0 4.0 4.0 Assistant 10.1 10.1 10.1 10.1

Child Psychotherapy 2.0 2.0 2.0 2.0 Qualified 2.0 2.0 2.0 2.0 In Training - - - - Assistant - - - -

49

Chart 32 - Psychology WTE Redesign – 2006

Scenario 2Psychology WTE as at 30 September 2006

52.2, 79%

4.0, 6%

10.1, 15%

Qualif ied In Training Assistant

Chart 33 - Psychology Projections Redesign – 2009

Scenario 2Psychology Projections based on Service Redesign WTE

in 2009

52.2, 79%

4.0, 6%

10.1, 15%

Qualif ied In Training Assistant

50

Table 20 - All other staff categories projections based on service redesign in WTE 2006 – 2009

ISD Baseline Data Year 1 Year 2 Year 3 2006 2007 2008 2009

WTE Staff in Post(at 30th Sept)

WTE Expected

WTE Expected

WTE Expected

Healthcare Science staff 247.4 247.0 246.6 246.1 Qualified 193.3 192.7 192.0 191.4 In Training 12.0 12.0 12.1 12.1 Assistant 42.2 42.3 42.5 42.6

Technical staff 359.5 359.0 358.6 358.1 Qualified 251.5 250.7 249.8 249.0 In Training 15.0 15.0 15.1 15.1 Assistant 93.0 93.3 93.6 93.9

Pharmacy staff 144.8 150.5 155.8 161.3 Qualified 120.6 124.1 128.0 132.0 In Training 4.0 4.4 4.8 5.3 Assistant 20.2 22.0 23.0 24.0

Administrative & Clerical staff 1,809.1 1,815.1 1,821.1 1,827.1 Works 38.6 38.0 37.3 36.7 Trades 150.7 148.2 145.8 143.4 Ancillary 1,262.8 1,267.0 1,271.1 1,275.3

Chart 34 - All other Staff Categories WTE Redesign – 2006

Scenario 2All other staff categories WTE as at 30 September 2006

247.4, 6%

359.5, 9%

144.8, 4%

1,809.1, 45%38.6, 1%

150.7, 4%

1,262.8, 31%

Healthcare Science staff Technical staff Pharmacy staff

Administrative & Clerical staff Works Trades

Ancillary

51

Chart 35 - All other Staff Categories Projections Redesign – 2009

Scenario 2All other staff categories projections based on Service

Redesign WTE in 2009246.1, 6%

358.1, 9%

161.3, 4%

1,827.1, 44%36.7, 1%

143.4, 4%

1,275.3, 32%

Healthcare Science staff Technical staff Pharmacy staff

Administrative & Clerical staff Works Trades

Ancillary

4.3 Key Workforce ChangesChanges in any one staff group will impact on another staff group and therefore it is crucial that we

look at the whole picture and not just single professional groups when developing the Workforce Plan

in NHS Grampian.

A summary of the key changes would be

Small Changes

– Increases for AHPs (specialist, advanced, community)

– Increases in Support Workers (generic and specific)

– Increases in Nurses (specialist, advanced)

– Decreases through natural wastage

– Some redeployment e.g. Aberdeenshire and Mental Health

– Some recruitment issues e.g. Mental Health, Support Workers, Health Visitors District

Nurses and Community Night Nurses

Medium Changes

– Nurses, AHPs, Support Workers

– Skills development

– Role development

– Enhanced roles

Large Changes

– Dentistry

52– As a percentage of current staff but not huge numbers

53

4.4 Notes o These projections are based on current levels of funding and do not include developments

which have not been agreed or funded. However if funding becomes available for specific

work then the projected numbers are likely to increase.

o Projected Pharmacy increases relate to the development of the Emergency Care Centre, the

implementation of the new contract and out of hours services.

o Projections provided at a summary level for a staff group do not reflect the changes in

different services e.g. in adult nursing the projected changes are small but this may not reflect

the level of changes within different sectors or CHPs which may mean increases in one area

but decreases in another.

o Projected figures for Doctors in Training are proving extremely difficult to project given the

impact of MMC in the longer term. The belief is that figures are currently somewhat fluid,

however broad estimates are indicating a relatively consistent number for the next 3 years.

Thereafter projections are yet to be agreed.

o Joint work on predicting future projections through the Transitional Boards, Health Boards and

NES is required.

o Future midwifery numbers may increase if the current trend for an increasing birth-rate

continues. The increase last year was a significant 350.

o Projections have not included vacancies into the future staff numbers as even with significant

effort we assume that we will have a percentage of vacant posts. These vacancies are

necessary to allow flexibility within services and allow for circumstances such as the

conversion of posts, the use of internal bank staff and also where necessary the use of

locums and other agency staff.

o Historically we have seen an increase in the number of vacant posts, especially for nurses

and to some extent AHPs (although this is more variable). This reflects the fact that we have

experienced difficulties in some areas in relation to attracting staff and practice of utilising

posts to develop alternative roles.

o The 2001 - 2016 dental figures are likely to alter with the integration with CHPs and this may

affect either the management structure or the numbers of staff involved. Other areas that will

be affected by the integration are the merging of the Community and Salaried services in

2008. There is also general acceptance that the Non Cash Limited budgets will, in the near

future, come into line with other budgets and be allocated to each NHS board. This change

will have a significant impact on NHS Grampian's ability to continue its increase in staff

numbers.

o There may be discrepancies in some staff groups due to figures being based on registration

(e.g. midwives and health visitors) rather than current area of work.

Section 5 NHS Grampian Workforce Action Plan

The following provides a summary of the key Actions which NHS Grampian has committed to implement in the short to medium term.

OBJECTIVE

ACTIONS

TIMESCALES

PRIORITY

RESPONSIBILITY

1. Ensure Workforce Plan is part of the Planning process (Service, Financial, Workforce)

1. Develop appropriate tools 2. Work with sectors and CHPs focusing on the CIP Annual action Plan for 07/08 3. Promote the utilisation of models such as Rightfit (appendix 4) and Workforce Development Cycle Tool with staff. Workforce Planning Tool 4. Identify and develop key individuals to support Workforce Redesign and Planning 5. Engage senior managers and other partners through a Strategic Service and Redesign Committee Workshop

Throughout 2007 and 2008 Throughout 2007 and 2008 Throughout 2007 and 2008 September 2007 Throughout 2007 and 2008

1 1 1 1 1

Service Teams with HR Team support HR and Learning and Development Teams G Lawrie/ M Hamil

2. Improve basic workforce information to services and managers

1. Encourage the development of SWISS Staff utilisation and SSTS to support Workforce Planning 2. Influence SWISS/STSS at a national level 3. Improve information quality provided for input into systems 4 Improve information through the development of staff information systems such the Electronic Staff Record

On going action On going action October 2007 On going action

1 1 1 1

NHSG Workforce Team All Managers All Managers Workforce Team and HR Managers

3. Utilisation of Workforce planning, information, development and redesign to support the reduction of our overall pay bill

1. All managers responsible through Workforce Planning of identifying opportunities 2. Utilisation of Vacancy process 3. Develop clear action plans based on service and workforce plans

Ongoing target Ongoing target On going target

1 1 1

All Managers All Managers All Managers

4. Initiate a project group to broadly look at the role of carers. This will include both paid and unpaid carer roles.

1. Raise as a priority with Executive Team and Board 2. Explore ‘generic’ worker concept 3. Explore carers role & supporting self care 4. Ensure part of service planning and redesign

By April 2008 By April 2008 By April 2008 By April 2009

1 2 2 2

L Wilkie M Hamil E McDowd

54

55

5. Review training and development and registration re Paid Carers 6. Consider ways of valuing and incentivising ‘care work’

From April 2008 From April 2008

2 2

5. Manage the impact of Agenda for Change on services

1. Identify appropriate measurements to assess impact e.g. turnover/stability 2. Identify how we will retain staff 3. Identify how we will attract new staff or encourage returners

April – June 2007 April – June 2007 April – June 2007

1 1 1

GAPF with HR team and staff side support

6. Develop robust Workforce module sessions for courses such as People Management, Institute Leadership and Management etc.

1. Ensure that Leadership programme has an updated Workforce Module 2. Develop a workforce module for People Management 3. Increase Learning and development teams’ knowledge and understanding of Workforce issues and processes

October 2007 October 2007 December 2007

1 1 2

G Lawrie and Learning and Development Team

7. Promote use of KSF in workforce redesign and development.

1. Identify tools to simplify the use of KSF in workforce redesign i.e. competencies 2. Pilot use of tool(s)

By January 2008 1 A Inglis/Glawrie

8. Improve regional workforce connections 1. Develop relationships and improve connections with regional work 2. Ensure better communication for information exchange e.g. in relation to the development of Managed Clinical Networks

By April 2008 On going target

2 2

Chairs of NOSWG and NOSPG Regional Workforce Network

9. Reinforce and strengthen links with partners e.g. universities, local authorities, voluntary sector, private care sector, community planning, Grampian Racial Equality Commission (GREC)

1. Through symbiotic relationships share information, develop joint planning and identify opportunities for development to allow better planning and utilisation of staff e.g. in terms of university and college places and courses developed to support new roles or to identify potential labour supply opportunities. 2. Work more closely with universities, schools and colleges regarding, career promotion, placements and work experience

On going target 2 2

Workforce Team, A Inglis, Jane Ormerod, Nigel Firth, Sectors, CHPs, Universities and Local Authorities

10. Encourage a pilot of workload measurement which involves all members of the service team

1. Utilising learning from the Telford Model and pilot a project where the Workload of the whole team are considered

From April 2008 3 G Lawrie Pilot yet to be identified

Section 6 - Education, Redesign and Regulatory The following section provides examples of a number of initiatives relating to Workforce education,

development and redesign. Some of these initiatives are based on national programmes whilst others

relate to local needs. Also included are examples of some of the statutory developments required for

staff.

1. NHS Knowledge and Skills Framework (KSF)Current KSF activity is focused around equipping managers and staff to implement KSF in their areas.

This is being done via a number of routes. Various options such as DVD’S, leaflets and information

sessions are available for staff to gain awareness of the concept of KSF. Additionally there are a

number of embedded trainers and facilitators across the system that are updated and supported by

the Learning and Development team. Managers are being supported to develop KSF outlines for their

areas, following completion of these outlines training sessions. They are also supported in the use of

KSF for development review. Work around e-KSF is at present focussed on pilot sites and managers

but it is planned to include reviewers in the near future.

Key staff members are linked into all relevant national and regional forums which enables the

organisation to share intelligence across Scotland.

2. Rights, Relationships and Recovery -The Report of the National Review of Mental Health Nursing in Scotland 2006 This report is driven by a core purpose: to enhance and develop mental health nursing so service

users, families and carers gain continual improvements in their experiences and outcomes of care.

The action plan is a wide and challenging agenda which has short, medium and long term time

scales.

Learning and Development are supporting this agenda through involvement with several specific

actions either as a group member or taking a lead role in driving the change forward in relation to the

stipulated timescales. It is anticipated there shall be an ongoing requirement to support the initiative in

terms of delivery of training sessions, working with key managers to ensure development options are

clearly identified within a learning plan and to ensure any commissioned development options are

meeting the demands of the action plan in a timely manner.

3. Job Jump StartThis programme is a 2 year Scottish Executive funded project. It has a success rate of 72% of

participants gaining employment through the programme; 90% of which has been within NHS

Grampian. The programme is designed to make unemployed people job ready by providing

necessary training e.g. within nursing, it involves ensuring development of basic life support skills,

manual handling etc. This allows individuals immediate access to the nurse bank if they are

successful at interview stage.

56

It provides the organisation with a source of recruitment to fill full and part time vacancies. This

programme is open to any area that can offer a placement for the clients. It runs for a total of 9 weeks

and the clients can apply for a position at any time throughout the programme or when the

programme is complete. We intend to mainstream this into the organisation at the end of the project

which is September 2007.

4. Review of Nurse Resourcing and WorkloadThe Telford Method (sometimes known as the (‘consultative approach’) combines the use of

information, such as nurse staffing numbers, workload, patient dependency, skill mix, manager’s role,

the impact of other services on the nursing workload and the professional views of nurses to

determine suggested levels of nurse staffing for each clinical area.

The Telford study was carried out during a two-week period during the summer of 2006. All of the

Telford data was compared to benchmarked data giving the whole process a considerable degree of

robustness as the same themes were apparent in both pieces of analysis. (The only exception being

community hospital inpatient wards).

In order to provide an indication of workload as well as the nurse to bed ratio, occupied bed days per

WTE nurse for 2005/06 were also considered. This provides an indication based upon occupancy as

to the actual workload for each WTE nurse in a particular clinical area. It is acknowledged that this is

not a perfect measure of workload but it is the most comprehensive one currently available. To meet

the service requirements for NHS Grampian and the need to redistribute resources, a Grampian Wide

approach is required to be taken when considering future nurse-staffing issues.

As proposed activity shifts in keeping with the strategic direction of NHS Grampian from acute to

community there will be opportunities to review nurse workload and resources. The Telford method

illustrates that each clinical area has a proposed Telford workload figure and that this should be

incorporated into the decision making process when nursing vacancies occur NHS Grampian wide.

This will enable appropriate decisions to be made on resourcing priorities and allow staff

appointments to be targeted to those clinical areas that show a high workload per WTE nurse.

The Telford work is not yet complete as there are still areas to be analysed by Health Intelligence

before NHS Grampian can usefully look at total resource.

5. Scottish Vocational QualificationsThe SVQ Programme has expanded and developed over the past year. The NHS Grampian Centre

now offers a total of 33 awards and is awaiting accreditation to offer a further two. Resources have

been developed and are now in place to support the knowledge component of awards being offered.

The Centre has also been developing a NHS Grampian SVQ website that will allow greater access to

information about SVQ activities and awards for all staff. The website will be linked to the main SQA

website. E-learning packages are currently being developed to ensure access to learning for staff

throughout the large geographical area covered by NHS Grampian.

SVQs have been mapped to the Knowledge and Skills Framework and provide a flexible framework

for career development for staff in most disciplines and departments throughout the organisation.

57

Individuals may undertake a complete award or may choose to undertake specific units that endorse

their competence in specific aspects of their role. Key plans for the future include:

• a joint future approach to future awards, sharing of materials and support

• the introduction of e-portfolios to allow easier and wider access to assessment

• further development of the Management and Team Leading awards

The SVQ programme supports a culture of learning within the organisation and supports the

philosophy of ‘Learning Together’ and improving access to learning and opportunity for all.

6. National incremental Competencies in Healthcare Education (NICHE) Update NICHE began in NHS Grampian began in October 2006, with fourteen participants from AMAU (5),

Out of hours (2), Out Patient Dept., Dr.Grays (6), Juniper (2). Banff & Buchan locality were offered a

place, however they were keen but unable to provide a candidate. Respiratory and the Night Nurse

Practitioner Service at Aberdeen Royal Infirmary were also keen but unable to start in October. Both

of these areas, however, have since come on board in January 2007. All candidates attended 4 x 2

hour sessions in the evenings to enable them to get started. Their assessors also attended a 2 hour

session to provide them with information regarding their role.

All candidates are presently employed as Nursing Auxiliaries within NHS Grampian, and it is the

intention of most managers in (with the exception of the Out of Hours Team, who employ B grades)

that NICHE will enable staff to role develop into a more autonomous role.

Current activity includes:

o The development of local policy and protocols in each area that supports these new roles

o Enshrining new activities in new job roles through performance review or managers writing

new job descriptions and KSF outlines for the newly developed roles and

o Establishing data to facilitate the formal evaluation of NICHE in October this year, to assess

the pilot’s success and the transferability of any results.

7. Violence and Aggression (V+A) TrainingViolence and Aggression training is provided across NHS Grampian in a range of formats to meet the

diverse needs of different areas and professional disciplines. The Risk Trainer (V+A) in conjunction

with the Risk Management Advisor (V+A) and a network of embedded V+A Trainers based in clinical

areas endeavour to deliver training which meets the needs of all our staff and provide operational

advice and support for staff in relation to the management of aggression. NHS Grampian promotes a

Zero Tolerance Promise in relation to violent or aggressive behaviour and supports its staff by

providing tools to minimise risk and promote a safe working environment for all.

In 2006 approximately 3500 NHS Grampian staff accessed Violence and Aggression Training. The

department continues to develop the current training on offer and in 2007 will be offering e-learning

and workbook based courses for theoretical techniques and improved accessibility to practical

58

courses. Our highest priority is the development of the network of trainers to provide specialist support

to staff across Grampian. Increased partnership working between Learning and Development, the

Risk Management Support Unit, Grampian Police and other agencies ensures that the best possible

resources in relation to violence in the workplace will be available.

8. Moving and Handling (M&H) TrainingFollowing the successful completion of a trial of the Moving &Handling (M&H) Competency

Framework at Chalmers Hospital, Banff the Operational Management Team sanctioned the

implementation of the Moving & Handling Competency Framework throughout NHS Grampian. The

next area to undertake the Competency Framework implementation is Central Aberdeenshire.

Meanwhile, NHS Grampians existing Key Handlers are being updated in the competency approach in

preparation for the Competency Framework being implemented in their areas. The framework ties

into the Knowledge and Skills Framework and allows for recognition of prior learning.

The Moving & Handling Trainers have continued to assist with the Preparation for Practice

programme for newly qualified Staff Nurses. This continues to be well received.

9. SSTS & Staff Utilisation Information SSTS (Scottish Standard Time System) is an electronic system for collection of information regarding

hours worked by all categories of staff. It is being rolled out primarily throughout the nursing

profession in NHS Grampian. The system which processes staff information directly into the payroll

system, also gives us up to date information on Sickness Absence, Annual Leave, Staff in post and

why extra staff are utilised. This important information is used to inform and support workforce

planning and redesign.

The Staff Utilisation system provides information about the General Bank and Agency Staff’s working

time. It provides real time information as to why these staff are utilised in each ward. Combining this

information from both these systems provides a monthly report for Managers up to Board level and

gives up to date information and vital historic information to assist in future planning of services.

10. Patient Focus Public Involvement (PFPI) The Patient Focus Public Involvement (PFPI) agenda has grown significantly over the last few years.

The Consultation and Public Involvement in Service Change – Draft Interim Guidance (HDL (2002)

42) detail a number of obligations and guidance on NHS Boards by stating that when involving the

public in service change consultation at the end of the process is not acceptable. Instead Boards

should consult on all service change including new services; they should develop proposals for

service change in partnership with all affected groups and communities and they should formally

consult on the outcome of that development process. Additional PFPI drivers have included the NHS

Reform (Scotland) Act (2004) (which gives a statutory duty to involve patients), National Standards for

Community Engagement (2005); Equality Impact Assessment Toolkit (Interim Guidance) (2005) and

Delivering for Health (2005).

59

As a commitment to the PFPI agenda there is Committee at Board level which oversees an Action

Plan. Forums have been developed within the CHPs and patient representatives recruited. In house

training has been piloted, with planned rollout to build capacity within the organisation and ensure that

staff have a toolkit of interventions to take forward.

11. Dentists with Special Interests (DwSI)An Action Plan for improving Oral Health and Modernising Dental Services in Scotland (2005) details

the encouragement of Dentists with Special Interests (DwSIs). The intention is to develop a career

structure for primary care dentists and associated Dental Care Professionals (DCPs).

DwSIs are experienced dentists who have built up knowledge and skills of their special interest over a

period of time. Before they can be appointed, all DwSIs have to provide evidence of their skills in the

form of training qualifications and/or proof of practical experience in their special interest area.

A DwSI provides a service which is complementary to the hospital services (Oral Surgery, Restorative

Dentistry, Orthodontics, etc), but does not replace that provided by a dentist who has undergone

formal training to become a registered specialist. Although having a special interest, a DwSI remains

a generalist primary care dentist. Such a career structure could ultimately reduce the numbers of

referrals to specialist dental services, deliver services geographically closer to the patient, and reduce

waiting lists.

A Managed Clinical Network (MCN) for dentistry is being progressed as a North of Scotland (NOS)

initiative (a partnership between NHS Grampian and NHS Highland). The concept of DwSIs links very

well to the development of a NOS MCN. There are issues around the training, funding and

accountability of DwSIs but there are many benefits from such a system of delivery of intermediate

dental care to both the patient and service provider.

A recent survey of primary care dentists in Grampian showed around 25 dentists express an interest

in providing a DwSI style of service. Most respondents had an interest in Orthodontics and most were

based in the Aberdeen City area so there is some work to do in both widening the special interest and

the geographic location of the practitioners.

12. NMC Simulation and Practice Learning Project for Pre-registration nursing. The NMC, with the support of the council of Dean’s and Nurse Directors’ Association, intends to

develop UK-wide principles for the use of simulation to support practice learning. This development

has followed feedback gathered for the Review of Fitness for Practice at point of registration. It

strongly supported the use of simulation and skills rehearsal as a vehicle for increasing opportunities

for students to familiarise themselves with skills before rehearsing and consolidating these in practice.

To facilitate this, the NMC has commissioned 13 pilot sites to evaluate simulation in pre-registration

nursing programmes. The School of Nursing and Midwifery, Robert Gordon University in conjunction

with NHS Grampian has become one the pilot sites taking part in the evaluation. The NMC have been

asked to consider permitting some practice hours to be used for simulation. The outcomes of this

project will enable the NMC to consider whether current requirements for practice hours need to be

reviewed.

60

13. Simulated Ward ExerciseThe Transition to Professional practice module has been development and delivered in partnership

between NHS Grampian and Robert Gordon University for 3 years. This module forms part of the

stage 3 pre-registration nursing programme in which students participate in a simulated ward exercise

in prioritising, organising and delivering care to patient volunteers within the simulated ward setting.

To date this work has been confined to pre-registration nursing students only however, for the first

time this year this exercise will be piloted with AHP students.

14. Scientists

Laboratories staff make up around 5% of the NHS Grampian workforce. To date a number of

initiatives have been introduced to support this part of the workforce who are experiencing on average

a 10% year on year increase in workload. These have included working differently and looking at

different roles such as advanced and assistant practitioner.

Future projects such as the Emergency Care Centre will also increase the work requirements and the

timescales of this service as has the new GMS contract. An example of this would be a 60% increase

in the number of tests requested for diabetes in the first year of the new GMS contract (GP work

accounts for approximately 50% of the workload).

There is a commitment within this service to automate appropriate manual processes with the latest

example being the imminent introduction of Optical Character Recognition. This would work hand in

hand with the Electronic Request Form; dealing with 2 million requests per year.

Initiatives which are likely to impact on this service are the increasing requirement for 24:7 working

altering working patterns, rising workloads and meeting external accreditation requirements.

15. Hospital at Night (H@N)A variety of multi-disciplinary posts have been filled to support junior doctors and to best provide care

to patients who become sick at night. From the end of October 2006, the new role of H@N Chest

physiotherapist will review and treat patients between the hours of 5pm and 10pm. This is in addition

to the current on-call service provided by the physiotherapy department. A further two Night Nurse

Practitioners (NNP) have been recruited, and are completing their training programme. A total of 7

Health Care Support Workers (HCSW) has been appointed comprising of a mix of auxiliary staff,

medical and nursing students who will form a flexible resource to further support the night team.

16. Inspection by Management (IBM)In the last year the Learning and Development Risk Training team have developed the Inspection by

Management (IBM) Course and the New & Expectant Mothers (NEM) risk assessment module. An

information sheet for managers about what they need to do for NEM has also been developed. The

L&D Risk Trainers have also been supporting and advising staff and managers out in their

workplaces.

61

17. Flying Start Learning ProgrammeFlying Start is a national web based learning programme set up by NHS Education Scotland at the

request of the Scottish Executive. Flying Start was launched along side a pilot project, the AHP

Support and Development Scheme, which aimed to increase the numbers of newly qualified AHPs

employed in Scotland by offering financial support to help develop their careers. This pilot scheme

ended on 31st March 2007.

It is aimed at all newly qualified nurses, midwifes and AHPs to assist in the transition between student

and newly qualified independent practitioner. Although many areas have development programmes

for their newly qualified staff, there is great inequity in the level and standard at which these are

delivered. It is hoped that this programme will provide support where there is none as well as

complement and add structure to existing programmes. Flying Start modules are also mapped to the

Knowledge and Skills Framework and can help in building a strong portfolio of evidence.

Funding has been obtained from the Scottish Executive to create a one year secondment to the post

of professional development facilitator to help roll out Flying Start throughout Grampian. The

Professional & Practice Development unit has recently taken on a secondee for a year to help

implement the Programme throughout Grampian.

18. SNDP UpdateThe SNDP continues to prove successful within NHS Grampian. We have been challenged with the

introduction of NHS Scotland Flying Start programme and incorporating that into the SNDP.

The aim of the programme as well as supporting individuals at a very vulnerable time is “to gain a

national standard to an area where there are real inequities”. (NES 2006).

In April 2005, letters were sent to all Health Boards in Scotland, inviting applications for participation

in the initiative to employ newly qualified nurses (NQN) in to GP practices.

Having the already well established SNDP with placements available in the community setting, nurse

managers and practice education staff enthusiasticly welcomed the challenge of how newly qualified

nurses could be better supported to commence a career in practice nursing.

Five GP Practices in Grampian agreed to take a NQN as part of their practice nurse teams for one

year as part of the SNDP. Each NQN was fully supported throughout the development experience by

mentorship. At the end of the year in general practice, the NQN moved on to year 2 of SNDP some

went to other primary care settings and some chose to pursue a career in the acute setting.

62

63

A short life working group was established to take this initiative forward. Year 1 of the SNDP will

consist of Flying Start and year 2 of the SNDP incorporate competencies that will focus on

management, leadership and people development skills.

64

Appendix 1 WORKFORCE PLANNING MODEL

Based on Carol Brooks and Tineke Bosma’s Planning Model

Population demographics

Health plan Labour market Legislation Technology

National initiatives CIP

Local initiatives

What services will meet the needs of patients and the strategic environment?

What skills/competencies are needed to deliver the services?

What do we have now?

Learning plan Recruitment Retention

Service Plan Regional/NationalWorkforce Plans

Skill/Competencies

What are the patients need and the strategic environment for the next X years?

What is the gap and how can we bridge it?

What type of staff does this employ and how many are needed?

Appendix 2 WORKFORCE REDESIGN

Mental Health

Acute

Re-skill Re-Train Develop

Relocation Recruitment

Retention

Role ChangesRetirement Redundancy

Aberdeenshire

Aberdeen City

Facilities

Moray

65

Appendix 3

Appendix 3

Staff Group Glossary

Admin & Clerical/Senior Management Ancillary Dental Health Science Services Clinical Scientists Audiological Biochemist Clinical Cytogeneticist Cytologist Haematologist Histopathologist Immunologist Microbiologist Physicist Biomedical Scientists Medical Nursing & Midwifery Pharmacy Technical Cytology Screeners Dental Technicians Medical Technical Officers Optometrist Therapeutic Allied Health Profession Art Therapy (art/music/drama) Dietetics Occupational Therapy Orthoptics Orthotics and Prosthetics Physiotherapy Podiatry Radiography Sonography Speech & Language Therapy Clinical Psychology Trades Works

66

Appendix 4

NHS Grampian Policies

• NHSG Consumption of Alcohol Policy (pdf version)

• NHSG Dignity at Work (pdf version)

• NHSG Dignity at Work - List of Confidential Contacts (pdf version)

• NHSG Dignity at Work Audit: About the Audit (word version)

• NHSG Dignity at Work Audit: Step by Step DIF and DIA (word version)

• NHSG Dignity at Work Audit: Investigator's Form (DIF) (word version)

• NHSG Dignity at Work Audit: Interview Attendee Form (DIA) (word version)

• NHSG Dignity at Work Audit: Step by Step Informal Processes Monitoring Form (word version)

• NHSG Dignity at Work Audit: Informal Processes Monitoring Form (DIPM) (word version)

• NHSG Domestic Abuse (Support for Staff) Policy (pdf version)

• NHSG Employee Capability (pdf version)

• NHSG Employee Conduct (pdf version)

• NHSG Grievance Policy (pdf version)

• NHSG Guidance for Employees/Non-Employees Accompanying Employees to Meetings

• NHSG Guidance on Use of Mobile Phones (pdf version)

• NHSG Learning & Development Policy (pdf version)

• NHSG Long Service and Retirement Awards (pdf version)

o Long Service Claim Form (word version)

• NHSG Management of Stress at Work (pdf version)

• NHSG Maternity Leave (word version)

• NHSG Organisational Change Policy (pdf version)

• NHSG Parental Leave (pdf version)

• NHSG Paternity Leave (pdf version)

• NHSG Recruitment of Ex Offenders (pdf version)

• NHSG Recruitment and Selection Policy Framework (pdf version)

• NHSG Recruitment of Agency Staff Protocol (word version)

• NHSG Redeployment Policy (pdf version)

67

• NHSG Staff Induction Handbook 2005 (pdf version)

• NHSG Special and Carer Leave etc (pdf version)

• NHSG Secure Handling, Use, Storage, Retention Disclosure Information (pdf version)

• NHSG Scottish Criminal Record Office Checks (pdf version)

• NHSG Secondment Policy (pdf version)

• NHSG Retirement Planning and Administration Policy (pdf version)

• NHSG Voluntary Severance Scheme (pdf version)

• NHSG Tobacco Policy (pdf version)

• NHSG Stress Workbook (pdf version)

• NHSG Voicing Concern Policy (pdf version)

• NHSG School Pupil Work Experience Policy (pdf version)

• NHSG Support for Breastfeeding Mothers (pdf version)

o Voluntary Severance Questions and Answers (pdf version)

o Retirement Planning and Administration Explanatory Notes (pdf version)

o Voluntary Severance Flow Chart (pdf version)

o School Pupil Work Experience Forms (word version)

o Voluntary Severance Forms and Template Letters (word version)

o Voluntary Severance Request for Estimate Template (word version)

68

69

APPENDIX 5 – CIP Workforce Map

70

NHS GRAMPIAN

STAFF GOVERNANCE SELF ASSESSMENT AUDIT 2007/2008 ACTION PLAN

A WELL INFORMED A1 – WE MAKE SURE WE COMMUNICATE EFFECTIVELY WITH OUR EMPLOYEES. Action Timing Responsibility (a) Complete a review of the current range of local newsletters and develop

a strategy for sharing information across NHSG.

By March, 2008.

Director of Corporate Communications and the Communications Sub Group of the GAPF.

(b) Increase face to face contact between senior management and staff as part of a regular and recurring commitment. The results of this will be audited via the 2008 Staff Survey.

Ongoing

Director of Corporate Communications, OMT and GAPF.

A2 – WE MAKE SURE WE LISTEN TO OUR EMPLOYEES. Action Timing Responsibility (a) Review the overall NHSG communication Strategy. By March, 2008. Director of Corp. Comms. (b) Review the global email information update system. By March, 2008. Director of Corp. Comms. A3 – WE MAKE EFFECTIVE USE OF TECHNOLOGY. Action Timing Responsibility (a) Develop the Learning Zone on the Intranet site to allow easy access to

external and internal training for staff. By December, 2007. Head of L&D and IM&T General Manager.

(b) Continue to develop e-learning programmes based on the priorities in the organisation.

Ongoing Head of L&D and IM&T General Manager.

(c) Implement On-Core and align with the E-KSF system for maximum benefit.

By March, 2008. Head of L&D and IM&T General Manager.

(d) Explore the possibility of greater connectivity between NHSG intranet site and the internet to increase staff access to information.

By March, 2008. Director of Corp. Comms.

(e) Finalise the design of the embryonic Partnership Intranet site and ensure that it is fully populated with the appropriate information.

By March, 2008. The Communications Sub Group of the GAPF

B APPROPRIATELY TRAINED B1 – OUR GOALS ARE REALISTIC GIVEN THE PEOPLE WE HAVE. Action Timing Responsibility

71

(a) Provide training to managers on how to identify training needs to better support staff and personal development planning *e.g. via the People Management programme.

Ongoing.

Head of L&D and HRMs

(b) Complete Phase lll KSF training.

By May, 2007. Head of L&D

(c) Implementation of KSF to whole organisation. By March, 2008 Head of L&D B2 – WE MAKE SURE THAT THERE ARE CLEAR LINKS BETWEEN WHAT THE EMPLOYER WANTS TO ACHIEVE, WHAT DEPARTMENTS/FUNCTIONS AND TEAMS HAVE TO ACHIEVE AND WHAT OUR EMPLOYEES HAVE TO ACHIEVE.

Action Timing Responsibility (a) Evaluate E-KSF pilots and use information to inform the roll-out to rest of

organisation . By June, 2007. Head of L&D

(b) Roll out of E-KSF to whole organisation. By March, 2008. Head of L&D B3 – WE HAVE ASSESSED THE NUMBERS, SKILLS AND MIX OF PEOPLE WE NEED AND HAVE IDENTIFIED ACTIONS NEEDED TO ACHIEVE THIS. Action Timing Responsibility (a) Continue roll out of the Workforce Planning Tool across service redesign

projects during 2006/2007.

Ongoing.

Head of Workforce Development and Redesign, Director of Planning and HRMs.

(b) Develop Workforce Planning knowledge and understanding through management and leadership courses.

On going Head of Workforce Development and Redesign

(c) Ensure that employee information is input to systems accurately and timeously in order that robust workforce reports can be extracted.

Ongoing Head of HR Service Centre and Head of Workforce Development and Redesign.

(d) Continue the Job Jump Start programme and mainstream.

By March, 2008. Head of L&D.

B4 – WE ACTIVELY ENCOURAGE CONTINUOUS PERFORMANCE IMPROVEMENT. Action Timing Responsibility Conduct a review of the Learning and Development strategy and

implement any amendments. By June, 2007. Head of L&D.

72

C INVOLVED IN DECISIONS WHICH AFFECT THEM C1 – WE HAVE LEADERS AT ALL LEVELS WHO, IN PARTNERSHIP, TAKE RESPONSIBILITY FOR ENSURING THAT STAFF INVOLVEMENT IS DEVELOPED, REGULARLY REVIEWED AND THAT PROGRESS HAS BEEN MADE.

Action Timing Responsibility (a) Continue to roll out training on the People Management Programme.

Ongoing. Head of L&D, HRMs and Staff Side

representatives. (b) Continue to improve sector linkage between sector partnership fora and

GAPF.

Ongoing.

Director of HR, Employee Director and HRMs.

(c) Investigate the viability of siting a Partnership Notice Board at each NHSG location across Grampian.

By May, 2007. Communication Sub Group of the GAPF.

(d) Review the Leadership Strategy for the organisation. By March, 2008. Head of L&D (e) Update the NHS Grampian Leadership Programme. By March, 2008. Head of L&D C2 – ALL EMPLOYEES ARE INVOLVED IN (I.E. HAVE THE OPPORTUNITY TO CONTRIBUTE AND INFLUENCE) SERVICE PLANNING AND, AS A RESULT, PATIENT CARE BENEFITS.

Action Timing Responsibility Ensure the continued involvement of Staff Side representatives in

change projects and detailed in Project Initiation Documents (PIDs). Ongoing.

Director of Planning, General Managers, Director of HR and GAPF.

C3 – BY BEING INVOLVED, OUR EMPLOYEES ARE MOTIVATED AND COMMITTED TO THE ACHIEVEMENT OF AGREED SERVICE AND PATIENT CARE OBJECTIVES.

Action Timing Responsibility Continue delivery of the Pay modernisation benefit delivery plan

throughout 2007/2008. Ongoing. Head of Workforce Development and Redesign,

Pay Modernisation leads and the Employee Director.

73

D TREATED FAIRLY AND CONSISTENTLY D1 – PIN GUIDELINES AND BEST PRACTICE POLICIES ARE DEVELOPED BY AREA AND LOCAL PARTNERSHIP FORA WITH THE FULL INVOLVEMENT AND SUPPORT OF STAFF THROUGH THEIR TRADE UNION/PROFESSIONAL ORGANISATION REPRESENTATIVES.

Action Timing Responsibility (a) Finalise and implement an Attendance Management Policy. By August, 2007.

Policies and Procedures Sub Group of the GAPF, HR Directorate and Head of Partnership and Staff Governance.

(b) Implement a full range of flexible working policies in line with the updated PIN.

By June, 2007.

Policies and Procedures Sub Group of the GAPF, HR Directorate and Head of Partnership and Staff Governance.

(c) Review the Employee Conduct Policy to ensure it meets the requirements for AfC.

By March, 2008 Policies and Procedures Sub Group of the GAPF, HR Directorate and Head of Partnership and Staff Governance.

(d) Review the Employee Capability Policy to ensure it meets the requirements for AfC.

By March, 2008 Policies and Procedures Sub Group of the GAPF, HR Directorate and Head of Partnership and Staff Governance.

(e) Review the Secondment Policy to ensure it meets the requirements for AfC.

By March, 2008 Policies and Procedures Sub Group of the GAPF, HR Directorate and Head of Partnership and Staff Governance.

D2 – WE HAVE UP-TO-DATE CORPORATE PROCEDURES OR GUIDELINES FOR DEPARTMENTS/ FUNCTIONS RECRUITING EMPLOYEES.

Action Timing Responsibility Continue to review and refine the Induction Handbook at 6 monthly

intervals. Ongoing. Head of L&D, Head of HR Service Centre and the

Induction Steering Committee.

D3 – WE TAKE APPROPRIATE ACTION ACROSS THE ORGANISATION TO MANAGE TURNOVER. (a) Complete outstanding work on the development and implementation of a

process for conducting exit interviews. By March, 2008.

Head of Workforce Development and Redesign.

(b) Continuation of Workforce Plans in service projects and plans. Ongoing.

Head of Workforce Development and Redesign and HRMs.

(c) Put processes in place to ensure that temporary and fixed term contracts are only used where they are justified e.g. to facilitate organisational redesign.

By 1st January, 2008.

General Managers and HR Managers.

(c) Ensure that appropriate exit strategies are in place where temporary and fixed term contracts are utilised.

By 1st January, 2008.

Director of HR and GAPF.

D4 – WHERE IT IS NECESSARY TO REDUCE EMPLOYEE NUMBERS, WE ENSURE THAT THIS IS DONE IN PARTNERSHIP, GIVING FULL CONSIDERATION TO JOB SECURITY, SALARY PROTECTION AND INDIVIDUALS’ DEVELOPMENT CHOICES.

74

Action Timing Responsibility Continue to develop procedures which ensure staffing levels are

consistent with achieving financial balance within NHSG.

Ongoing.

Workforce Management Steering Group.

D5 – WE IMPLEMENT COLLECTIVE AGREEMENTS THROUGH APPROPRIATE LOCAL FORA IN ACCORDANCE WITH AGREED PROCESSES AND

TIMESCALES. Action Timing Responsibility

No actions - NHS Grampian is content that this issue is satisfactory.

E PROVIDED WITH AN IMPROVED AND SAFE WORKING ENVIRONMENT E1 – WE HAVE A HEALTH AND SAFETY STRATEGY IN PLACE, WHICH WAS DEVELOPED IN PARTNERSHIP.

Action Timing Responsibility (a) Development of an Occupational Road Risk Policy and Implementation

plan

By March, 2008 Head of CG/RM

(b) Approval of Risk Assessment Policy with agreed implementation plan By May, 2007

Head of CG/RM

(c) NHSG wide implementation of Risk Assessment Policy By March, 2008 Head of CG/RM E2 – WE ARE COMMITTED TO ENSURING THE WELLBEING OF OUR EMPLOYEES AND HAVE ENSURED RESOURCES ARE AVAILABLE TO SUPPORT THIS.

Action Timing Responsibility (a) Work towards the full involvement of all sectors in Scotland’s Healthy

Working Lives programme during 2007/2008. Ongoing.

Health at Work Network Group (or successor) and Sector General Managers.

(b) Work towards achieving the Healthy Working Lives bronze award for NHSG’s corporate headquarters.

By March, 2008.

Summerfield House Working Group

(c) Implementation of the Moving and Handling Competency Framework as per the NHSG Implementation plan

By March, 2008

Head of CG/RM and Head of L&D

(d) Development of Implementation plan for the Risk Training Strategy as per November 06 workshop outcomes

By August, 2007

Head of CG/RM and Head of L&D

(e) Delivery of the Implementation plan for the Risk Training Strategy (as above)

By March, 2008

Head of CG/RM and Head of L&D

75

(f) Implementation of Chemical Management System (Sypol) to ensure Safety Data Sheets and Risk Assessments for CoSHH are widely available to staff

By March, 2008

Head of CG/RM

(g) Implementation the OHSXtra services throughout NHS Grampian By 31st March, 2008. Lead Consultant Occupational Physician E3 – WE HAVE A CLEAR UNDERSTANDING OF THE HEALTH AND SAFETY ISSUES FACED BY OUR EMPLOYEES.

Action Timing Responsibility (a) Further roll out of Datix including: -

1. Risk Control Plan module 2. Occurrence Recording module- scoping exercise for General

Practice

By August, 2008

Head of CG/RM

(b) Monitoring of Datix information : – 1. Provision of high level reports to relevant Assurance Committees by

RMSU 2. The production of Datix output reports by local Datix leads to relevant

committees 3. Monitoring of Datix information by CHP management teams as per

risk management KPI’s

By August, 2008

Head of CG/RM

(c) Implementation of the theoretical aspects of V&A training as workbooks and e-learning options as per plan.

By November, 2007

Head of L&D

(d) Distribute Confidential Contacts’ leaflet to all employees with their pay slips and commence a recruitment drive for new CCs via UpFront in the same month as the leaflet is distributed.

By August, 2007

HR Director

(e) Assess the training needs of Confidential Contacts with a view to developing new provision to support their needs.

By March, 2008.

HR Director

(f) Complete review of the Stress Workbook and implement revised version. By August, 2007.

HR Director

E4 – WE ARE UNDERTAKING BENCHMARKING IN RELATION TO ACCIDENTS/NEAR MISSES, STAFF ABSENCES, VIOLENT AND AGGRESSIVE ASSAULT AND NEEDLESTICK INJURIES.

Action Timing Responsibility (a) Submit 2006/2007 OHS-MDS return to ISD. By May, 2007 Head of CG/RM (b) Follow up on any actions resulting from the benchmarking exercises with

NHS Highland and IOSH. By March, 2008

Head of CG/RM

76

E5 – WE ARE COMMITTED TO ENSURING THAT OUR WORKING ARRANGEMENTS DO NOT CAUSE HARM TO OUR EMPLOYEES.

Action Timing Responsibility (a) Audit of H&S Systems and Policies including: -

1) Sector use of Risk Key Performance Indicators 2) Sector use of information from Datix, Feedback, SABS, RCA 3) Managerial competencies to manage local risk 4) 2/3 key H&S policies

By March, 2008

Head of CG/RM

(b) Review and Development of an all encompassing systems for the dissemination of Safety Action Notices, Risk Control Notices, QIS Notices and Hazard Notices. (Safety Alert Broadcast System)

By March, 2008

Head of CG/RM