workforce plan 2016 - nhs grampian...table 24: nhs grampian turnover 1 april 2015 - 31 march 2016 69...

Workforce Plan NHS Grampian 2016 - 2019

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Author Caron Fraser

Service Lead Gerry Lawrie

Executive Lead Dr Annie Ingram

WORKFORCE PLAN 2016

Wo

rkforce

Plan

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g & R

ed

esign


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Foreword

NHS Grampian, like many NHS Boards, is in a time of significant change. The new Scottish

Government have signalled a review of the structure and regulation of NHS Boards which

will take place over the summer, following the National Conversation and in light of the

changing landscape of health and social care and the recently published National Clinical

Strategy. The challenges of the NHS, nationally and locally is to do more than change but

to transform. Transform the approach to services, with a greater emphasis on prevention

and anticipation; accessible and flexible services, centred on the needs of the individual;

improving community empowerment and improving outcomes. There is also a growing

emphasis on regional working in both clinical and support services.

In April 2016, three Integrated Joint Boards for Health and Social Care (IJBs) in Grampian

took over responsibility for the strategic direction and, for many services, delivery of

services, previously delivered by the NHS alone. Improvement, empowerment and

partnership working are key to delivery of the strategic outcomes identified by each IJB.

The IJBs are now established as legal entities with NHS staff, Local Authority staff and

those from the third sector being increasingly directed by the priorities of the IJBs. The IJBs

will also have a different working relationship with Acute Services.

The impact on NHS Grampian is that it is an organisation in transition and work is

progressing to provide clarity of direction for the health system and for NHS Grampian’s

role locally and in the North of Scotland. The emerging Clinical Strategy will be one of a

suite of strategies that the Board will use to focus on the strategic issues that the Board is

uniquely placed to develop.

It is in this context that this Workforce Plan has been developed. The Plan recognises the

different staff groups within the NHS and within partner organisations, recognising that high

quality services are delivered by hard working people, responding to the changing demand,

evolving delivery models and rising public expectation in an ever-changing environment.

Success will require a motivated, innovative, developed and capable workforce, working in

collaboration with others: patients, public and partners to bring the vision to reality.

I am confident that the people who work for NHS Grampian are up to that challenge. Past

performance is an indicator of future delivery and the achievements of our staff, their

capability and commitment would suggest that together we can deliver the best care in

Scotland.

Malcolm Wright – Chief Executive


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Table of Contents Foreword .............................................................................................................................. 2 List of Tables ........................................................................................................................ 4

Step 1: Defining the Plan ..................................................................................................... 5 1.1 Introduction .............................................................................................................. 5 1.2 Purpose of the plan ................................................................................................. 5 1.3 Scope of the plan ..................................................................................................... 5 1.4 Ownership of the plan .............................................................................................. 6

1.5 Update on Workforce Planning Action Plan 2014/15 ............................................... 7 Step 2: Service Change ......................................................................................................10

2.1 National context: .....................................................................................................10

2.2 Local context: .............................................................................................................13 Step 3: Defining the Required Workforce ............................................................................19

3.1 Data Cleansing ...........................................................................................................19 3.2 Projections ..................................................................................................................19 3.3 Future Workforce Demand .........................................................................................19

3.4 New roles ...............................................................................................................39 Step 4: Workforce Capacity and Capability ........................................................................43

4.1 Current Workforce ..................................................................................................43

4.2 Finance ...................................................................................................................49 4.3 Nursing and Midwifery Workload Workforce Tools .................................................50

Step 5: Workforce Action Plan ............................................................................................52

5.1 The Workforce Risk Plan ........................................................................................52

5.2 The Learning and Education plan ...........................................................................53 5.3 The Workforce Planning Action Plan ......................................................................58

Step 6: Implementation .......................................................................................................61

6.1 Monitoring ...............................................................................................................61 6.2 Review / Refresh ....................................................................................................61

Appendix 1: NHS Grampian Vision and Values ...................................................................62 Appendix 2 – Current Workforce Profile ..............................................................................63


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List of Figures Figure 1: Map of NHS Grampian .......................................................................................... 5 Figure 2: Grampian Clinical Services Strategy Proposed Strategic Themes .......................14

Figure 3: Health and Social Care and NHS Grampian Strategic Overlap ............................15

List of Tables

Table 1: NHS Grampian wte and % Split by Job Family 31st March 2016 43 Table 2: Split between Whole-Time and Part-Time by Job Family 31 March 2016 44 Table 3: NHS Grampian Age Profile by Three Main Clinical Job Families 31 March 2016 45 Table 4: NHS Grampian Gender Split 45

Table 5: NHS Grampian Sickness Absence Rates, Monthly ISD, April 2016 - March 2016 46 Table 6: Job Planning Completion as at 31 April 2016 46 Table 7: Employment Rates 2004 - 2015 47 Table 8: Unemployment Rates 48

Table 9: Expenditure on Overtime and Additional Hours 50 Table 10: Gender Split as at 31 March 2016 63 Table 11: NHS Grampian Age Range as at 31 March 2016 63 Table 12: Age Profiling by Job Family, by Headcount as at 31 March 2016 64

Table 13: NHS Grampian Age Range by Job Family as at 31 March 2016 64 Table 14: Age Profiling by Job Family as Percentages 31 March 2016 65

Table 15: wte (Whole Time Equivalent) as at 31 March 2016 65 Table 16: NHS Grampian wte by Job Family as at 31 March 2016 65

Table 17: NHS Grampian Headcount as at 31 March 2016 66 Table 18: NHS Grampian Headcount by Job Family as at 31 March 2016 66 Table 19: NHS Grampian Whole-Time Part-Time Split (wte) as at 31 March 2016 67

Table 20: NHS Grampian Whole-Time Part-Time Split as at 31 March 2016 67 Table 21: NHS Grampian Sickness Absence Information (SWISS) 1 April 2015 - 31 March 2016 68 Table 22: NHS Grampian Sickness Absences (SWISS) 1 April 2015 - 31 April 2016 68 Table 23: Aggregated Starters and Leavers 1 April 2015 - 31 March 2016 69 Table 24: NHS Grampian Turnover 1 April 2015 - 31 March 2016 69

Table 25: Current NHS Grampian Vacancies by Division and Unit 71


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Step 1: Defining the Plan

1.1 Introduction

This workforce plan for NHS Grampian describes the future workforce required to ensure

delivery of quality services within the agreed values of Caring, Listening and Improving,

outlined in Appendix 1.

1.2 Purpose of the plan

The aims of this plan are to describe:

the overall direction of travel for the workforce;

the context and drivers for change;

the type and level of changes required;

the new roles and skills requiring investment;

the new ways of working with our colleagues;

the workforce risks; and

the key actions to implement change.

1.3 Scope of the plan

The Workforce Plan covers all services and locations across NHS Grampian (see figure 1).

Figure 1: Map of NHS Grampian


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NHS Grampian provides clinical, corporate and support services for the people of Grampian

and through Service Level Agreements (SLA) for other NHS Boards, including NHS Orkney

and NHS Shetland. The Board also provides some services for the population of Scotland,

for example, Extra Corporeal Membrane Oxygenation (ECMO). These services are

included within the Board and Sector Workforce Plans to ensure comprehensive planning

across all services that the Board is responsible for providing.

Integrated Joint Boards (IJBs) for Health and Social Care assumed responsibility for

strategic commissioning and delivery of a number for services on the 1 April 2016. NHS

staff who work in the IJBs remain NHS Grampian employees and the IJBs have therefore

been involved in the development of this Plan to ensure that the entire NHS Grampian

workforce is represented. There has also been some early work with partners including

Health and Social Care Partnerships to develop a consistent methodology for workforce

planning across these new organisations.

Effective Workforce Planning supports strong financial governance, financial planning and

ensures the capacity and capability of the workforce are developed to support service

development plans.

All staff referenced within this plan are covered under the following national job families:

Administrative Services.

Allied Health Profession.

Dental Support.

Healthcare Sciences.

Medical and Dental.

Medical Support.

Nursing and Midwifery.

Other Therapeutic.

Personal and Social Care.

Support Services.

1.4 Ownership of the plan

This Plan has been informed by the local Workforce Plans developed in partnership within

each Sector, each Health and Social Care Partnership1, as well as with Corporate and

Support Services. It is by its nature, a summary plan and does not cover the substantial

detail of any given Sector.

The Workforce Plan fully recognises and accounts for the wide stakeholder and partner

organisations influence on the planning of workforce resources within NHS Grampian. NHS

Grampian works closely with other NHS Boards in the North East of Scotland through SLA

1 Health and Social Care Partnerships (HSCP) are the organisations and the Integrated Joint Boards (IJBs) are the Boards that oversee

the strategic direction and governance of these partnerships.


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arrangements, managed clinical networks and the North of Scotland Planning Group. NHS

Grampian fully recognises the importance of working with other partner organisations such

as Aberdeen University, the Robert Gordon University, North East of Scotland College

(NESCOL) and the three local authorities within the Grampian region to ensure that

sustainable services are provided by appropriately trained professionals. Through public

involvement and feedback, as well as the recent Local Clinical Strategy consultation, NHS

Grampian fully recognises the contribution and expectation of the public and service users.

The Workforce Plan and Workforce Projections are jointly approved by the Senior

Leadership and the Board. The Director of Finance approves the Workforce Projections for

affordability. The Director of Nursing and Allied Health Professionals approves the

Workforce Plan as the Executive Lead for the use of Nursing and Midwifery Workforce

Workload Tools.

1.5 Update on Workforce Planning Action Plan 2014/15

The following provides a brief summary of the progress against the ten key actions

identified from the annual workforce planning cycle across NHS Grampian in 2015. Whilst

this was not a complete list, it highlighted the priorities across the Board.

1. Actions to achieve the Workforce 2020 Vision have continued to develop and

emerge through recent workforce planning cycles, including the development of new

roles, for example, Clinical Development Fellows. The emerging Clinical Strategy for

NHS Grampian recognises workforce as one of the key enablers and the Workforce

vision will be reviewed.

2. Integration of Health and Social Care was recognised as a key priority as the

organisational structures of the shadow IJB’s started to emerge. Workforce planning

is recognised as key work stream within each Health and Social Care Partnership

(HSCP). Developing joint workforce plans that reflect the entirety of the HSCP

workforce has and will continue to be supported by the NHS Grampian Workforce

Team, the Senior Project Officer for Integration and Local Authority partners.

Progress to date includes the development of profile and workforce planning

templates.

3. Recruitment and overall workforce supply was a focus in 2015 with increased

investment in the overall establishment. Initiatives such as earlier recruitment of

students to posts within NHS Grampian, agreement of an SLA for moving and

handling training of healthcare students with Robert Gordon’s University have each

contributed to the improved recruitment and retention of nursing students. The

strategic governance and oversight provided by the Nursing Resources Group has

contributed to 186 additional nurses in the workforce. A Return to Practice Nursing

scheme has proved successful and a third cohort is planned. International and UK

recruitment has aided recruitment of GPs and other doctors.


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4. A Professional Lead for Health Care Support Workers (HCSW) was appointed by

NHS Grampian in 2014. Throughout 2015, work to strengthen education links,

increase training and education, provide more qualification opportunities and the

redesign of the HCSW role were undertaken and will continue to be a priority. See

section 3.4 for further information on the progress of this action.

5. Nursing and Midwifery Workforce and Workload Tools have been applied

consistently across the organisation. The use of these Tools has been overseen and

strategically supported by the Nursing Resources Group who have established

workforce governance groups, agreed methodology for validating workforce

establishments and identified risks. See section 4.3 for further information on the

progress of this action.

6. The age profile of the NHS Grampian workforce has been discussed in the 2015

Workforce Plan, and again in this Workforce Plan. With changes to the Scottish

Public Pension Agency retrial age for NHS employees further work on age profile

modelling and sustainability of an ageing workforce will be required.

7. The Scottish Government investment in Primary Care includes a national GP

recruitment and retention programme which will contribute to local work being

undertaken in Grampian. In 2015, work to promote Grampian as a desirable place to

live and work remained a local priority. Social media, (Facebook and Blogspot), were

utilised to widely promote the General Practice opportunities in Grampian and have

been widely used. The Facebook page has 281 ‘likes’ and in an average week in

June posts to the page reached on average 840 people. The last post on the

Blogspot received 4063 views, the majority, 3164, were from the UK. However there

has been a wide geographic reach; 247 views were from the USA, 94 from Russia,

25 from China.

8. Succession planning for staff about to retire is a key issue documented in the

Sectors and Service Workforce Plans during the 2014/15 workforce planning cycle. A

Talent Forum has been established comprising of some Directors and Chief Officers.

A revised Talent Programme for band 7 and above has been developed and a

programme for band 4-6 has now been designed. This new programme will

commence in September.

Discussions have commenced with North East Learning Collaborative (NELC)

partners, in particular Aberdeen Council, Aberdeenshire Council, Police Scotland

and the Scottish Fire and Rescue Service, to share development opportunities and

learn from each other, opening up master classes to the wider public sector pool and

further support the development of talent.


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9. Work has continued on career pathways to support the development of our

workforce. Recent work around AHPs and Healthcare Scientists highlight

opportunities to further develop the workforce in support of service redesign. A

significant programme to promote succession planning and the development of

Careers within Facilities’ and Estates has been progressed, with the creation of

specific new roles to target risk, compliance and governance arrangements. There is

also a significant element of up-skilling and skills transfer, associated with

development of new and changing roles. These changes link very closely to both

Career Planning and Service Redesign across the Sector.

10. Sector, Service and CHP workforce plans in 2015 continued to identify a requirement

for an improved local supply of Advanced Clinical Practitioners. This has included

Advanced Nursing Practitioners, Allied Health Professionals, Healthcare Scientists

and Physician Associates. Please see section 3.4 for further information on the

development of new roles.


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Step 2: Service Change

Change is now common place across all health and social care services with ever

developing demands on these services. Within this context of development and change,

NHS Grampian continues to provide services which meet the needs and expectations of

patients. This is managed, whilst striving for greater efficiency, ensuring best use of public

funds, meeting national targets for patient care whilst achieving all aspects of governance

and energy efficiency.

NHS Grampian works with its partners to deliver services within the context of national and

local drivers for change and complexity of planning over which it has little or no control.

Through the workforce planning process each sector has identified the local and national

drivers for change and complexity of planning for their specific services. Within this

Workforce Plan the broader national and local context is considered below.

2.1 National context:

NHS Grampian provides local services within the national context of NHS Scotland. In 2015

the Scottish Government identified the need for ‘transformational change in NHSScotland to

meet people’s health and social care needs by 2020’2. This has been further developed into

‘A National Clinical Strategy for Scotland’3, published February 2016, which proposes how

clinical services need to change in order to provide sustainable health and social care

services fit for the future. This clinical strategy recognises a number of key principles:

Quality must remain a primary concern;

Service developments should be evidence based;

Services will be based around supporting people rather than single disease

pathways;

Services will continue to be planned and delivered at a local level where clinically

appropriate; and

Health inequalities will be minimised to ensure equitable access to health and social

care.

Prevention, encouraging people to live healthy lives, assuming responsibility for their

own health is a key policy driver. This requires a different approach across health

and social care.

Whilst prevention and anticipation is important, access, when necessary, is equally

important. The National Strategy has an emphasis on well-designed, accessible Primary

Care in recognition of ‘evidence from around the world that systems with a strong primary

care service tend to produce better overall outcomes’4. The Strategy recognises that

secondary care settings will also need to adapt, providing evidence that complex operations

2 The Scottish Government, 2016. ‘A National Clinical Strategy for Scotland’. Edinburgh: The Scottish Government

3 ibid

4 ibid


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should be planned on a national, regional or local level on population rather than

geographical boundary basis. With the recent announcement of four major trauma centres

to be created in Scotland, one of which will be in Aberdeen, the strategic vision to create

regional tertiary centres becomes more tenable. More regionalised services across NHS

Acute services is anticipated, this is further supported by the themes within the Chief

Medical Officer’s Annual Report for 2014-15: Realistic Medicine5 and the recent

announcement by the Cabinet Secretary for Health Wellbeing and Sport at the NHS

Scotland event where she announced a review of the number, structure and regulation of

NHS Boards.

The Chief Medical Officer’s Annual Report 2014-15 Realistic Medicine supports the

direction of the National Clinical Strategy, and recognises ‘current models of healthcare

services are stretched and do not always suit patients, their carers or the aspirations of the

workforce’6. Through Realistic Medicine, a personalised approach to care can be built;

where decision making is collaborative and relational; unnecessary variation in practice and

outcomes is reduced; harm and waste are reduced and risk is better managed.

Whilst, the national context steers strategic direction for NHS services and workforce

planning, the Local Delivery Plan (LPD) Guidance7 also highlights a range of measure and

metrics which must be achieved and this has been considered in the development of this

Plan, together with the Strategic Commissioning Plans of the Health and Social Care

Partnerships (HSCP).

The Scottish Government has prioritised investment towards transforming services to meet

the needs of the future. The fundamental realignment of resources announced in the draft

Budget are designed to build capacity of community-based services.

Health and Social Care Integration

Legislation to implement health and social care integration was passed by the Scottish

Parliament in February 2014 and came into force on 1 April 2016; bringing together NHS

and local authority care services under one partnership arrangement for each area.

In total thirty one local partnerships have been set up across Scotland and will manage

almost £8 billion of health and social care resources, including those currently associated

with 96 per cent of delayed discharge and 83 per cent of unplanned admissions in the over

75s.

HSCP will be jointly responsible for the health and care needs of patients, in particular the

elderly, to ensure when people move between hospital and care settings their journey is

better coordinated and, as seamless, as possible.

5 Calderwood, C. 2016. Chief Medical Officers Annual Report 2014-15: Realistic Medicine’. Edinburgh: The Scottish Government.

6 ibid

7 The Scottish Government, 2015. NHSScotland Local Delivery Plan Guidance 2015-16. Edinburgh: The Scottish Government.


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One of the key aims is to ensure that local populations receive the care they need at the

right time, in the right setting and that the workforce move towards a more preventative and

community based approach. Governance and management arrangements are in place, but,

there is still a degree of uncertainty as to how this will work in practice and significant long-

term workforce issues need to be addressed, if integration is to successfully change the

delivery of health and care services. For example, each partner body have long standing

recruitment difficulties: within the NHS recruitment of GPs is recognised as a challenge;

HSCP and Local Authorities report similar challenges in the recruitment and retention of

care staff.

Developing a suitably skilled workforce is crucial to the success of integration health and

social care. This is challenging given the wide range of staff involved and the size of the

workforce. NHS Scotland employs approximately 160,000 staff. Social services employ

around 200,000 people, including those from local authorities, the voluntary sector and the

private sector.

Although HSCPs will not directly employ staff, they are responsible for coordinating

services from a diverse mix of staff and carers and, as services change and develop, this

will impact on the experience competence and capability required from these workforces to

deliver more community-based support. The financial pressures on the NHS and Local

Authorities will add to the challenge to meet the workforce needs; and difficulties in

recruiting and retaining staff across different sectors, will impact on service delivery,

including the role of the voluntary and private sectors.

Once For Scotland

The public service reform agenda, reiterated in the 2015-16 Programme for Government8,

has direct implications on health service provision, with an emphasis on the need to reduce

duplication and inefficiency. The ‘Once for Scotland’9 approach of shared services supports

this through the anticipated reduction in geographical and organisational barriers to the

delivery of support services and functions i.e. Finance, Payroll, Workforce, Catering,

Decontamination, Linen and Laundry and Logistics. The Once for Scotland agenda

promotes, where appropriate, that “services should be managed on a Scotland-wide basis

and should be delivered in a consistent way, unless a compelling reason exists for

variation”10. Moving towards shared services at a regional or national level has implications

for Corporate, Clinical and Support workforces across NHS Scotland.

NHS Grampian fully recognises the potential benefits of working to the shared services

agenda and has undertaken tests of concept for regionalised services outlined in section

2.2.

9 The Scottish Government. ‘NHS Scotland Shared Services’ accessed online; http://www.qihub.scot.nhs.uk/quality-and-

efficiency/shared-services.aspx 10

The Scottish Government. ‘NHS Scotland Shared Services’ accessed online; http://www.qihub.scot.nhs.uk/quality-and-efficiency/shared-services.aspx

http://www.qihub.scot.nhs.uk/quality-and-efficiency/shared-services.aspx





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Underpinning the shared services concept is the identified need for support services to

sustain a health service that will increasingly have to work across boundaries, organised

around the individual rather than a single disease pathway, as outlined in the National

Clinical Strategy. The integration of health and social care services is a fundamental shift to

achieving this, the potential regionalisation of Acute Services would be consistent with aims

of the National Clinical Strategy and public sector reform.

Staff Governance

Staff, who are well informed, appropriately trained and sharing best practices can influence

and deliver services in the changing health care setting. The Staff Governance Standard of

NHS Scotland11 supports, through a statutory commitment, the continuous improvement of

the experiences of NHS staff. The Everyone Matters 20:20 Workforce Vision12 recognises

in order to provide a health service that is safe, effective and person-centred, the workforce

of NHS Scotland must work within a healthy organisational culture, underpinned by a

workforce that is capable, sustainable and integrated, managed and led by effective

leaders.

Everyone Matters 20:20 Workforce Vision provides the strategic workforce direction and

Boards are also required to submit an implementation plan annually. The 2016-17

implementation plan13 is the third of its kind since the launch of Everyone Matters. The

focus this year moves away from embedding NHSScotland values, leadership and quality

improvement, towards focusing upon on health inequalities and on integration.

2.2 Local context: The national context, within which NHS Grampian operates and provides services,

influences the local context. Across NHSScotland there is a drive for improved financial

efficiency and savings. NHS Grampian requires to make estimated cash savings of £18.5

million in 2016/17. To achieve this, NHS Grampian will require to consider how it can

support its workforce to work differently, providing services in new and innovative ways to

ensure long term sustainability, with strong financial governance.

To achieve NHS Grampian’s 20:20 Healthfit Vision and develop a sustainable health

service, NHS Grampian recognises the need to encourage the workforce to be innovative,

but this will also require investment in services, workforce and new infrastructure.

NHS Grampian has an excellent track record of innovation, leading the way in service

delivery and, importantly, improving care, health and patient outcomes. This is due to the

dedication and drive of staff.

11

The Scottish Government. 2012. ‘Staff Governance Standard A Framework for NHSScotland Organisations and Employees’. Edinburgh: The Scottish Government. 12

The Scottish Government. 2013. ‘Everyone Matters 20:20 Workforce Vision’. Edinburgh: Scottish Government. 13

ibid


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Like many NHS Boards in Scotland, the population of NHS Grampian is ageing, with an

increasing number of people living with multiple long term conditions. This has an impact on

service models and, as the workforce ages, the way services are provided.

Over the next thirty years, it is estimated that those over 85 years will increase by 123%,

and those aged 65 to 84 years will increase by 39%14. Currently 30% of the population of

Scotland is obese, 20% smoke and 78% do not meet the recommended daily intake of fruit

or vegetables15. These estimates suggest the challenges currently faced will intensify over

the coming 30 years.

NHS Grampian is developing its local Clinical Services Strategy16 to support the

development of services and workforce to sustainably meet the health needs of the local

population. The Grampian Clinical Services Strategy was consulted on between 9th March

and 6th May 2016. The consultation had a focus upon the priorities identified below:

Figure 2: Grampian Clinical Services Strategy Proposed Strategic Themes

These strategic themes recognise that prevention of ill-health through promotion of healthy

living is crucial if health and social care providers are to be sustainable in the long term.

Recognising that many of the population do have one or a number of long term conditions,

an approach that fosters active self management is a key aspect of living healthier for

longer. Improved self management should reduce the requirements for both planned care

and unscheduled care, or should ensure that interactions are planned rather than

unplanned. There is a need to achieve the right balance to meet the needs of the

population. As an organisation the aim is to ensure that the change and improvement

across all four strategic themes is balanced.

14

NHS Grampian. 2016. ‘Grampian Clinical Services Strategy The Case for Change: Factors Influencing Change in Planning For Health and Health Care’. NHS Grampian : Aberdeen. 15

ibid 16

NHS Grampian. 2016. ‘Grampian Clinical Services Strategy Consultation Pack’. NHS Grampian: Aberdeen


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The expectations of patients, services users and the public were identified through the

consultation on the Grampian Clinical Services Strategy. As reflected in the National

Clinical Strategy and extensive consultation exercises in support of Integration, people do

want to have greater say in how their health is managed. When care is required, this should

be at home or closer to home in a homely setting, within their local community. Teams

should be better aligned, with more ‘joined up team working’ around individual needs.

Better communication and coordination for complex care was also identified as important,

reinforcing the move toward person centred care, over single disease pathway, supported

by collaborative decision making. The consultations highlighted an expectation that the

NHS should be using more technology, with better involvement of the community and

community resources.

The expectation of patients and service users that there are no boundaries between HSCP

highlight challenges in the way we work. Not only of the NHS and social cares staff working

in the HSCPs, or the Acute Sector, but also for those in the third sector. All three

partnerships have different priorities based on client need and service demand, within the

context of their localities, and are developing their own strategic plans to respond to current

and future needs. Working with three individual partners in this way increases the

complexity of future planning for a sustainable and capable workforce across the system.

Figure 3: Health and Social Care and NHS Grampian Strategic Overlap

In the current period of transition and looking to the future, the NHS Grampian Clinical

Strategy and the supporting Workforce Plan must focus not only on NHS Grampian

priorities, but also those of partners and must ensure appropriate support to develop and

maintain strategic and operational links with the new organisations. Across all strategic

plans, the focus on individual patient pathways and person centred care is the priority, not

who is providing them. Efficient and effective strategic and operational relationships should

enable the needs of individuals to be met across all services.


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Caring, Listening, Improving

NHS Grampian seeks to foster a culture of Caring, Listening and Improving (Appendix 1).

Cultures are created by people, not by organisations. Organisations can, however,

influence culture through identification and embedding of accepted behaviours. During

2015-16, the Staff Experience Group, reviewed the underpinning behaviours that support

the NHSScotland Values17, as defined within NHS Grampian (see Appendix 1), not only in

relation to patient care but also to support the improvement of staff experience. Research18

suggests that where staff experience a positive culture in a healthcare environment,

outcomes improve and mortality reduces.

Engaging employees positively can foster a culture where retention of staff is better and

sickness absence and stress are reduced. Measuring staff experience, and measuring it

over time, is important to demonstrate improvement. iMatter is NHS Scotland’s proprietary

tool to measure staff experience, currently being implemented across Scotland under

Everyone Matters 20:20 Workforce Vision.

Over the course of the year from April 2015, iMatter has been successfully implemented to

6167 staff, in three cohorts within NHS Grampian. The consistently high response rates

across all three cohorts suggest that staff have greater ownership over the iMatter tool than

the national staff survey. Staff, Team and Directorate ownership of the tool is a fundamental

part of empowering and engaging staff more effectively in their experience at work. The

iMatter tool is being implemented and utilised to support the values of NHS Grampian,

supporting our workforce to be engaged.

Shared Services – Proving it Works

NHS Grampian is involved with other regional partners to prove that shared services can

work and deliver sustainability and improvements19. The shared services agenda’s

influence and impact reaches beyond the immediate workforce involved in providing a

particular service. It impacts on the broader workforce particularly when that service is a

Workforce support service.

NHS Grampian has for some time provided payroll services for NHS Shetland and NHS

Orkney. Over 2015-16, the HR Service Centre has been working with colleagues from NHS

Tayside, to demonstrate how a collaborative approach for the delivery of Payroll, Car

Leasing, Expenses and Scottish Standard Time System (SSTS) services might be

delivered. A single management structure will be introduced, with the two Boards working

as a virtual team to improve processes and increase areas of best practice, whilst

continuing to deliver high quality local services for local people. NHS Highland have

17 NHS Scotland Values: Care and Compassion; Dignity and Respect; Openness, Honesty and Responsibility; and Quality and

Teamwork 18 West, M. 2012. Employee Engagement and NHS Performance. London: Kings Fund 19

The Scottish Government. ‘NHS Scotland Shared Services’ accessed online; http://www.qihub.scot.nhs.uk/quality-and-efficiency/shared-services.aspx




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recently joined this collaborative. Key to the success of this collaborative is sustainability of

services for the long term and protecting local jobs for local people.

With an effective Service Level Agreement (SLA) in place since 2012, NHS Grampian was

invited by NHS Orkney in 2015 to develop an integrated HR service. It was agreed by both

organisations, that this could also be an important proof of concept, demonstrating how two

HR services could integrate; ahead of the final roll-out of electronic Employee Services

System (eESS), which will assist the implementation of shared services.

NHS Grampian and NHS Shetland are collaborating in terms of an SLA for Payroll Services

and in relation to Public Health Services, with the Director of Public Health for NHS

Grampian taking responsibility for NHS Shetland. This presents an opportunity to identify

Public Health shared services across the boards and further connect acute care pathways

which impact on Island patients. Such support for care networks may provide learning for

future regional working.

There are other shared services initiatives emerging, particularly in Facilities and Estates,

where NHS Grampian is engaging in emerging regional solutions for laundry and linen,

sterile supplies, logistics, waste, and procurement.

Recruitment

The local economy and labour market within Grampian is primarily driven and influenced by

the oil and gas industry. The impact of this has been two-fold; attraction and retention of

common staff groups, particularly trades staff within Facilities and Estates and IT experts;

and through an increased cost of living and competition within the NHS that served to

detract medical, nursing and AHP professionals from relocating to Grampian.

Brent oil prices have fallen dramatically since 2014, and whilst there has been some

recovery over 2015 and 2016, the industry remains in a significant downturn period. It is

estimated that 375,00020 individuals are employed within the Scottish oil and gas industry,

with a significant proportion based within the North East of Scotland. With redundancies

and employee benefit cuts expected to continue as the industry strives for sustained

efficiencies, the labour market within the North East of Scotland remains significantly

unsettled. This seems to have improved recruitment to a variety of hard to fill roles, as the

ongoing downturn in oil and changing labour market has led to an increase in applications

in a number of roles: Healthcare Support Workers, Administrative, HR, Finance and IT.

Overall recruitment activity has continued to increase over the year and 2015/16 saw 2,248

vacancies being advertised, which attracted 50,237 applications. In comparison to 2014/15

figures (1,950 and 42,607 respectively), this equates to an increase of 15% in jobs

advertised and 18% increase in applications. The average of twenty-two applicants for each

20

Scottish Enterprise. 2016. Scottish Keyfacts. Edinburgh: Scottish Enterprise.


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vacancy is being maintained. Since 2012/13, the actual number of applications processed

has increased by 65%.

Despite the improving market, the difficulty of capturing the interest of suitable candidates

and filling posts remains challenging, particularly for nursing and midwifery posts and some

medical roles. In response, various initiatives have been put in place, including the

implementation of Return to Practice courses to enable people to return to various

specialties within Nursing and Midwifery, attendance at various careers fairs across the UK

and a presentation to the Consultant’s Sub Committee to raise awareness of the necessary

Medical Recruitment procedures.


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Step 3: Defining the Required Workforce 3.1 Data Cleansing Effective workforce planning should describe the required future workforce, based upon

drivers for change, utilising accurate and quality data on the existing workforce and

identifying key workforce trends. To maintain the quality of this data, NHS Grampian

continues to work with local managers and with Information Services Division (ISD), to

maintain a robust data cleansing process. An annual data cleansing process commenced

early December 2015 and was carried through to end of March 2016.

3.2 Projections

Workforce projections have been undertaken in each sector and are submitted to the Board

separately to this Plan to ensure appropriate governance. These projections have

influenced workforce planning with each sector and are published by Information Services

Division (ISD).

3.3 Future Workforce Demand

NHS Grampian has already made significant progress towards development of the future

workforce following analysis of service need and changing landscapes to develop new roles

and approaches. In recognition of changes to Corporate and Support Services, NHS

Grampian is undertaking proof of concept of shared services, developing services which

remove potential barriers to ensure flexible and efficient working.

To meet the future demand on health care services and ensure a service fit for purpose,

where heath and social care services fully integrated, there is a clinical focus on prevention,

supporting self management and a move to support people within their community or

locality. A changing focus of healthcare, with a stronger focus on support rather than

intervention, will change the role of staff within community settings. The emphasis on

hospital at home, for example, will mean that staff who have traditionally worked within the

Acute sector will work across traditional boundaries, working within localities to support

people in the Community. The emphasis for the Acute sector will be to provide more

specialist services as the tertiary centre for the North with a specialist workforce.

Increasingly, the workforce across NHS Grampian, including those working within the

HSCP’s, will need to operate within a digital environment, utilising innovative approaches,

including digital platforms to support self management, hospital at home and the delivery of

outpatient services. The aim is to reduce the number of return visits to hospital; provide

more diagnostic tests locally and provide advice directly to service users at home.

Through the workforce planning process each sector has highlighted the future demand for

their workforce, summarised below:


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Aberdeen City Health and Social Care Partnership

Aberdeen City Health and Social Care Partnership are responsible for planning and delivery

of adult health and social care services across the City. Social Workers, Community

Nurses, Allied Health Professionals, GPs and other colleagues from services in the health,

care, third, independent and housing sectors will be working more closely together to offer

an improved ’seamless’ service to individuals and their carers.

Aberdeen City HSCP aims to invest in Telecare and Telehealth solutions to give people

more control over the management of their health problems at home and reduce reliance

on traditional health services. The involvement of service users and carers in the planning

and delivery of community based health and social care services is seen as key and

consideration is also being given to locality based roles including Link Workers and Local

Area Co-ordinators.

Their plan is to develop fully integrated teams that will work across sectors and pathways to

ensure that individuals and their carers who use the services have more positive outcomes.

Strong collaborative relationships will be developed with the Acute sector so that mutual

challenges can be addressed and shared objectives fulfilled.

The key workforce considerations for this first year are highlighted below and are mirrored

in the other HSCPs in Aberdeenshire and Moray:

Recruitment and retention of staff, particularly the resources required for care and

support services for Adults living independently. As the population ages, the demand for

support for people to remain at home for as long as possible is increasing.

Investing in staff induction and training e.g. effective leadership skills, people

management skills, advanced skills training, particularly for staff who are not affiliated to

a professional body and are delivering care in the community, many of whom are

involved in new ways of working.

Change Management i.e. accepting the cultural differences of all partner organisations

and professions. Acknowledging that integrating different cultures will require an

understanding of roles and responsibilities and the support required in achieving this

awareness and acceptance.

Strengthening the links with all services that are hosted by and those that may move

into the Aberdeen City HSCP.

Engaging with staff at all levels, listening to them and involving them in decisions which

will affect them. Gathering knowledge of what is important to staff, listening to what goes

on at the front line, facilitating relationships that support collaborative working across all

organisations through existing and new forums such as staff surveys, team meetings,

appraisals and networking.


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Aberdeenshire Health and Social Care Partnership

By the year 2035, the number of people living in Aberdeenshire aged over 65 will have

increased by 65%. Health and social services in the area are not currently resourced,

organised and provided in ways that are likely to equal these challenges.

Recruitment and retention of staff is a major challenge; in some areas there are problems in

employing enough home carers, health assistants and GPs.

Health and Social Care Services in Aberdeenshire are primarily delivered through NHS

Grampian and Aberdeenshire Council in partnership with the third sector and independent

organisations. Although recruiting and retaining staff is a major challenge in some areas, as

noted above, the plan for the next 12 months will be to focus on maintaining a stable

workforce with limited change.

As integrated teams develop, workforce and organisational development plans will be

created, considered and approved by the IJB.

Some of the key considerations for this first year are:

Recruitment and retention of staff; particularly the resources required for care and

support services for Adults living independently. As with Aberdeen City, the demand

for support for independent living is increasing. Aberdeenshire will focus on: creative

recruitment solutions for specific workforce groups with higher than average rates of

turnover; developing and implementing robust recruitment processes; promoting the

benefits of working within the Aberdeenshire HSCP; and developing closer links with

schools, colleges and universities.

Remaining mindful of the Christie Commission Report: investing in staff induction

and training e.g. effective leadership skills, people management skills, advanced

training, particularly for staff who may not be affiliated to a professional body but are

a valued resource by delivering care in the community and becoming involved in

‘new ways of working’.

With support from colleagues in Learning and Development, create a workforce

which will deliver quality care; support all staff development needs, particularly those

working in specialist units, encouraging positive leadership and accountability.

Consider and implement a range of retention tools to help support, retain and

develop specific workforce groups, initiatives may include ‘grow our own schemes’,

offering existing staff career pathways for development; mentoring or buddy

schemes.

Change Management i.e. accepting the cultural differences of all partner

organisations and professions. Acknowledging that integrating different cultures will

require an understanding of roles and responsibilities and the support required in

achieving this awareness and acceptance. Involving Organisational Development


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colleagues in cultivating a collaborative workforce which will create equal and

reciprocal relationships between health and social care professionals.

Strengthening the links with all services that are hosted by and those that may move

into the Aberdeenshire HSCP e.g. Integrate Community Mental Health/Some Acute

Medical Services into Aberdeenshire HSCP (once approved by the IJB).

Engaging with staff at all levels, listening to them and involving them in decisions

which will affect them. Gathering knowledge of what is important to staff, listening to

what goes on at the front line and using this to influence working links across all

organisations e.g. Staff surveys, team meetings, appraisals and networking.

Moray Health & Social Care Partnership

The Moray Health and Social Care Partnership (MHSCP) comprises of an integrated

workforce delivering services to all adults (18+) in the Moray region. This includes existing

service user client group’s e.g. older people, learning disability, and mental health.

Moray, like many areas, faces major challenges in recruitment and retention of

appropriately skilled staff and there is a continuing need to train and develop skills as the

nature and demands of jobs change within integrated services. Staff are a valuable

resource and the changes required across health and social care will not happen without

them. Supporting informal carers and volunteers and ensuring a flexible, well-trained,

motivated and highly-valued workforce will be pivotal in the delivery of the Moray Strategic

Plan.

Services in Moray are primarily delivered through the NHS and Moray Council, in

partnership with communities and the voluntary and independent sectors. Over the coming

year, the plan is to retain a stable workforce with little change as the process of developing

integrated teams are initiated and Workforce and Organisational Development Plans are

updated, considered and approved by the IJB. Some of the key considerations for the

coming year are:

Focus on recruitment and retention particularly the supply of resources for highly

skilled specialist units and targeting the supply of specific workforce groups with

higher than average rates of turnover.

Induction and Training e.g. Leadership skills, People Management skills, additional

training particularly for staff who are not registered to a professional body and are

involved in delivering ‘The Reshaping Care for Older People’ programme. The aim of

the programme is transforming the culture and philosophy of care and ‘The

Community Care Redesign’ programme that will assist in meeting future demands on

services.

Cultivate a collaborative workforce: develop equal and reciprocal relationships

between health and social care professionals. Develop career pathways and provide

opportunities for staff motivated to advance in their chosen career.


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Change Management: Support culture change by developing a positive ethos and

working environment where needs and expectations are understood and responded

to by staff with different cultural backgrounds.

Strengthening the links with services that are hosted within or may move into the

Moray IJB e.g. Integrate Mental Health and Learning Disabilities services into the

MHSCP.

Feedback from staff surveys and the ongoing benefits of the already established

‘Employee Engagement Programme’. Achieve a National Health and Wellbeing

Outcome prescribed by Scottish Ministers i.e. Listen to the feedback from staff

surveys, respect the workforce and provide the support and trust needed to help

them achieve positive outcomes for their client group whilst feeling engaged with the

work they do.

Improve information sharing and develop easy access to service information across

Moray.

Acute

The Acute sector care model is one of consultant led clinical services, delivered through

multidisciplinary teams. It assumes continued development of community alternatives to

inpatient care, together with more rapid and direct access to diagnostic services.

The Acute model of care seeks draw a distinction between access to specialist opinion via

either an elective or unscheduled care referral, and the requirement for a patient to be

present to receive access to that opinion. Achieving the new model of care will require close

working with other sectors, improved workforce planning and a fundamental shift in mind

set. It will be facilitated via the use of technology e.g. the Clinical Guidance Intranet (CGI),

and innovative solutions to enhance electronic analysis and communication. Integration of

health and social care, working across primary and secondary care will impact upon the

workforce requirements. Some of the key considerations for the coming year are:

The continual refurbishment of the estate with particular developments within the

timescale of this Workforce Plan, including the continuation of the Phase 2

refurbishment; development of new theatre capacity; the Baird Project to build a new

Family Hospital and replace Aberdeen Maternity Hospital; and the Anchor Project to

extend the Cancer Centre will all have a direct impact upon the workforce plans and

roles required for the delivery of service.

Recruitment of many staff groups remains a challenge within the sector. Whilst many

of these are also national issues, including Oncologists, Interventional Radiologists

and Pain Consultants, others are affected by more locally based conditions. Active

recruitment is ongoing across professions and disciplines supported strategically

through Recruitment 20:20 and the Nurse Resources Group; including new

initiatives, such as the NHS Grampian “Return to Practice” nursing scheme. The

Acute sector continues to utilise block adverts, external advertising and recruitment


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initiatives, and engagement with the local Universities to improve recruitment and

reduce attrition rates. The need to continue to be inventive in recruitment endeavours

and share successes across all areas is recognised.

Ongoing skill mix redesign will continue across all teams, however some already

defined patterns will remain; with more band 3 administration staff, more band 3 or 4

Health Care Support Workers and more band 2 Housekeepers. The difference in this

workforce plan is the likelihood of recruitment, as the local labour market adjusts.

There will be a broad requirement for generic skills training in support of band 3 and

4 roles. These roles are developing across the Acute sector, from very specialist

areas like Laboratories and Intensive Care to general wards and out-patients. As an

organisation, NHS Grampian needs to support staff to move across different sectors

and services. Further work is required to develop a process supporting greater

flexibility in the workforce, through movement of staff to ensure effective utilisation

based on patient needs.

Although there has been an increase in the medical and nursing workforce over

recent years, the Acute sector will continue to engage with the development of and

utilisation of new roles to support service delivery i.e. Physician Associates,

Advanced Critical Care Practitioners, and Clinical Development Fellows. It is fully

recognised that new roles will need new competencies and the organisation will

need to be able to support staff in their training needs.

Mental Health and Learning Disabilities

The Mental Health and Learning Disability (MHLD) Services currently provide secondary

and tertiary care for the population of Grampian. Support is also provided to NHS Orkney

and NHS Shetland through the Obligate Network. In addition, the Specialism’s Directorate

hosts the Eden Unit, which is a North of Scotland facility for adults with Eating Disorders.

Grampian is served by a Learning Disability Service comprising an eighteen bedded in-

patient facility in Aberdeen (Elmwood), and five Community Learning Disability Teams

(CLDTs). The MHLD Workforce Plan defines the future workforce and the changes that are

required to ensure safe and sustainable service delivery. It covers all staff groups within in-

patient, out-patient and community based services, including the impact on non-NHS

services. Some of the key priorities the workforce plan covers are:

Continuing a whole service redesign, in partnership with staff and their

representatives, which will have a significant impact on the future workforce profile.

Work to revise referral criteria is complete and the emphasis has moved to the

MHLDS service pathway and the alignment of the Community Mental Health Teams

(CMHT’s) and Community Learning Disability Teams (CLDT’s). The impact of this is

un-quantified at this stage. The Child and Adolescent Mental Health Services

(CAMHS) are also undergoing review.


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Future developments around health and social care integration will impact on future

workforce demand. Current workforce planning is based on the current model and

projections, but this is expected to change significantly over the next year as the

MHLD redesign, and the integration agenda progresses.

MHLD have seen a significant reduction in the number of Career Grade medical staff

due to retirement and difficult to fill vacancies. Nationally, there are significant gaps

in the Higher Training programmes for doctors in training and locally, there are

substantially fewer doctors at all levels of training working with NHS Grampian.

There are plans to merge rotas but there is an urgent need to address the gaps in

training if Scotland is to secure a future Psychiatry workforce. Recruitment and

retention of career grade medical staff and doctors in training, is likely to require

further redesign for Nurse Practitioners, Physician Associates and Medical Support

Nurses.

Nursing workforce risks are generally related to vacancies, which are addressed

through extensive use of bank staff to staff wards to a safe level. The use of bank

staff ensures patient and staff safety, however, mental health care is provided largely

through effective relationship building and unfamiliar bank staff impact on this

therapeutic relationship and can increase the risks.

The recent appointment of twenty two HCSW and the anticipated appointment

of Robert Gordon University Stage 3 Students to band 5 registered Mental Health

Nurse posts will help create a more sustainable workforce. This will have a positive

impact on nursing vacancies and will lead to a significant reduction in bank use and,

more importantly, an increase in quality of care. More opportunities for advanced and

specialist practice will be available due to integrated services, service redesign and

changes to the mix of health and social care staff.

There are also ongoing difficulties with recruitment of MHLD AHP staff and in

particular, recruitment of AHP staff from outwith Grampian. Some redesign and skill

mix has been necessary to try to address these shortages. MHLD AHP Leads are

working with leads in other sectors with similar recruitment challenges, to identify

common solutions.

In response to consistent challenges in the recruitment and retention of Psychology

staff, MHLD are working in partnership with Primary Care colleagues, across the

three Grampian Integrated Joint Boards (IJB). MHLD have supported the bids for

Scottish Government money to redesign access to Psychological Therapies and

CAMHS Services to include Psychology Assistants, Clinical Associate Applied

Psychologist (CAAP’s), and Primary Care Mental Health Workers. These roles can

offer low intensity psychological therapies for mild to moderate psychological

disorders in Primary Care and should reduce the likelihood of patients developing

more complex and severe psychological disorders, and consequently, potentially

reduce the demand on secondary care.


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The skill mix over all other disciplines continues to be reviewed; including a reduction

in higher bandings and an increase in staff in lower bandings. Redesigned roles will

allow specialist staff to concentrate time on those patients who most need their skills

and expertise.

It is planned that the acute MHLD service will be hosted within one of the IJBs. Work

is ongoing to agree the budget. Several areas of financial review relating to service

redesign and property have been explored with a view to a number of financial

savings.

Corporate Services

Corporate Services are provided from across a number of Directorates: Workforce,

Finance, Corporate Communications and Board Secretariat, Modernisation and eHealth.

These services support clinical services and NHS Grampian as an organisation, to achieve

its strategic aims and ensure that Clinical, Staff, Financial and Information Governance

standards are maintained.

Corporate Workforce Planning is influenced by the needs and demands of stakeholders,

together with national and local strategic priorities. Some of the key considerations from

across Corporate Services in the coming year are:

In line with the Shared Services and Once for Scotland concept, workforce planning

and service demands are being reviewed. Consideration given to how boundaries to

providing services across current silo’s can be provided internally, and shared with

other NHS Boards through tests of concept of regional shared services.

Across services, new ways of working, review of skill mix, increased flexibility and

review of competencies are being taken forward to ensure capacity to respond to

increasing demands on services.

Improving opportunities for young people is a Government priority, with a stated aim

to increase the number of Modern Apprenticeships (MA’s). This will improve

succession planning, enable services to build career pathways and address

recruitment and retention difficulties. Modern Apprenticeship (MA’s) have been

established within a number of directorates, including Finance and Workforce.

Facilities and Estates

As a predominantly demand driven service, future projections in workload, and therefore

workforce, are determined by the level of clinical and other healthcare demands placed on

Facilities and Estates services. A key element in this demand is the delivery of the NHS

Grampian Vision21, supported by the Local Delivery Plan and the Property and Asset

21 NHS Grampian. 2014. Health and Care Framework, the NHS Grampian 2020 – A Possible Future. Aberdeen


27 | P a g e

Management Plan22. These are likely to lead to significant disinvestment in property and a

reduction in estate. Future changes in workforce within the Estates and Facilities Sector will

be mainly dependent on a variety of these factors.

In previous years, the Facilities and Estates Sector has been able to make significant

progress in service redesign aimed at increasing efficiency and effectiveness. The

Workforce Plan, covering the period 2016–2019, builds on existing work and provides a

renewed focus on workforce planning. Some of the key priorities being:

The Facilities and Estates Sector will seek to ensure that staff resources are fully

utilised at all times. Facilities staff frequently move between the various services,

including between NHS Grampian sites. This model drives integration and flexible

working within teams, the creation of generic roles to support service delivery, and

the opportunity to increase quality, performance and safety.

There are a number of changes to skill mix across the sector, most notably with the

creation of specific new roles to target risk, compliance and governance

arrangements. There is also a significant element of upskilling, skills transfer,

associated with development of new and changing roles. These changes will link

very closely to both Career Succession Planning and Service Redesign across the

Sector.

New ways of working have been indentified that seek to support the wider

programme of clinical redesign. This will ensure that services can be provided in a

different way, with minimal disruption to local health care needs. Skills transfer and

upskilling will enable a more efficient process, and options around both out-sourcing

and in-sourcing of specialist skills will be explored, investigated, and implemented

where appropriate.

Effective service redesign and workforce planning will equip the Facilities and

Estates Sector with an increased ability to respond to service need, to improve the

overall patient experience, and to meet mandatory and statutory requirements with

respect to property, environment and risk. In addition, there is also heightened

scrutiny around quality assurance of the physical built environment, hygiene and

cleanliness of the clinical environment to ensure the continual achievement of the

cleanliness standards, ensuring a safe environment for patients and staff.

Public Health

There are two overarching outcomes that set the vision for the whole public health system

aim for the population’s health:

Increased healthy life expectancy, taking account of the health quality, as well as the

length of life; and

22 NHS Grampian. 2014. Local Delivery Plan & Property and Assets Management Plan. Aberdeen


28 | P a g e

Reduced differences in life expectancy and healthy life expectancy between

communities, through greater targeted improvements in more disadvantaged

communities.

The Public Health Workforce Plan describes the support required by NHS Grampian to

become a public health organisation, which places the highest priority on improving and

protecting health, delivering best possible health care and reducing inequalities.

Public Health within NHS Grampian face local challenges in the delivery of the system wide

aims. Although the service has the lowest number of consultants in public health per head

of population in Scotland, it is anticipated that workforce numbers will need to be

maintained. The workforce continues to develop and change. Some of the key

considerations for workforce planning are:

With a heavy reliance on ear marked funding, which will no longer be earmarked for

health improvement areas, but replaced with a ‘super bundle’ for public health,

health improvement staff will require to take an innovate approach to financial

resourcing, in terms of recurring and non-recurring monies, to enable capacity to

address national and local priorities.

In the context of Health and Social Care Integration, the priority is to ensure that a

critical mass of public health expertise is available to drive the public health agenda,

across the public sector with potentially different structures.

With ongoing issues around capacity and recruitment, it is vital focus is maintained

on key work programmes. Public Health are committed to ensuring that there is a

workforce who are skilled and equipped to cope with delivery of these key work

programmes.

NHS Grampian and NHS Shetland are collaborating public health services with the

Director of Public Health for NHS Grampian taking over responsibility for NHS

Shetland. This presents new opportunities to develop services and work across

boundaries.

Dentistry

Dentistry provides oral health care as an integral part of an individual’s health. There is an

increasing awareness about oral health and an increased demand exists for conservative

treatments, including endodontics and dental implants, while dental extractions have taken

a backseat. As prevention is a priority, the workforce will be well equipped and able to cope

with the changing needs of the population.

The strengthening role of primary and community services may lead to an increase in

workload for General Dental Practitioners and Dentists with enhanced skills as well as

Dental Care Practitioners (DCPs). The General Dental Council (GDC) provided for patients


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to have direct access to Dental Hygienists and Therapists in prescribed circumstances, with

effect from May 2013. This means Dental Hygienists and Therapists are now permitted to

provide dental treatment within their scope of practice without a prescription from a Dentist.

These changes have the potential to enable clinicians to concentrate on more complex

clinical work and focus on the development of enhanced skills but will require the necessary

enabling legislation to allow the change in practice for hygienists and therapists. The

establishment of an Managed Clinical Network in Endodontics within Grampian is

responding to this need and will help to reduce waiting times within secondary care.

Recent changes in this specialty include targeted training and recruitment of primary care

practitioners into the North of Scotland, including the establishment of the Dental School in

2007, and the employment of overseas Dentists and those returning to practice.

There has been an increase in the number of Dentists originating from EEA member states

and from other overseas countries working in the North of Scotland. EEA policies on

freedom of movement coupled with overtraining in some European countries have

contributed to this trend.

There is, however, no longer a shortage of NHS Dentists in the area, although Grampian

has one of the lowest adult registration rates in Scotland.

Given the risk of an oversupply in the future, the Scottish Government continue to monitor

and reduce the annual student intake. The University of Aberdeen Dental School and

Hospital currently offer 20 places per year on the 4 year graduate entry BDS course.

Completion of this permits entry to the GDC Register. Following this, mandatory dental

foundation training (formerly known as vocational training) is needed for new UK graduates

wishing to work in NHS primary care. This training is a minimum of one year full-time and is

spent in primary care, providing NHS general dental services. Post-foundation training is

undertaken to develop basic skills and experience further, and (in some cases) prepare for

specialist training.

The PDS was created in January 2014 from the amalgamation of the Community Dental Service and the Salaried Dental Service. The key remit for the PDS is the provision of dentistry for the vulnerable population. The PDS provides a wide range of dental services which includes expert dental care for patients with:

1. Special care needs e.g. people with significant learning and physical disabilities,

significant mental health problems or with significant medically compromising

conditions.

2. Difficulties accessing ‘high street’ dental services e.g. Looked after children, frail

elderly housebound patients, migrants & homeless people and those with substance

misuse and dependency

3. Needs requiring behaviour management, sedation and general anaesthetic services.

4. Needs requiring referral for specialised and specialist services e.g. special care

dentistry, paediatric dentistry.


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In addition, the PDS has a role in dental public health and oral health improvement programmes, the provision of emergency and out of hours dental services, care for unregistered dental patients and education and training of the dental team. Given this very broad remit, the aspiration for the PDS in Grampian is for an equitable and responsive oral healthcare service with a focus on prevention, supported self-care and management and tackling oral health inequalities. Some of the key challenges for the PDS include:

The management of the oral health of an aging dentate population with complex

needs alongside a younger predominantly disease free population;

The increasing requirement for specialist workforce input but with very limited or no

capacity across the service in areas such as special care dentistry, paediatric

dentistry, general anaesthetic (GA) and sedation.

There is a need to support and invest in the PDS workforce to meet the current and future care needs of the Grampian population through:

Training and up-skilling of current staff and by;

Recruiting specialist staff in areas such as paediatric dentistry, special care dentistry

and sedation.

Secondary Care Dentistry The North of Scotland region has a variable Paediatric Dental Service across the 6 NHS board areas of Grampian, Highland, Tayside, Orkney, Shetland and Western Isles, with even more variable specialist or consultant input. There is no specialist input in Grampian and the island boards and NHS Highland have an interim arrangement buying 2 sessions of Paediatric Consultant cover every six weeks from Tayside. There is some paediatric service provision in the Public Dental Service across the boards, but this is variable and is not supervised by consultants nor has input from specialists. The role of the specialist paediatric dentist is to provide care as part of a multi-disciplinary team to a wide range of medically compromised children, children with learning or physical disabilities, those with inherited anomalies of the dentition and those with complex trauma liaising with colleagues in secondary care, primary care, social care, education and child protection as required. Paediatric specialists offer a full range of oral health care to anxious children who are unable to accept treatment under local anaesthesia and require additional behavioural management including conscious sedation and general anaesthesia. The current arrangements are not sustainable and are associated with some key risks in the management of children with conditions requiring specialist/consultant input. Efforts are ongoing through the Oral and Dental Health subgroup of NOSPG to develop a North of Scotland solution for specialist paediatric dental services across the North of Scotland (NoS). Depending on the outcome of this process, NHS Grampian will have to consider investing in specialist paediatric dentistry capacity either at a NoS level or at Board level.


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3.3.1 Specific highlights

The NHS Grampian 2020 Workforce vision recognises that going forward the workforce

needs to be:

“By 2020”:

NHS Grampian will employ a leaner, more flexible, multi-skilled, workforce, who will enable

and empower people to take responsibility for their own health, the workforce will be

organised in an integrated way, focussing on the needs of the individual rather than the

desires of the professional. Whilst managing growth and demand, healthcare professionals

will be more accessible to the public and to each other. There will be a sense of

responsibility across the organisation that will focus on:

Results & value for patients;

Enablement, anticipation & rehabilitation;

Safety & Quality; and

Those who need it most.”23

The 2016 Workforce Plan continues to support this vision, but amended to reflect the

national and local clinical strategies. An example of this is the development and growth of

new roles such as Physician Associate and Clinical Development Fellows and the

expansion of existing roles such as Advanced Practitioners and the extension of these to

new areas outlined in section 3.4.

It is not possible within this Workforce Plan to represent all the ways in which the workforce

is being developed across the organisation. Whilst the individual sections above provide a

summary of the priorities of the sectors and services, the following section provides

examples of the different ways in which individuals, teams and projects have changed how

they work together to provide efficient and effective services.

Recruitment 20:20

In light of the continuing recruitment challenges, workstreams under Recruitment 2020

continues to be a priority. NHS Grampian attendance at medical and non medical

recruitment events continues. In February 2016, NHS Grampian took the opportunity to

participate in a week long Community Road Show event in the Bon Accord Centre,

Aberdeen. This opportunity was used to produce a film to showcase the work of Health

Care Support Workers and attract suitable applicants. This event attracted 179 applications,

the vast majority of which were of a high calibre and suitable for appointment. Teams within

the Workforce Directorate continue to work with Nursing and Midwifery, and AHP senior

managers to progress a number of initiatives to attract staff to NHS Grampian.

23 NHS Grampian. 2013. “Workforce 2020”. NHS Grampian: Aberdeen


32 | P a g e

Through the Return to Practice programme nurses and midwives with lapsed registration

are able to undertake education and clinical placement to regain their professional

registration with the Nursing and Midwifery Council, whilst working for NHS Grampian. A

total of thirty-eight nurses have been employed and the programme continues to run three

times per year as demand necessitates, and in response to continuing recruitment

challenges.

Medical Workforce Planning for Secondary Care

Recruitment of medical staff continues to be challenging in a number of specialties. A

separate Secondary Care Medical Workforce Plan has been produced, in support of this

more generic Plan to proactively support improved planning of the medical workforce,

necessary to maintain vital services in the North East of Scotland.

The Secondary Care Medical Workforce Plan Volume 1, provides workforce profiles,

highlights risks and makes recommendations for the future direction of travel for the

medical workforce in a number of secondary care specialties within both the Acute Sector

and Mental Health and Learning Disabilities.

This Secondary Care Medical Workforce Plan 2015/16 included a comprehensive

workforce profile, provided baseline quantitative detail on the medical workforce employed

in Secondary Care and qualitative information obtained from primary research by visiting

individual specialities. The Volume 1 plan did not include all specialties within the Acute

Sector; the 2016/17, Volume 2, Secondary Care medical will be completed during autumn

2016.

There have been a number of themes which have been recurrent throughout Volume 1.

Consistently, services aim to ensure that the medical workforce have the relevant

competencies capability and capacity necessary to meet the current and future service

demand. Delivery of care and treatment in a patient centred, safe and effective way, with

flexible and responsive staff, working in multi-disciplinary teams, appropriately skilled to

meet the future demands is a consistent theme for all services.

This is a time of uncertainty and opportunity for specialties around redesign of services,

meeting efficiency targets and responding to the impact of integration of Health and Social

Care. Most services recognise the need to deliver a different 24/7 service, with increased

Consultant presence during peak activity periods, supported by a robust governance

framework that delivers improved safety and quality of care. This is likely to require service

re-design with extended hours and a different working pattern for Consultants.

A shift towards more day case care will also change the pattern of care. A blended,

integrated workforce that shifts seamlessly between community and acute environments is

the future norm for many specialities within this plan. In addition, there is a need for national


33 | P a g e

and regional networks to support local delivery and maintain specialist skills and expertise.

There will be a continual increase in demand for services due to an increasing elderly

population. The skill mix has to be appropriate for the demand.

The recruitment into Consultant, Specialty Doctor and Doctors in Training posts remains

crucial to enable continuation of service delivery. The age profile is of particular concern

especially in: Dr Grays; General Adult Psychiatry; Forensic Psychiatry and Old Age

Psychiatry. These are all areas where NHS Grampian finds replacement of senior doctors

challenging. Improving the attractiveness of posts in Grampian and developing appropriate

support roles, including development of a career framework for Doctors following non-

traditional career pathway and the development of Medical Support workers will be key to

future sustainability of services.

Job Planning

Improved Job Planning has been a key priority for NHS Grampian since 2012. Health

Improvement Scotland (HIS) also highlighted this requirement in its 2014 Report: ‘NHS

Grampian should develop and implement a robust medical workforce plan’24.

All Consultants and Specialty Doctors should have an agreed job plan and this should be

reviewed annually. Job planning is a key mechanism through which objectives are agreed,

monitored and delivered and therefore contribute significantly to the achievement of NHS

Grampians objectives.

In response to this, work was undertaken to review internal processes to ensure that the job

planning process is as paper light and efficient as possible, without availability of a

dedicated electronic system to capture job planning information directly. This significantly

contributed to the highest return of Job Plans within NHS Grampian for April 2015. A

decline in the completed Job Plans for 2016 has emphasised the need for continued

support. To ensure return rates and the quality of job plan completion continues an options

appraisal exercise for an electronic system is currently being undertaken.

Medical Leadership Framework

Clinical leadership, and within that context medical leadership, is fundamentally important to

delivery of safe, effective and person centred services. Engagement of all doctors in the

future of their services, within the overall NHS Grampian framework is a priority for the

Board and is recognised as a priority for NHS Grampian. In 2015, a principle based,

Medical Leadership Framework was developed with stakeholders, that sought to increase

the number of medical leaders in the Acute and Mental Health and Learning Disability

Sectors; refining the required roles and reward those leaders in line with performance

management approaches used for other senior leaders in the Board. This is being rolled out

from April 2016. The principles were also commended to the IJBs.

24

(2014) “ Aberdeen Royal Infirmary: Short-Life Review of Quality and Safety”. Healthcare Improvement Scotland, Edinburgh:


34 | P a g e

Medical Education

Attracting medical students and doctors in training to NHS Grampian not only ensures

stability of rota’s for doctors in training, with a reduction in gaps; it ensures stability of

training and improves the experience across this workforce. Longer term, those who have

had positive training and education experiences, within NHS Grampian, are more likely to

be retained as Career Grade medical staff, supporting the maintenance of a capable and

sustainable senior medical workforce, addressing recruitment issues at these grades.

To support medical education, the Medical and Dental Education Governance Group

(MDEGG) has been established as a sub-group of the Staff Governance Committee. This

group is responsible for the development of the medical and dental education governance

priorities for NHS Grampian and assure the quality of education provided. This will include

the development of a medical and dental education strategy for Grampian to include

mandatory and statutory learning for established staff and ensure that as a Local Education

Provider (LEP), NHS Grampian has the appropriate workforce and resource to provide

educational governance.

The General Medical Council (GMC) survey Doctors in Training each year and completion

is mandatory. The results are used to inform the Board of the educational profile of

departments within NHS Grampian and identify priorities for action. MDEGG will ensure that

there is Board level oversight of the survey result and actions.

MDEGG will also interpret and provide strategic guidance in relation to national professional

and workforce developments e.g. Shape of Training4. Working collaboratively with regional

and national partners, NHS Education for Scotland (NES) and key education partners, such

as Aberdeen University, MDEGG will foster an integrated approach to medical education

governance.

To support medical education within each division and sector, Associate Medical Directors

(aDME) have recently been appointed, with one aligned to each of the following divisions:

Medicine and Unscheduled Care, Surgery, Women and Children, Clinical Support Services

and Dr Grays Hospital. Appointments are also expected for Mental Health and Primary

Care in the near future. The aDME's will support the Directors of Medical Education and

have become part of the Workforce Directorate Medical Education Team.

The inaugural NHS Grampian Medical Education Conference held in November 2015 was a

success and plans are underway for another conference to take place on the 18 November

2016.


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The General Medical Council (GMC) standards for the delivery of Medical Education

“Promoting Excellence”25 were released in January 2016. The Medical Education Team

have created a quality group which meets weekly with the aim to implement the new

standards in partnership with colleagues from Aberdeen University and NHS Education for

Scotland (NES), and gather evidence prior to the GMC visit.

NHS Grampian is actively supporting those who provide the training and development of

doctors in training through the Grampian Learning Initiative for Trainers (GLINT). GLINT is

a joint initiative with Aberdeen University, launched as a pilot project in July 2015. The aim

of GLINT is to introduce and establish peer facilitated learning in NHS Grampian. Modules

have been developed on educationally themed topics which enable participants to gain

educational knowledge and skills, as well as show evidence of engagement in educational

activity for GMC recognition of trainers.

To date six modules have been developed, on topics such as “Feedback” and “Learning in

the Workplace” with further topics planned for the coming months. At the launch, three

participant groups were established, aimed at developing supportive networks of educators

across the organisation. GLINT was promoted at the NHS Grampian conference in

November 2015 and through this and word of mouth, four more groups have since been

established. Further promotion of GLINT will take place in an ongoing basis.

eRostering

NHS Grampian identified existing doctor in training rostering practices were outdated, time

consuming and lacked robust governance. These impact on the ability of wards and

departments to provide optimum medical cover to care for patients, and the ability to

provide the best possible training experience and work life balance for staff.

NHS Grampian was approached by the Scottish Government and asked to pilot an

electronic rostering system for doctors in training, Doctors Rostering System (DRS)

RealTime. DRS RealTime is a ‘tool’ to support senior medical staff when building and

managing rosters and to provide current rostering information to doctors in training.

DRS RealTime is currently in pilot phase, however, the outcome of the pilot work to date

indicates it will be of benefit to both doctors in training, as well as to the senior clinicians

who are building and managing the rosters.

Some benefits associated with DRS RealTime are:

• Clear, understandable and accountable rosters;

• Having the right staff, in the right place at the right time; and

• Having rosters built and managed which are Working Time Regulations and New

Deal compliant.

25

General Medical Council. 2016. ‘Promoting Excellence: Standards for Medical Education and Training’. General Medical Council:

Edinburgh.


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Currently DRS RealTime is being utilised with the Emergency Department, Acute Medical

Initial Assessment and Anaesthetics, with a full roll out plan currently out for consultation.

Professionalism Compliance Analysis Tool (PCAT)

NHS Grampian is piloting the use of PCAT on a Board level. The tool analyses rotas in

terms of their ability to foster patient-centred care, high quality of training and trainee

wellbeing.

At Board level, the principles of PCAT underpin the Rota Quality Improvement Database

and the High Risk Rota register; which are soon to be available for relevant stakeholders to

view on the intranet. The accessibility of such databases will allow decision makers to

formulate workforce plans in holistic approach, resulting in higher quality rotas and

significant savings in locums and Band 3 financial penalties.

At a departmental level, PCAT was used in Emergency Medicine, General Surgery,

Vascular Surgery, Paediatric Surgery and Anaesthesia. The tool empowered trainees’

engagement in the process of improvement and quantified challenges faced by junior

doctors across the Acute sector objectively and comprehensively.

The PCAT work has resulted in Pan-Surgical approach to Rota challenges and united

Clinical Leads and Management in identifying tangible solutions that include healthier rota

designs and diversifying workforce to fill rota gaps creatively when trainee doctors are not

available.

Bank Review

Under the strategic direction of Nursing Resources Group (NRG), an external review of the

bank nursing arrangements within NHS Grampian was undertaken from August 2015. This

review recognised the pivotal role a nurse bank has on resourcing workforce requirements.

It highlighted that to ensure efficiency and effectiveness; issues in relation to demand and

supply need to be addressed. NHS Grampian has four main nurse banks in operation, with

a number of ‘local banks’ in operation leading to inconsistency in process. The review

recognised the need to improve the governance of the current approach and the need for

services to consider wider organisational requirements and cross cover between

Departments, Divisions and Sectors.

The review made nine recommendations all of which were accepted by NRG. These

recommendations set out the need to move to a single Nurse Bank; with greater integration

with Corporate Services and all request arrangements being coordinated through one Bank.

The need to maintain local knowledge and relationships was recognised; but the need to

achieve higher performance, governance, consistency and standardisation was also

highlighted. In the interests of ensuring efficiency and effectiveness, services should

consider when additional hours and/or overtime are more cost effective alternatives to using


37 | P a g e

bank staff, as well as increasing the number of substantive posts, as an alternative to long

term bank positions. The recommendations also highlight the ongoing need for work on

rostering shift patterns; a review of funded establishments which includes budget and skill

mix; and the use of workload tools to develop a robust workforce plan.

Nursing and Midwifery Workload and Workforce Tools

NHS Grampian continues to use all 12 Nursing and Midwifery National Workload and

Workforce Tools (NMWWT).

NHS Grampian is currently following the national guidance when applying these tools,

which aligns with the Healthcare Quality Strategy for NHS Scotland. It aims to build upon

quality healthcare services ensuring all work is integrated and allied to the quality ambitions

resulting in measurable improvements within the local workforce. Section 4.3 provides a full

update on the use of these tools within NHS Grampian to support staffing for quality

services.

Primary Care Workforce Planning

General Practice (GP) workforce challenges for NHS Grampian have been well

documented since publication of the NHS Grampian 2013 General Practice Workforce

Survey26. In response to these challenges, a NHS Grampian General Practice Workforce

Action Plan27 was created with stakeholders and has now undergone a fifth iteration. This

plan supports the recruitment, development and retention of the GP workforce; it is

supported by the Primary Care Education, Training and Workforce Sub-Group.

This Group’s remit is to bring together organisations that have an interest and remit in

education, training and workforce management in Primary Care to address key workforce,

training and education issues, and make recommendations to the Primary Care Integrated

Management Group (PCIMG). Initially there has been a focus on the findings of the 2013

Survey26 and implementing the Action Plan.

The group is chaired by the local Training Programme Director for General Practice, who

also has one session a week working for the Workforce Directorate to support recruitment

and retention of the General Practice workforce.

This group has worked to promote and market General Practice in Grampian and explored,

via education and training, the multi-disciplinary workforce that can support General

Practice into the future.

The work to promote Grampian as a good place for GPs to live and work has included the

development of web based blog, which includes current vacancies. The team have also

26

NHS Grampian. 2013. General Practice Workforce Survey. NHS Grampian: Aberdeen. 27

NHS Grampian “Grampian General Practice Action Plan”. NHS Grampian: Aberdeen.


38 | P a g e

created and maintain a Facebook page; posting regular vacancy information and articles for

followers to view. The popularity and engagement with the Facebook page continues to

grow.

The Facebook page can be found by searching GP Jobs Grampian on Facebook. The

Blogspot is accessible via: http://gpjobsgrampian.blogspot.co.uk/?m=1

The Virtual Community Ward

The Virtual Community Ward (VCW) concept aims to improve care at home and reduce

avoidable admissions, particularly of elderly patients. A multi-disciplinary team of doctors,

carers, care managers, district nurses and AHPs hold a virtual ward round every morning to

share information and make collaborative decisions about the needs of patients that day.

The initial VCW, which was based within a practice in Elgin has proven successful and the

concept is now being spread across Health and Social Care Partnerships in Grampian. The

success of VCW model has required dedicated medical, caring and nursing resource,

utilising their skills and working in a new way based within a community setting.

No Delays

To aid self management of conditions, support care within the community and prevent

unnecessary scheduled and unscheduled care visits, the No Delays digital platform was

developed by NHS Grampian. It supports patients to manage their long term condition(s),

use medication effectively, or prepare for appointments or treatment.

The platform holds video clips and other resources developed by local clinical teams. The

video clips are ‘prescribed’ to patients by their health care professional, as a digital

postcard, via a secure email link. On receiving a digital postcard, the patient can view the

content as often as they wish and share it with family and carers, if they choose. The

platform currently holds content developed by eleven different teams, including footage to

support patients with type 2 diabetes, chronic obstructive pulmonary disease (COPD) and

heart failure.

The No Delays team works with clinical teams to understand the various contact points and

exchanges of information that occur along the patient pathway. This allows the clinical team

to identify opportunities to change the way they work with patients and digitise elements of

the care pathway. The team then create video content and if appropriate, patients are

invited to participate and share their story.

The majority of the content on No Delays has been created in Grampian but clinical teams

from other NHS Boards and indeed other parts of the world have expressed an interest in

developing their own No Delays resources.

http://gpjobsgrampian.blogspot.co.uk/?m=1


39 | P a g e

No delays supports the self management of conditions and care in the community, this in

turn reduces unnecessary planned care appointments and interventions, and consequently

reduce unscheduled care needs. Through this work, NHS Grampian’s workforce has

developed to enable them to work differently, utilising technology to meet patient needs

effectively and efficiently.

3.4 New roles Physician Associates

The Physician Associates workforce continues to grow and is extending to more specialties

across NHS Grampian. There are 18, headcount, and 17.9 wte Physician Associates (PA)

employed across primary and secondary care within Grampian.

This role has been recognised in many Sector Workforce Action Plans as having potential

to provide valuable support alongside doctors in training.

The University of Aberdeen Course has just advertised for its 6th cohort of Physician

Associates, and across the UK there are at least ten PA courses recruiting, or about to

recruit students with another 5-10 courses anticipated.

Clinical Development Fellows

A new role of Clinical Development Fellow (CDF) has been identified and developed as a

solution to the ongoing risk associated with unfilled posts, resulting in non-resilient junior

doctor rotas. The aim of the role is to ensure high quality, safe and patient-centred care is

maintained; improve the resilience of doctors in training rotas’ to ensure high quality

training; and support the recruitment and retention of high quality doctors in training.

The development package agreed with the University of Aberdeen, at no additional cost,

highlights excellent cross working between organisations to support the medical workforce

development in Grampian. The development aspect of the CDF year will support

incumbents to engage positively with local service issues turning them into quality

improvement projects. This will add value to services beyond the initial benefit of ensuring

resilient rotas. There has been interest from several departments in hosting CDF’s, and 9

have been appointed to date. It is hoped that a second round of recruitment for CDF posts

will attract further applicants.

Advanced Practitioners

Advanced Practitioner roles within the nursing and AHPs have existed for some time. Work

is ongoing in NHS Grampian to extend these further within a wide range of specialisms.

These roles ensure NHS Grampian can meet the changing service demands, as

professionals work to the top of their licence within a specialised area; and are supported


40 | P a g e

through appropriate training and development. An example of such a role is the Advanced

Critical Care Practitioner (ACCP) within Intensive Care Unit, which was initially created in

response to an expected reduction in Foundation Year 2 doctors.

Within ICU, this role has proven very successful and has enabled development of robust

standardised protocols and procedures, to ensure that the ACCP’s practice safely. Due to

an anticipated reduction Higher Specialist Trainees in ICU projected for autumn 2016, and

the increase in the role and remit of the ACCPs, discussions are ongoing to further expand

the team. This would ensure resilience within this small specialist workforce.

Different AHP professions have progressed with Advanced Practitioner roles in a number of

areas. Currently, there is a Consultant Occupational Therapist within Stroke Services,

leading on a number of Grampian wide projects. One particular achievement is a significant

reduction in length of stay for some stroke patients, through the use of goal setting in

discharge planning.

Within ENT, an Advanced Practice Speech and Language Therapist is responsible for the

operation of the Throat Therapy Clinic, using nassendoscopy and biofeedback. This has

supported an improvement in Head and Neck Cancer waiting times by freeing up

appointments within the cancer clinics; and has assisted in reducing the waiting times for

patients from referral by the GP to point of contact for treatment.

AHPs possess a range and diversity of skills and knowledge, which position them well to

develop further Advanced Practitioner Roles, supporting the delivery of some services

traditionally provided by medical staff. The further development of these roles faces

challenges such as the availability of resources and sourcing appropriate training to

underpin these roles as new models of care.

Health Care Support Workers

Partly due to vacancy levels, the number of band 2 to 4 nursing vacancies has decreased

by 20% between 2015 and 2016, however, the development of band 4 roles continues.

Whilst there are existing education pathways for development, professional development

for specific services and sectors requires to be further developed. The professional lead for

HCSW is reinvigorating the role, recognising the support and empowerment required by

services to develop these roles.

Partnership links with Further Education Colleges have been strengthened through the

provision of work experience placements for students undertaking the Health and Social

Care Certificate programme of study within North East Scotland College (NESCOL). Fifteen

students attended for one day per week, over a six month period. The work experience

placement students were mentored by more experienced HCSWs, who were provided with

additional training to support them in this role.


41 | P a g e

A new band 4 ‘Associate Practice Educator’ role has been developed and will be piloted as

a one year secondment during 2016. The primary function of the role is to support the

education and the development of HCSWs in clinical settings. Services are being supported

to further develop and maximise HCSW roles, with support from NES. Band 4 roles and

professional career pathways developed within Theatres and ITU.

The career pathway for HCSWs has been expanded, through funding provided by the

Scottish Government to enable three HCSWs to register for the Adult Nursing and Mental

Health Nursing degree programme in September 2016 with the Open University. This is a

pilot project to test the feasibility of this distance learning route to Nursing within NHS

Grampian.

NHS Grampian continues to work in partnership with Moray College, NESCOL and Robert

Gordon University to provide HCSWs with a route to become Registered Nurses, via the

HNC Care in Administrative Practice programme. Applications for the HNC were higher this

year with thirty-seven HCSWs submitting an application. NHS Grampian will also offer up to

five Modern Apprentices (MA) for young people in Nursing, Midwifery and Allied Health

Professions during 2016, with Moray College as the provider.

The induction programme for newly recruited HCSWs has been redesigned, with a three

day programme provided through the Professional and Practice Development Unit. The

programme will continue to be evaluated during 2016.

NHS Grampian participated in a week long community road show event, which resulted in

one hundred and forty-five out of one hundred and seventy-nine applicants being

interviewed for HCSW roles. In addition, Mental Health Services undertook a large

recruitment initiative, which resulted in twenty-two additional appointments to band 2 HCSW

posts.

To meet growing demand on laboratory services specialist healthcare support workers

band three and four roles have been developed for all sub-specialist areas. This has

ensured demand is met whilst maintaining qualified staff require as a regulated services

and regulated.

Modern Apprenticeships

For many years, NHS Grampian has employed Modern Apprentices (MA) within Estates

trades, with an annual intake of one Mechanical and one Electrical MA. This will continue in

2016. The range of MA Frameworks now available in Scotland means that these roles are

suitable to support the learning of new recruits in a wide range of service areas and is being

utilised within NHS Grampian to recruit and develop the workforce, in line with a national

drive to develop MA’s within the NHS in Scotland.


42 | P a g e

An MA in Accounting and one in Business Administration are being appointed to during

Summer 2016 and as stated above, the HCSW MA framework is also being offered, which

can be clinical or non-clinical based. This new pathway is being currently being considered

across NHS Grampian.


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Step 4: Workforce Capacity and Capability

4.1 Current Workforce

This section of the Workforce Plan provides a summary of data with comparisons to

previous years information whilst providing analysis which informs all aspects of workforce

risk assessment and action planning28. Detailed workforce information is provided in

Appendix 2

Current Workforce Highlights

Staff in Post

NHS Grampian employed 11,967.8 whole time equivalent (wte) staff and a headcount of

14,442 as at 31 March 2016, which is shown below broken down into job families. Across

the entire workforce there has been an increase of 147.8 wte staff from 31 March 2015, as

a result of improved recruitment and the increase in full-time working, as indicated in table

2.

Table 1: NHS Grampian wte and % Split by Job Family 31st March 2016

Whole/Part Time Working

28 The workforce figures throughout this section do not include Honorary Contracts or GP’s with clinical lead roles.

Administrative Services, 1825.0,

15%

Allied Health Profession, 919.6, 8%

Dental Support, 186.5, 2%

Healthcare Sciences, 425.4, 3%

Medical and Dental, 1285.4, 11%

Medical Support, 49.6, 0%

Other Therapeutic, 317.6, 3%

Personal and Social Care, 78.1, 1%

Senior Managers, 42.3, 0%

Support Services, 1627.1, 14% Nursing / Midwifery,

5211.2, 43%


44 | P a g e

Over the previous 4 years, there has been a shift from whole time towards more part-time

working across the Grampian workforce, although more staff still work whole time (62.9%),

which is only slightly reduced from last year’s 63% whole time staff.

The chart below shows the split between whole and part-time by job family. Support

Services continues to be the only job family with a higher ratio of part-time to whole time.

Table 2: Split between Whole-Time and Part-Time by Job Family 31 March 2016

Age and Gender Profiles

Understanding the workforce age profile is required to ensure appropriate and considered

succession planning, and prevent a void in knowledge and or experience within any

profession. It is also be recognised that there are increasing numbers of individuals who are

choosing to work beyond State Pension Age (SPA) and many are having to work longer

than planned to assure their income in retirement, particularly in light of recent changes to

SPA” 29. NHS Grampian needs to consider the employment needs of older people to ensure

a sustainable and capable workforce.

The chart below shows the age profile of NHS Grampian workforce. The three largest

clinical job families have been plotted relative to each other along with the overall

population represented by the dotted line. Nursing and Midwifery, as the largest group

within NHS Grampian, is influencing the overall age profile and highlights a drop in the

number of younger people following behind the soon to retire baby boomer group, (50 and

over).

29

2016. http://www.ilcuk.org.uk/images/uploads/publication-pdfs/The_missing_millions_web.pdf

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

ADMIN SERVICES

Allied Health

Profession

Dental Support

Healthcare Sciences

Medical and Dental

(inc Trainees)

Medical Support

Nursing / Midwifery

Other Therapeuti

c

Personal and Social

Care

Senior Managers

Support Services

Total

% Part-Time 34.7% 41.6% 38.3% 21.0% 14.6% 17.4% 39.7% 30.1% 34.7% 5.3% 53.9% 37.1%

% Whole-Time 65.3% 58.4% 61.7% 79.0% 85.4% 82.6% 60.3% 69.9% 65.3% 94.7% 46.1% 62.9%

53.9%

37.1%

65.3%

58.4% 61.7%

79.0% 85.4%

82.6%

60.3%

69.9% 65.3%

94.7%

62.9%

% Part-Time % Whole-Time


45 | P a g e

Table 3: NHS Grampian Age Profile by Three Main Clinical Job Families 31 March 2016

Gender

This gender profile has varied by less that 1% in the last 5 years and indicates that the

organisation will continue to be predominantly female.

NHS Grampian’s workforce is

predominantly female (83%). The chart on

the left shows this in pictorial form.

Sickness Absence

NHS Grampian’s sickness absence rate has fluctuated throughout 2015/16 between 4.06%

and 5.14%. NHS Grampians sickness absence levels are still consistently below the

average for NHS Scotland. Throughout the year the absence rates reflect a pattern, as

seen in previous years, with lower absence in summer and higher in winter. NHS

Grampian’s long term absence is consistently below all other territorial Boards in Scotland.

This reflects the work by managers, HR and Grampian Occupational Health Services to

support staff back to work using appropriate adjustments, where required.

01 thru 19 20 thru 24 25 thru 29 30 thru 34 35 thru 39 40 thru 44 45 thru 49 50 thru 54 55 thru 59 60+

1.00%

6.00%

11.00%

16.00%

21.00%

Overall Staffing Medical and Dental (inc Trainees)

Allied Health Profession Nursing / Midwifery

Male 17%

Female 83%

Table 4: NHS Grampian Gender Split


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Table 5: NHS Grampian Sickness Absence Rates, Monthly ISD, April 2016 - March 2016

In comparison with other boards within the north region, the year ending annualised figures

are as follows: Highland 5.09%, Orkney 5.10%, Tayside 5.04%, Western Isles 5.93%, and

Shetland 5.20%. Compared with Grampian at 4.62%, shows a good performance compared

with the Scottish average, and also at regional level. The Scottish average for 2015-16 was

5.16%.

A study to improve sickness absence levels is currently underway, the NHS Grampian+

Attendance Management, Short Life Working Group (SLWG) is about to survey managers

in order to better understand the management and recording of sickness absence.

Job Planning

The contractual arrangements for Consultant Medical Staff and for Specialty Doctors

require these staff have an agreed job plan, which describes all of their professional and

service commitments.

Table 6: Job Planning Completion as at 31 April 2016

Year Consultants Honorary

Consultant

Job Plans

Submitted

% Job plans

Submitted

2014/15 485 49 450 84.3%

2015/16 521 54 362 63.4%

There has been a decline in Consultant submissions from last year from 84.3% returned in

2015 to 63.4% returned in 2016.

2.48% 2.58% 2.43%

2.26% 2.20% 2.47%

2.62% 2.54% 2.68%

3.11% 2.86% 2.86%

1.92% 2.00% 1.83% 1.94% 1.86% 1.84% 1.91% 1.91%

2.21% 2.03% 2.13%

1.95%

4.40% 4.58% 4.26% 4.20%

4.06% 4.31%

4.53% 4.45% 4.89%

5.14% 4.98%

4.81%

4.78% 4.86% 4.78% 4.88% 4.81% 4.95%

5.17% 5.24% 5.42%

5.70% 5.31% 5.33%

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

short-term long-term Total National HEAT Target Scotland

Short-Term = 28 days or less Long-Term = greater than 28 days ISD = Information Services Division

Scotland

NHS Grampian

HEAT Target 4%


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In 2016, 22.9% of Associate Specialist and Specialty Doctors job plans were submitted; this

represents an improvement of 7.9% from last year.

Understanding Workforce Availability and Supply

Grampian continues to have one of the highest employment rates in the country at 77.0%,

despite the recent downturn in the oil market. Scotland, as a whole, averages at 73.1%30.

Moray has suffered from a downturn in employment rates over the last 3 years from 78.7%

down to 73.3%, now mirroring the Scottish average.

Table 7: Employment Rates 2004 - 2015

Unemployment rates31 over the past year have decreased slightly over Scotland. However,

Aberdeen City has seen an increase in unemployment rates, with the downturn in the oil

and gas industry having had a significant impact upon these figures. Unemployment rates

within Aberdeen City, in particular, have increased by 1.10% over this period.

The longer term view, from a low of 2008 (Table 8) is showing that the north-east of

Scotland unemployment figures fluctuate in line with the fortunes of the Oil & Gas market.

30

2015. ‘Economy and Labour Markets in Scotland; Statistics from the Annual Population Survey ‘ 31

2015. ‘Economy and Labour Markets in Scotland; Statistics from the Annual Population Survey’

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Scotland 72.6% 73.0% 73.7% 73.9% 73.6% 72.0% 71.0% 70.5% 70.5% 70.8% 72.6% 73.1%

Aberdeen City 74.3% 77.2% 79.7% 77.7% 77.9% 78.3% 78.4% 75.0% 77.0% 76.3% 76.0% 77.1%

Aberdeenshire 77.7% 78.3% 79.5% 80.5% 80.2% 80.4% 81.1% 79.5% 80.0% 78.7% 80.9% 80.5%

Moray 75.7% 75.0% 76.7% 78.0% 79.6% 77.8% 79.9% 78.5% 77.6% 78.7% 77.1% 73.3%

Grampian 75.9% 76.8% 78.6% 78.7% 79.2% 78.8% 79.8% 77.7% 78.2% 77.9% 78.0% 77.0%

64.0%

66.0%

68.0%

70.0%

72.0%

74.0%

76.0%

78.0%

80.0%

82.0%


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Table 8: Unemployment Rates

Equality and Diversity

The ethnic makeup of the NHS Grampian Workforce, as at July 2015, is shown in Appendix

2. The ethnic makeup of the NHS Grampian workforce is less ethnically diverse (2%) than

the wider population of Grampian (4%). Those that preferred not to declare ethnicity

accounted for 30% of NHS Grampian workforce.

Risk and Issues

Analysis of the workforce profiles within the national and local context of NHS Grampian

indentifies a number of risks to a sustainable and capable workforce.

Ageing Workforce

33.1% of the Nursing workforce are aged over 50; 38.5% of Healthcare Scientists are aged

over 50; 25% of Administration Services staff are aged over 55 and within Support Services

32% of the workforce are aged over 55. With a high percentage of over 50’s across a

number of job families and the increase of the Scottish Public Pensions Agency (SPPA)

retirement age, in line with state pension age, there is a requirement for NHS Grampian to

continue closely monitor the age profile.

To ensure a sustainable workforce, NHS Grampian must support professions such as

Nursing to stay in the workforce longer than was historically required. Return to Practice

programmes and the strengthened links with Robert Gordon University to support the

recruitment of Nursing staff has the potential to mitigate some anticipated gaps in workforce

capacity and experience when staff choose to retire.

Given the identified risk of an ageing workforce, supporting staff to maintain their health and

well being could influence their ability to remain in the workplace and will improve stability of

the workforce.

Unemployment Rates

2008 2009 2010 2011 2012 2013 2014 2015Change on

year

Change

since 2008

Rate Rate Rate Rate Rate Rate Rate Rate Rate Rate

Scotland 4.9% 6.9% 7.7% 8.2% 8.0% 7.7% 6.2% 5.8% -0.40% 0.90%

Aberdeen City 3.6% 4.0% 5.1% 5.8% 5.0% 4.6% 4.5% 4.7% 0.20% 1.10%

Aberdeenshire 2.5% 2.8% 3.6% 4.0% 3.3% 3.3% 2.9% 2.7% -0.20% 0.20%

Moray 3.7% 4.4% 4.6% 5.3% 4.9% 4.9% 4.5% 4.2% -0.30% 0.50%

Geography

(Residence Based)


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Sickness Absence

Whilst the overall sickness absence of NHS Grampian is below the NHS Scotland average

it presents an ongoing risk to a sustainable and capable workforce. With absence levels

fluctuating across professions and sectors, the need to help staff to return and stay in work

through appropriate management and Occupational Health support must be maintained.

This could have an impact on reducing bank and locum usage.

Vacancies

Turnover of staff within any organisation creates opportunity to redesign and review the

workforce and skill mix as required. However, a high turnover rate may suggest staff are not

appropriately engaged or having positive experiences in the workplace. NHS Grampian’s

turnover rate averages a healthy 10.72%, allowing opportunity for reviewing roles. This rate

does not suggest concerns in relation to staff governance.

Whilst turnover rates are broadly positive, AHP’s, Nursing and Midwifery, and Medical

staffing hold a large proportion of vacancies for more than 3 months. This creates additional

pressures on existing workforce and creates instability. An example of this is the increase in

band 5 to 9 nursing and AHP vacancies in the last year, see Appendix 2.

The focus upon Consultant recruitment since 2014 highlights the benefits of the

Recruitment 2020 work, with Consultant vacancies almost halving from 2015 to 34.5 wte at

31st March 2016. Continued targeted recruitment through the agreed Recruitment 2020

actions will be required to maintain this success and allow the work Nursing and AHP’s

have commenced to come to fruition.

4.2 Finance NHS Grampian’s expenditure on staff costs for the 2015-16 financial year was £559 million.

Excluding Family Health Services costs, this represented 64% of total expenditure by NHS

Grampian. It is therefore imperative that NHS Grampian uses all staff resources in an

efficient and effective way. To achieve financial balance, NHS Grampian estimates a

requirement to make £18.5 million of cash savings in the 2016/17 financial year.

NHS Grampian’s expenditure on Agency Medical Locums, Agency Nursing and Nursing

Bank for the 2015/16 financial year was £33.8 million:

Agency medical locums £16.0m;

Agency nursing £2.0m; and

Bank nursing £15.8m


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Whilst the expenditure on bank was slightly above that in 2014-15, the expenditure on

Medical locums increased by £9m and the nursing agency expenditure doubled.

NHS Grampians expenditure on additional hours for 2015/16 is broadly consistent with that

in 2014/15, with a small reduction in overtime.

Table 9: Expenditure on Overtime and Additional Hours

Expenditure 2014/15 2015/16 Difference In

Expenditure

Overtime £2.687m £2.614m -£73,000

Additional Hours £2.933m £2.966m +£33,000

Consideration of appropriate use of bank and agency staff, versus use of overtime and

additional hours is required, as highlighted through the Bank Review. Limitations on

additional hours, or overtime, may not be effective in reducing financial impact of staff

shortages or vacancies, when compared with cost and use of bank or agency staff.

Better use of staffing is a key action in delivering safe and effective workforce, as well as

potential savings. Spending on the following areas are being targeted:

Reducing the demand for agency medical locums, by a combination of: filling long

term vacancies; improving controls around demand management; creating more

accurate billing for breaks taken and a new payment mechanism which should

deliver savings on VAT charges;

Eliminating non-compliant junior medical rotas by filling vacancies, including the

planned recruitment of Clinical Development Fellows;

Reducing the amount of agency nursing used, by recruiting to vacancies and

improved use of bank nursing;

Implementing improved processes around rostering to deliver efficiencies in the use

of bank nursing staff;

Continued vacancy management to ensure that all new and replacement posts are

properly scrutinised for potential efficiencies before being filled; and

Ongoing review of skill mix opportunities to ensure an appropriate grade mix for

duties performed.

4.3 Nursing and Midwifery Workload Workforce Tools

Nursing and Midwifery staff account for 43% of the NHS Grampian workforce, including the

varied Healthcare Support Worker role. To meet service, safety and quality requirements a

balance must be struck between registered and unregistered staff and those in both generic

and specialist roles.


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Understanding the capacity and demands will ensure this workforce can not only respond to

service needs but provide a quality service. The Nursing and Midwifery Workload and

Workforce Tools (NMWWTs) are utilised within NHS Grampian with this aim.

NHS Grampian continues to use all 12 Nursing and Midwifery National Workload and

Workforce Tools, following national guidance when applying these tools. The tools are used

across NHS Grampian, on a rolling programme, to ensure that there is current measurable

information for all areas. As part of this process, Nursing Workforce Validation meetings

have been used to identify baselines for safe and effective practice. This is done using a

triangulated approach, taking account of the current workforce, the local context, Clinical

Quality indicators and the results from the Tools used.

Using the triangulated information, the Nursing Resources Group agreed to additional

investment in the established nursing workforce (50.88 wte).

The NMWWTs have also been used to monitor and highlight risk to ensure safe staffing

levels across the organisation and in conjunction with NHS Grampian’s new governance

process to support the escalation, management and reduction of risk.


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Step 5: Workforce Action Plan 5.1 The Workforce Risk Plan

The Workforce Risk Plan highlights the workforce risks, how these are being controlled,

mitigated and managed. The risks are identified by sectors through the Workforce Planning

and Workforce Projection Process. Within this section a broad summary of the NHS

Grampian identified risks is provided.

Recruitment

Recruitment challenges continue across many sectors and professions, most keenly within

Medical and Nursing professions, however, some of the small occupational groups such as

those within HealthCare Science or AHP professions are also vulnerable in terms of their

level of vacancies. Currently, 44% of AHP posts have been vacant for more than three

months and 59% of Consultant posts have been vacant for more than six months. There

continues to be a national shortage of GPs and recruitment has been challenging. A bid to

the national GP Recruitment and Retention Fund has been submitted to support the

attraction and recruitment to the area.

Recruitment of Doctors in Training is a further challenge and there are a number of gaps in

rotas, as posts have not been filled for August 2016. Although work continues to fill these

gaps, alternative roles are also being used such as Physician Associates, Medical Support

Nurses, Advanced Practitioners and Clinical Development Fellows. Throughout this Plan,

the challenges of recruitment are recognised and the strategic and operational innovations

to counter and mitigate this risk are identified. This will continue to be a priority for NHS

Grampian in 2016 -17.

Age Profile

As recognised in Section 4.1, the age profile of the organisation presents a risk to a

sustainable workforce, particularly in light of changes to pension age. To ensure a

sustainable workforce, NHS Grampian must support employee to work longer, particularly

in professions such as Nursing where historically, some specialties could retire at age 55

without loss of pension benefits.

There is a view that, as staff get older, absence is likely to increase and anecdotal evidence

suggests that more physical roles, longer shifts and full time working will be less attractive.

Further work is required around understanding the overall workforce to identify how the

organisation can retain the skills and experience of the older workforce, whilst providing

safe and manageable roles.


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Change Management

The rate of change continues to quicken across the organisation, responding to impact of

changes in legislation, as well as the overall strategic direction of the NHS, nationally,

regionally and locally. This is a permanent and ongoing process; change itself is recognised

as having the potential to cause a level of destabilisation on the workforce and this risk is

acknowledged. Change processes and work with Partnership and staff side colleagues are

already well developed and work collaboratively to ensure that issues are handled swiftly

and sensitively acknowledging the importance of ongoing communication.

Balancing the demands of the changes through the IJBs, with the potential regionalisation

and the move towards shared services, will impact on all services. For those who provide

support to clinical services, these changes are likely to be greater.

There will be a need to ensure that the workforce required for the future is appropriately

developed both in terms of their individual competence, as well as in sufficient numbers.

For some areas, this will need to be completed in conjunction with the IJB’s and three

partner local authorities, all of whom have differing needs and requirements; this also

creates a level of risk. Building on relationships and working collaboratively will provide an

improved opportunity for this to be successful.

The pace and level of change are also driven by the public and patients expectations for

services and their delivery of a convenient community basis in their locality.

5.2 The Learning and Education plan The Learning and Education Plan supports the development of the workforce responding to

the needs identified from both mandatory requirements, such as Prevent and the analysis

undertaking within each sector, as part of the workforce planning process.

NHS Grampian supports this through design, delivery and evaluation of learning solutions

for staff and partners in the provision of: blended learning activities in the workplace;

classroom; online; via telephone learning and systems support; e-learning; coaching;

facilitating work experience opportunities; through the provision of a suite of management

development programmes; supporting and contributing to national learning activities and

policy; improving induction processes and facilitated events.

It is recognised that future working with Integrated Joint Boards will provide another

opportunity to review learning and training plans, as staff from all partner organisations

provide services to the same clients. This review could benefit by; sharing and learning;

reducing duplication across organisations; improving efficiency in organisations and

supporting change in partnership.

The current key priorities of the Learning and Education Plan are outlined below.


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Induction Process for New Starts

The purpose of induction is to ensure that employees are integrating well into or across the

organisation for the benefit of both parties. For employees, starting a new role in NHS

Grampian can be an anxious time and an induction programme enables them to

understand more about the organisation, their role, and ways of working.

At induction, all new staff now receive access to NHS mail and corporate statutory and

mandatory training via embedded induction processes provided by close working with

eHealth and Recruitment teams.

From the 1st April 2015 to March 2016, 3767 requests have been processed via the

Induction Spreadsheet of which 2152 are new staff to the organisation, with 619 internal

moves, and a further 916, Service Desk Requests to add individuals to the system.

Induction for Doctors in Training has been reviewed after annual delivery in 2015 and will

be more closely linked with departmental induction and educational induction in 2016.

The staff handbook has been reviewed and an orientation checklist provided for managers

and new staff. Induction roles and responsibilities will be clearly defined in the new

Statutory and Mandatory training policy being made ready for consultation early 2016.

A revised Learning and Development policy is being agreed at the Grampian Area

Partnership Forum Policies and Procedures sub group.

National Learning Activity

NHS Grampian is part of a national group reviewing statutory and mandatory training

requirements for all Boards to achieve “Once for Scotland”.

It is recognised that, while necessary, statutory and mandatory training (whether face to

face or e learning) can be time consuming. There is a clear need to remove, or at least

reduce, duplication of training when staff move from location to location.

This should reduce time away from service, whilst maintaining safety and corporate

governance responsibilities and maintaining or improving the quality of learning.

The initial focus of this work is to develop a framework consisting of a list of training topics

which are considered necessary for everyone within the NHS in Scotland. This will be

followed by grouping of job families to determine who should do what mandatory training.

This will show training considered ‘core’ for all staff and for specific roles. Doctors from

training through to Consultant grades will be the exemplar cohort. This work is to be

published in 2016.


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Learning Management Systems

AT Learning is the online learning management system through which staff book and

record their learning. AT Learning is already being accessed by Medical and Dental

undergraduates of the University of Aberdeen. Access is being progressed for Care Homes

and Robert Gordon University health related undergraduates and partners in the third

sector to provide further consistency for students on placements and future potential

employees.

All staff in General Practice have AT Learning accounts which allows them access to core

eLearning and development.

Employability

NHS Grampian participated in the Aberdeen based Skills Scotland event in late 2015. The

event was accessed by around 2000 pupils and students and the organisation worked

jointly with the University of Aberdeen. A certificate was awarded to NHS Grampian for

participation at this event for the last five years.

The launch of the NHS Grampian Work Experience Website continues to receive a positive

response from parents, staff, schools and local authority work experience units.

www.nhsgrampianworkexperience.com

NHS Grampian have organised of one hundred and eighty-nine work experience

placements for pupils and mature persons from across the region from March 2015 to the

present day: mostly for pupils interested in Allied Health Professionals e.g. Radiography

and Dental careers.

The ‘Doctors at Work’ scheme was been developed in partnership with the University of

Aberdeen Medical School and has run for several successful years. This week long

programme offers one hundred and fifty two pupils, (in 2016) and undergraduates; (in other

disciplines) the chance of finding out if a career in medicine is the correct choice for them.

Management Development

The Management Development Programme has developed in late 2015, with a challenging

schedule put in place to deliver a three day Supervisor’s Course every four weeks and a

four day Middle Manager’s Course every six weeks. The core part of this training

predominantly involves effective communication training and awareness as well as

presentations from both HR and Health and Safety colleagues and to date, has been very

well evaluated.

http://www.nhsgrampianworkexperience.com/


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Venues have been identified in both Aberdeen and Elgin, with one taking place in Huntly.

Interest, and subsequently bookings have also increased as word gets around and the

remainder of courses for the year are generally fully subscribed.

There is also ongoing work to design and implement Medical Management Development;

this project is still in the early stages with a plan to commence September 2016.

Medical Workforce Development

Medical workforce learning activities such as the Quality Improvement course are

administered by the Learning and Development Administration team. There are 2 - 3

courses a year with up to 18 Consultants and 4 Trainers attending each session.

The Doctors in Training corporate Medical Induction was delivered in July and August 2015.

Each revision of the programme aims to reduce the numbers of adverse patient incidents

attributable to junior staff. Diligent partnership working involving Recruitment, eHealth, IT

Security and Learning and Development teams have helped NHS Grampian work towards

the full implementation of CEL10 Guidance on the Induction and Shadowing of Foundation

Years Doctors32. Planning for the August 2016 programme, is underway and will involve

spending more time on individual medical staff requirements at induction events, having

made online access available for other important induction resources and information.

Appraisal and Development

The staff engagement issues with electronic Knowledge and Skills framework (eKSF) can

be evidenced from the annual completion rates for Personal Development Plans and

Personal Development Reviews. A critical review was carried out to identify and understand

why this is and how the system is currently being used to support effective appraisal. This

has revealed a number of areas where there is scope to improve and a comprehensive

strategy has been designed to address these area. This will take the form of effective

stakeholder engagement, legitimate shortcuts for recording evidence, accurate and

meaningful reporting and effective ‘workplace training’. It is anticipated that this will improve

engagement, competence and overall confidence in the system and in turn demonstrate

that effective appraisal is taking place.

A successful Endowment bid pilot of 20 hand held devices for improvement of access for

learning and development review work is underway. An effective evaluation could see the

purchase of a further 180 devices for sharing across Grampian.

32 Scottish Government. CEL 10 (2013), FY1 Induction and Shadowing Arrangements, Edinburgh, Scottish Government


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Prevent

Prevent is part of the UK’s counter terrorism strategy, preventing people from becoming

involved in terrorism or supporting terrorism. Legislation and guidance from NHS

Scotland has been issued which includes training expectations on Health Boards. The

Joint Training Co-ordinator has been leading across Grampian the learning and

development perspective of the strategy on behalf of NHS Grampian and the other statutory

partners to ensure compliance.

eLearning

eLearning is a part of a blended learning approach, which is designed to help staff gain

knowledge and understanding on a wide range of topics in their workplace (see table), at a

time that is convenient for them and their service meet whilst meeting staff the Governance

Standard.33

This approach can help ensure a consistency of message for staff, avoids duplication of

effort for providers of training and also supports effective and measurable compliance for

the manager and the organisation.

33 http://www.staffgovernance.scot.nhs.uk/

eLearning under development Published during 2015/16

Healthcare Waste Getting It Right For Every Child

Fire Safety 2016 Violence and Aggression - Phone Rage

Prevent Caring, Listening, Improving

IV Administration of medicines Welfare Reform

Nutritional Screening Moving and Handling

Hand Hygiene 2016 Think Capacity, Think Consent

Controlled Drugs Standard Infection Control Precautions

Accountability, Capacity & Consent Verification of Expected Death

Pressure Ulcer Prevention The Prevention of Falls in Hospital

iMatter Nicotine Replacement Therapy

Child Protection Module 2

Moving and Handling 2016

Paediatric Patient Controlled Analgesia

AT-Learning for Cascade Trainers

Stress & Distress

Skin Care at Work


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This risk assessed approach can release trainer time for the more detailed and specialist

face to face interactions required by individual staff and teams, given that, where

appropriate, basic principles of topics will have been conveyed using e learning.

Staff in NHS Grampian have followed the national trend of embracing eLearning and its

associated technologies as one of the key elements used to underpin their development,

competence and confidence in delivering their role.

5.3 The Workforce Planning Action Plan

NHS Grampian will continue to support Services, Directorates, Sectors and HSCP’s

develop their own Workforce 2020, through the annual Workforce Planning process.

Supporting them to ensure workforce capacity, capability and sustainability is understood,

accounted and planned for; enabling service developments in line with Health and Social

Care Integration, estate and clinical developments (i.e. Theatre’s, Anchor and Baird Project)

and the Grampian Clinical Services Strategy, when approved by the Board.

NHS Grampian will continue to support Workforce Planning for Medical Staff with

Primary and Secondary Care to support and inform local, regional and national workforce

planning. This will ensure that the implications of the future medical workforce in these

specific contexts are understood, alongside the impact this is likely to have on other staff

groups, and how these contexts are likely to influence workforce planning across the

system. This will further support the planning and utilisation of innovative recruitment

opportunities for nationally and locally difficult to fill medical posts.

NHS Grampian will continue to support improvements, moving towards NHS Grampian

being an exemplary employer for Medical Training posts. This will be achieved through

the implementation of the new DRS Realtime system, supporting Clinical Leaders to

achieve effective, safe rosters for doctors in training. Further support to Doctors in Training

will be provided by ensuring medical education is appropriately supported and governed

within NHS Grampian through the newly developed Medical and Dental Education

Governance Group (MDEGG) structure. Supportive work for this agenda, overseen by

MDEGG, will be the ongoing development and recruitment of the Clinical Development

Fellows, Clinical Leadership and support to medical trainers through initiatives such as

Grampian Learning Initiative for Trainers (GLINT). It is recognised that further work is

required to prepare for the anticipated 2017 GMC visit.

NHS Grampian will continue to support recruitment initiatives and overall workforce

supply across professions, Sectors and Divisions through the Recruitment 2020 strategy.

There will be an ongoing NHS Grampian presence at recruitment events and ongoing

campaigns to ensure momentum is maintained in the professions and roles targeted to

date. NHS Grampian will work with services to identify professions and roles which require

additional support for recruitment. NHS Grampian will work with partners to identify


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opportunities to develop sustainable accommodation for key workers to address cost of

living and accommodation barriers to recruitment.

NHS Grampian will continue to utilise Nursing and Midwifery National Workload and

Workforce Tools (NMWWT) to support the ongoing review of nursing resource, ensuring

that the nursing workforce is the most appropriate workforce available. This work will

support and ensure the appropriate skill mix and resource is available supporting an

improved balance, where possible, between the substantive and bank and agency staff.

To further support recruitment and retention, the Return to Practice programme will

continue to run up to 3 times per year as demand necessitates. Career Pathways will

continue to be developed across professions and sectors with the development of new

roles outlined above. NHS Grampian will continue to work collaboratively with Moray

College, North East of Scotland College (NESCOL), Aberdeen University and Robert

Gordon University to achieve this. An example of the work that will continue in this area is

HNC Care in Administrative Practice which is the first step in supporting HCSW to become

registered nurses.

NHS Grampian will continue to identify opportunities to develop new roles or expand the

areas in which recently developed roles are utilised; such as Advanced Clinical

Practitioners, Physician Associates and specialised Band 4 HCSW roles. This will only be

delivered through a collaborative approach with NHS Education Scotland, NESCOL, the

University of Aberdeen and Robert Gordon University, as well as regional and national

colleagues.

NHS Grampian will support the recommendations of the Nurse Bank Review being taken

forward to ensure the Nurse Bank fully supports a sustainable, effective and capable

nursing workforce. A focus of this shall be ensuring efficiency and effectiveness, whilst

addressing issues in relation of supply and demand as highlight within the nine

recommendations.

NHS Grampian will undertake further work on age profile modelling and sustainability of an

ageing workforce; in the continued recognition of the risks identified given the age profile of

the NHS Grampian workforce, and in light of changes to the Scottish Public Pension

Agency retrial age for NHS employees and State Pension age. Work is required to

understand the overall workforce in the workforce groups and identify how NHS Grampian

can retain the skills and experience of the older workforce whilst providing safe and

manageable roles.

Succession planning for staff about to retire continues to be a key issue documented in

the Sectors and Service Workforce Plans. The Talent forum will continue to be developed

with discussion with North East Learning Collaborative (NECL) partners (in particular

Aberdeen Council, Aberdeenshire Council, Police and Fire) so all can share and learn from

each other and open up master classes jointly to support the development of talent.


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NHS Grampian will continue to reflect upon the National Clinical Strategy and Grampian

Clinical Services Strategy, working with stakeholders to work collaboratively to identify

the operational and service developments required to achieve strategic clinical aims.

NHS Grampian will continue to increase collaborative working between Teams, Divisions

and Directorates within NHS Grampian and HSCP’s to support ever developing services

across boundaries. NHS Grampian will continue to extend its collaborative working, building

on existing relationships with other NHS Boards and partner organisations. To achieve this,

NHS Grampian will continue to support the proof concept for shared services and hub

working currently being undertaken in Operational HR and the Human Resource Service

Centre. Utilising learning from these proof of concepts will support NHS Grampian moving

forward towards regionalised models of working in other services and areas.

NHS Grampian will continue work collaboratively with all partners including primary care,

third sector, other public services, the education sector, carers and patients as well as our

organisational partners in the local authorities in terms of integration of Health and Social

Care. NHS Grampian is currently working with the three IJB’s and partner organisations on

priority work streams to ensure the continual improve the quality of care and provide a more

seamless person centred service through appropriate support for the workforce. Workforce

Planning and Development has been identified as one of these priority work streams. Other

priority work streams being taken forward are in relation to HR support to the New

Partnerships; Staff Governance and Staff Partnership Working; Recruitment and

Resourcing; Organisational Change and Organisation Development; Health Safety and

Wellbeing; Workforce Performance and Reporting; Policies; and The Integration Scheme.

NHS Grampian recognises it will, in light of the anticipated Scottish Government guidance,

require to review current processes for Workforce Planning and Workforce

Projections. This review will respond to the updated guidance, developments within the

Workforce Team and recognise the support management and partnership require to enable

an effective Workforce Planning and Workforce Projection process.

NHS Grampian will continue to support the engagement of staff through effective

partnership working, upholding the Staff Governance Standard. NHS Grampian will

continue to measure the experiences of staff through the use of local and national tools,

such as iMatter, to support and empower teams, and individuals and to be involved in the

improvement of their experiences at work. The implementation of iMatter will continue

across the Board; by the end of 2017 all NHS Grampian employees will be using this

annual tool. The development of Staff Governance Action plans (at board and at

partnership forum level) will continue to be informed by the views of staff through the use of

tools such as iMatter.


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Step 6: Implementation

6.1 Monitoring

The Workforce Plan and its Actions within Step 5 will be managed and monitored through

the Staff Governance Committee. This will be done on biannually and will include review of

progress.

6.2 Review / Refresh

The Workforce Planning process within NHS Grampian is undertaken annually to evaluate

current workforce capacity and sustainability and assess required developments to ensure

continued capacity and sustainability within the national and local context ensuring quality

services are provided in a Caring, Listening and Improving manner.


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Appendix 1: NHS Grampian Vision and Values

Workforce Plan 2016 - 2019

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Appendix 2 – Current Workforce Profile

The data used in this appendix was derived from local downloads from the Scottish

Workforce Information Standard System.

Gender Split/Age profile

Female members of staff out number males by, 11,976 headcount to 2,466 headcount

respectively.

Table 10: Gender Split as at 31 March 2016

Age Profiles

Table 11: NHS Grampian Age Range as at 31 March 2016

Male 2466 17%

Female 11976 83%

01 thru 19

20 thru 24

25 thru 29

30 thru 34

35 thru 39

40 thru 44

45 thru 49

50 thru 54

55 thru 59

60+

Headcount (left axis) 128 938 1589 1535 1543 1677 2028 2174 1710 1120

Percentage (right axis) 0.89% 6.49% 11.00% 10.63% 10.68% 11.61% 14.04% 15.05% 11.84% 7.76%

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%

0

500

1000

1500

2000

2500

Head

co

un

t


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Overall 34.6% of NHS Grampian’s workforce is over 50 years old. 33.1% of the nursing

workforce is aged over 50; 38.5% of healthcare scientists are aged over 50;25% of

administration services staff are aged over 55 and within support services 32% of the

workforce are aged over 55.

Table 12: Age Profiling by Job Family, by Headcount as at 31 March 2016

Table 13: NHS Grampian Age Range by Job Family as at 31 March 2016

Job Family 01 thru 19 20 thru 24 25 thru 29 30 thru 34 35 thru 39 40 thru 44 45 thru 49 50 thru 54 55 thru 59 60+ Grand Total

ADMINISTRATIVE SERVICES 5 96 142 171 203 274 378 349 322 247 2187

ALLIED HEALTH PROFESSION 78 164 189 132 154 160 135 113 52 1177

DENTAL SUPPORT 1 22 38 37 30 26 33 21 14 3 225

HEALTHCARE SCIENCES 1 38 49 58 56 46 53 79 74 36 490

MEDICAL AND DENTAL 65 288 201 231 171 166 142 127 53 1444

MEDICAL SUPPORT 15 9 3 5 6 8 5 2 53

NURSING/MIDWIFERY 27 489 677 642 660 731 937 1036 711 309 6219

OTHER THERAPEUTIC 23 58 50 59 54 42 47 33 13 379

PERSONAL AND SOCIAL CARE 3 6 12 7 11 17 12 12 19 99

SENIOR MANAGERS 1 6 21 10 5 43

SUPPORT SERVICES 94 124 152 166 162 204 230 324 289 381 2126

Grand Total 128 938 1589 1535 1543 1677 2028 2174 1710 1120 14442

01 thru 19 20 thru 24 25 thru 29 30 thru 34 35 thru 39 40 thru 44 45 thru 49 50 thru 54 55 thru 59 60+

ADMINISTRATIVE SERVICES 5 96 142 171 203 274 378 349 322 247

ALLIED HEALTH PROFESSION 78 164 189 132 154 160 135 113 52

DENTAL SUPPORT 1 22 38 37 30 26 33 21 14 3

HEALTHCARE SCIENCES 1 38 49 58 56 46 53 79 74 36

MEDICAL AND DENTAL 65 288 201 231 171 166 142 127 53

MEDICAL SUPPORT 15 9 3 5 6 8 5 2

OTHER THERAPEUTIC 23 58 50 59 54 42 47 33 13

PERSONAL AND SOCIAL CARE 3 6 12 7 11 17 12 12 19

SENIOR MANAGERS 1 6 21 10 5

SUPPORT SERVICES 94 124 152 166 162 204 230 324 289 381

NURSING / MIDWIFERY 27 489 677 642 660 731 937 1036 711 309

0

200

400

600

800

1000

1200

Hea

dc

ou

nt


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Table 14: Age Profiling by Job Family as Percentages 31 March 2016

Whole Time Equivalent and Headcount

Table 15: wte (Whole Time Equivalent) as at 31 March 2016

Table 16: NHS Grampian wte by Job Family as at 31 March 2016

Job Family 01 thru 19 20 thru 24 25 thru 29 30 thru 34 35 thru 39 40 thru 44 45 thru 49 50 thru 54 55 thru 59 60+

ADMINISTRATIVE SERVICES 0.2% 4.4% 6.5% 7.8% 9.3% 12.5% 17.3% 16.0% 14.7% 11.3%

ALLIED HEALTH PROFESSION 0.0% 6.6% 13.9% 16.1% 11.2% 13.1% 13.6% 11.5% 9.6% 4.4%

DENTAL SUPPORT 0.4% 9.8% 16.9% 16.4% 13.3% 11.6% 14.7% 9.3% 6.2% 1.3%

HEALTHCARE SCIENCES 0.2% 7.8% 10.0% 11.8% 11.4% 9.4% 10.8% 16.1% 15.1% 7.3%

MEDICAL AND DENTAL 0.0% 4.5% 19.9% 13.9% 16.0% 11.8% 11.5% 9.8% 8.8% 3.7%

MEDICAL SUPPORT 0.0% 0.0% 28.3% 17.0% 5.7% 9.4% 11.3% 15.1% 9.4% 3.8%

NURSING/MIDWIFERY 0.4% 7.9% 10.9% 10.3% 10.6% 11.8% 15.1% 16.7% 11.4% 5.0%

OTHER THERAPEUTIC 0.0% 6.1% 15.3% 13.2% 15.6% 14.2% 11.1% 12.4% 8.7% 3.4%

PERSONAL AND SOCIAL CARE 0.0% 3.0% 6.1% 12.1% 7.1% 11.1% 17.2% 12.1% 12.1% 19.2%

SENIOR MANAGERS 0.0% 0.0% 0.0% 0.0% 0.0% 2.3% 14.0% 48.8% 23.3% 11.6%

SUPPORT SERVICES 4.4% 5.8% 7.1% 7.8% 7.6% 9.6% 10.8% 15.2% 13.6% 17.9%

Grand Total 0.9% 6.5% 11.0% 10.6% 10.7% 11.6% 14.0% 15.1% 11.8% 7.8%

ADMINISTRATIVE SERVICES

ALLIED HEALTH

PROFESSION

DENTAL SUPPORT

HEALTHCARE SCIENCES

MEDICAL AND DENTAL

MEDICAL SUPPORT

NURSING / MIDWIFERY

OTHER THERAPEUTIC

PERSONAL AND SOCIAL

CARE

SENIOR MANAGERS

SUPPORT SERVICES

wte 1825.04 919.64 186.46 425.39 1285.41 49.62 5211.23 317.65 78.06 42.25 1627.05

1825.04

919.64

186.46 425.39

1285.41

49.62

5211.23

317.65 78.06 42.25

1627.05

0

1000

2000

3000

4000

5000

6000


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Headcount

Table 17: NHS Grampian Headcount as at 31 March 2016

Table 18: NHS Grampian Headcount by Job Family as at 31 March 2016

ADMIN SERVICES

ALLIED HEALTH

PROFESSION

DENTAL SUPPORT

HEALTHCARE SCIENCES

MEDICAL AND DENTAL

MEDICAL SUPPORT

NURSING / MIDWIFERY

OTHER THERAPEUTI

C

PERSONAL AND SOCIAL

CARE

SENIOR MANAGERS

SUPPORT SERVICES

Total 2187 1177 225 490 1444 53 6219 379 99 43 2126

2187

1177

225

490

1444

53

6219

379

99 43

2126

0

1000

2000

3000

4000

5000

6000

7000


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Whole-Time Part-time Split (wte)

Table 19: NHS Grampian Whole-Time Part-Time Split (wte) as at 31 March 2016

Table 20: NHS Grampian Whole-Time Part-Time Split as at 31 March 2016

ADMIN SERVICES

ALLIED HEALTH

PROFESSION

DENTAL SUPPORT

HEALTHCARE SCIENCES

MEDICAL AND DENTAL

MEDICAL SUPPORT

NURSING / MIDWIFERY

OTHER THERAPEUTI

C

PERSONAL AND SOCIAL

CARE

SENIOR MANAGERS

SUPPORT SERVICES

% Part-time 34.7% 41.6% 38.3% 21.0% 14.6% 17.4% 39.7% 30.1% 34.7% 5.3% 53.9%

% Whole-time 65.3% 58.4% 61.7% 79.0% 85.4% 82.6% 60.3% 69.9% 65.3% 94.7% 46.1%

34.7%

41.6% 38.3%

21.0%

14.6% 17.4%

39.7%

30.1% 34.7%

5.3%

53.9%

65.3%

58.4% 61.7%

79.0%

85.4% 82.6%

60.3%

69.9% 65.3%

94.7%

46.1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


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Sickness Absence from Scottish Workforce Information Standard System (SWISS)

Table 21: NHS Grampian Sickness Absence Information (SWISS) 1 April 2015 - 31 March 2016

Table 22: NHS Grampian Sickness Absences (SWISS) 1 April 2015 - 31 April 2016

3.00%

3.50%

4.00%

4.50%

5.00%

5.50%



Absence Rate 4.03% 4.59% 4.27% 4.21% 4.10% 4.32% 4.54% 4.46% 4.91% 5.15% 5.00% 4.82%

HEAT Target 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00%


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Turnover

Table 23: Aggregated Starters and Leavers 1 April 2015 - 31 March 2016

Note: Training Grade Doctors are not included within the Turnover figures.

Turnover is defined as employees leaving NHS Grampian. The current headcount is as at

31st March 2016

Table 24: NHS Grampian Turnover 1 April 2015 - 31 March 2016

Admin Services

Allied Health Profession

Dental Support

Healthcare Sciences

Medical and Dental

Medical Support

Nursing / Midwifery

Other Therapeutic

Personal and Social Care

Senior Managers

Support Services

Turnover 8.96% 10.20% 9.33% 9.39% 7.34% 9.43% 11.48% 15.57% 11.11% 9.30% 12.51%

8.96%

10.20%

9.33% 9.39%

7.34%

9.43%

11.48%

15.57%

11.11%

9.30%

12.51%


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Vacancies

Consultants

The number of Consultant vacancies has decreased significantly from 66.0 wte in 2015 to

34.3 wte as at 31st March 2016, with 59.2% being vacant for more than 6 months. Emergency

Medicine has 6.0 wte long term vacancies.

It should be noted that as at 31st March 2016, 8 wte Consultant posts have been appointed to

but individuals have not yet taken up post.

Junior Doctor Training Posts Junior Doctors Training Posts vacancies continue to be a challenge with around 50 vacancies identified across Grampian for August 2016. Acute Medicine and Emergency Medicine have significant Senior Trainee vacancies. These posts are deemed necessary to run a viable service and are less attractive due to their lack of training credentials. Collaborative work with Finance and services affected is ongoing to identify the total number of Rota gaps in Acute Sector and options for filling these gaps with substantive workforce; such as Physician Associates, Medical Support Nurses, Clinical Development Fellows and Medical Training Initiative (overseas doctors). Allied Health Professionals

Allied Health Professionals vacancies have increased from 66.4 wte the previous year to 71.2

wte (31st March 2016). Of these vacancies, 44.7% have been vacant for more than 3 months.

Occupational Therapy, Physiotherapy and Radiography Diagnostic contribute largely to the

proportion of the total vacancies at 13.3 wte, 23.0 wte and 18.6 wte respectively.

Radiography Therapeutic has seen a decrease to 0.0 wte (31st March 2016) compared to 4.0

wte (31st March 2015). Podiatry has 4.3 wte vacancies which is a decrease from last year,

5.8 wte respectively.

Nursing & Midwifery

The number of Bands 5 to 9 vacancies have increased significantly to 326.9 wte compared to

273.7 wte from previous year. This represents a 19.4% increase. Bands 2 to 4 decreased to

84.7 wte compared to 106.0 wte the previous year, which is a reduction of 20.1%

The number of vacancies for over 3 months has increased to 43.8% compared to 30.2% the

previous year.


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The majority of vacancies sit within Hospital Adult Nursing at 265.1 wte compared to 248.3

wte the previous year. This represents an increase of 6.8%.

Detailed Current Vacancies within NHS Grampian Nursing/Midwifery:

Table 25: Current NHS Grampian Vacancies by Division and Unit

Division and Unit

Acute Medicine

31st March

2016

31st March

2015Difference Percentage Change

Medicine 1 25.3 10.5 14.8 140.95%

Medicine 2 19.0 9.4 9.6 102.13%

Medicine 3 N/A 10.0 N/A Staff Decanted into 1, 2 and 5

Medicine 4 5.0 7.0 -2 -28.57%

Medicine 5 13.8 11.6 2.2 18.97%Acute Surgery

Surgery 1 3.8 19.6 -15.8 -80.61%

Surgery 2 39.5 22.6 16.9 74.78%

Surgery 3 18.0 13.2 4.8 36.36%Acute Women & Children

Women & Children 49.3 31.2 18.1 58.01%Acute Clinical Support Services

Clinical Support 1 0.0 0.0 0 NO CHANGE

Clinical Support 2 11.2 13.0 -1.8 -13.85%

Clinical Support 3 15.4 8.8 6.6 75.00%

Clinical Support 4 67.3 52.9 14.4 27.22%

Clinical Support 6 0.0 0.0 0 NO CHANGE

Acute Dr Grays

Dr Grays 6.6 4.7 1.9 40.43%Aberdeenshire CHP

Total Aberdeenshire H&SCP33.0 43.0 -10 -23.26%

Aberdeen CHP

Total Aberdeen H&SCP 38.7 28.0 10.7 38.21%Moray CHP

Total Moray H&SCP 7.6 2.9 4.7 INCREASED FROM 0

Mental Health Grampian

Mental Health Hospital 43.6 54.5 -10.9 -20.00%

Mental Health Community 12.5 12.3 0.2 1.63%GO Services - OHS

Occupational Health 2.0 0.0 2 INCREASED FROM 0

411.6 355.2 66.4Colour Code Key > <=0 >0 and <5 >=5

No. of Nursing/Midwifery Vacancies Table Financial Year Comparison

workforce plan 2016 - nhs grampian...table 24: nhs grampian turnover 1 april 2015 - 31 march 2016 69...

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