A Social Partnership Forum Action Plan for Maximising Employment Opportunities for Newly Qualified Healthcare Professionals in a Changing NHS
Current situation
Since 2005 it has become increasingly clear that the number of people seeking employment in the NHS exceeds the number of job opportunities available for the first time in a generation. Current indications suggest that the 2007 qualifiers will have similar experiences. However, projecting the numbers of retirements expected amongst healthcare professionals against five-year plans for healthcare delivery indicates that the NHS still needs to employ newly-qualified healthcare professionals over the coming years. In spite of this, competition for posts is much more challenging, and students in many professions are finding it increasingly difficult to find their first job post-qualification. Every effort is required to protect the valuable skills of these individuals and consideration for the long-term supply of a skilled workforce is paramount in avoiding workforce shortages in the future.
The launch of NHS Careers (www.nhscareers.nhs.uk) in 1999 and the NHS Plan in 2000 delivered the Department of Health's strategy for rapid growth in workforce numbers to improve capacity and access. This growth in the NHS workforce has delivered improved access and the unprecedented reduction in waiting times. Currently, initiatives aimed at improving quality of healthcare and access to services through structural change, such as provision of more care outside hospitals and the development of new roles for staff and new providers of services, are having an impact on how staff work, particularly in hospitals. In recent times, the context of very real financial pressures has also had an impact on the employment opportunities available in the NHS. In a bid to avoid/resolve financial problems, many employers have been revising their workforce plans for the present and immediate future to ensure that they can deliver services whilst achieving financial balance. This has also contributed to the reduction in the overall numbers of posts available in the NHS.
Newly-qualified healthcare professionals who have yet to secure their first jobs are the most vulnerable in the changing landscape. A concerted effort is required to retain valuable skills and ensure a return on the investment made by the NHS in commissioning the training of healthcare professionals for the future needs of the service. Solutions to these challenges in the long term will be the improved systems of workforce planning at every level from employers to policy makers, and the extent to which key partners can be involved in the process. It is important, however, to ensure that these solutions do not increase pressures for existing staff.
NHS Employers and the NHS trade unions (CSP, Unison, Amicus, RCN, RCM and SoR) met on January 8 2007 and had productive discussions about the current employment situation for newly-qualified healthcare professionals. This action plan makes recommendations aimed at addressing the current situation, both for the immediate and the long term. These include a series of practical steps based on evidence of current good practice.
The summit, Securing and Retaining Staff for Health and Social Care, on February 7 2007 provided a forum for all key stakeholders to engage in developing workable solutions. We have also agreed the principle that carefully planned practical activities across health communities – involving all potential employers, the NHS, the independent, voluntary and social care sectors - is the best approach to maximising employment opportunities for new qualifiers.
The role of strategic health authorities
An important role of a strategic health authority (SHA) is to commission a workforce supply for the NHS and the local community. SHAs will need to deliver a co-ordinated strategy to understand the extent of graduate unemployment now in their area as well as the number of healthcare professionals expected to leave higher education from March 2007 onwards. SHAs will need to have mechanisms in place to maintain contact with these healthcare professionals providing a matching service to employment opportunities as they occur, whilst working with employers to maximise employment opportunities. SHAs will also want to work with the social care, independent and third sector employers in their area to ensure integration of systems to support graduate employment into these alternative employers. Regional development agencies (RDA) will also have an interest in ensuring that employment opportunities in the regions are maintained and are not lost to the detriment of the local population.
Recommendation 1: SHAs to develop talent pools (of all new qualifiers seeking their first post) through the use of NHS Jobs (www.jobs.nhs.uk) to identify and quantify newly-qualified healthcare professionals seeking employment.
Recommendation 2: SHAs to work with each individual employer in their area, including Foundation Trusts, to ascertain the numbers of new qualifiers appointed in 2006 and plans for employing new qualifiers in 2007.
Recommendation 3: Using this data, SHAs to develop appropriate mechanisms for bringing employers together across all sectors and the RDAs in processes to facilitate employment of newly-qualified healthcare professionals, based on the principle of employers fairly sharing out the responsibility of ensuring that newly-qualified health care professionals have access to their first job.
Recommendation 4: SHAs to lead on a partnership approach across the sectors to audit the skill mix and staffing requirements to aid demand forecasting, ensuring that commissioners endorse these forecasts.
Recommendation 5: SHAs to work in partnership with trade unions to ensure that the delivery of the recommendations in this action plan is discussed at the earliest opportunity within the new social partnership forums at regional level.
Recommendation 6: East of England SHA to undertake a feasibility study to maximise employment opportunities for newly qualified healthcare professionals. One of the work streams of the study will include assessing the feasibility of an employment guarantee scheme for newly qualified healthcare professionals.
Recommendation 7: SHAs to coordinate the mapping of workforce capacity and implementation plans in their area to assess what may be needed for delivery of the 18 week target.
The role of NHS employers
It is important that employers take ownership of the process for maximising employment opportunities for newly-qualified healthcare professionals. This will require partnership working with trade unions and a commitment to securing the workforce of the future.
Recommendation 8: Employers (NHS Trusts, Foundation Trusts, independent and social care employers) will work together with SHAs to identify the number of new qualifiers that will be employed in the NHS as each cohort exits higher education.
Recommendation 9: NHS Trusts should eliminate obstacles for the employment of new qualifiers. For example, previous experience as a healthcare professional will not usually be required when appointing to Agenda for Change Band 5 posts in all parts of the NHS including mental health and primary care trusts.
Recommendation 10: NHS Trusts should consider ring-fencing jobs for newly qualified healthcare professionals who have been unable to secure their first permanent post in the appropriate band in relation to the job evaluation scheme, taking into account the needs of existing staff who have or may be declared at risk of redundancy due to financial deficits.
Recommendation 11: NHS Trusts should be aware of the potential impact on new qualifiers and future workforce supply when implementing or reviewing vacancy control strategies.
Recommendation 12: NHS Trust should work together with SHAs on demand forecasting ensuring a systematic process involving clinical service managers in the data collection.
Recommendation 13: NHS Trusts should, in submitting workforce plans, ensure these are endorsed by clinical service managers to validate the evidence base.
Recommendation 14: NHS Trusts to map workforce capacity and implementation plans to ensure delivery of the 18-week target in discussion with commissioners.
Recommendation 15: NHS Trusts should review their temporary staffing polices, stopping or dramatically reducing reliance on agency staff and making particular use of newly-qualified healthcare professionals through flexible pools internally, and redeploying staff when vacancies or opportunities arise.
The role of higher education institutions
Higher education institutions (HEIs) are key players in ensuring new qualifiers secure employment in the healthcare sector. They will want to ensure that SHAs have appropriate information on the numbers of newly qualified healthcare professionals exiting training programmes and seeking employment. Careers advisors in HEIs play a crucial role in ensuring students are fully aware of the current labour market conditions. In so doing students will be aware of the range of options available to make informed choices about their first employment destination following qualification. NHS Careers is well placed to inform on the employment landscape in the NHS.
Recommendation 16: HEIs to provide DH and employers with reliable data about the number of newly qualified healthcare professionals (by individual profession) seeking employment in the health and social care sector.
Recommendation 17: HEI career advisors should offer each qualifying healthcare professional at least one personal structured career interview and counselling session.
Recommendation 18: Careers services to develop an in depth understanding of mechanisms in place to support graduate employment as well as systematic intelligence gathering processes from employers in health and social care.
Recommendation 19: NHS Careers to produce information targeted at newly qualified healthcare professionals seeking employment, working with individual staff organisations.
Integrated workforce deployment and planning
The NHS is not the sole employer for newly-qualified healthcare professionals and opportunities are increasingly available outside the NHS. It is important that employers and higher education institutions work across local health communities to assure an adequate workforce supply, ensuring that newly-qualified healthcare professionals can access roles in the primary and social care settings as well as emerging independent and voluntary sector providers. To do this, a long term integrated approach to planning the health and social care workforce needs is required. This will be jointly led by the Workforce Review Team (WRT) and NHS Employers, alongside the relevant SHA both to assess the needs of local populations and the implications of future policies. This will also assure continuity of high quality healthcare delivery whilst maximising investment in training.
Recommendation 20: The DH, SHAs, NHS Employers and the WRT working alongside employers and trade unions, to lead on building an improved and integrated approach to workforce planning and deployment; identifying gaps in either supply, or employment opportunities and strategies to redress the balance.
Recommendation 21: The DH to lead and facilitate dialogue with SHAs, local employers and staff organisations on the process for monitoring data from the talent pools on newly qualified healthcare professionals seeking employment.
Recommendation 22: NHS Employers, independent sector and local government employers to provide clarity on employment opportunities that may be available for newly healthcare professionals e.g. by specifically mentioning this in advertisements and campaigns.
Retaining skills and knowledge
For the new qualifier unable to secure immediate employment as a healthcare professional, innovative programmes are required to help them maintain their skills and knowledge. Such programmes will act as effective retention tools. Good quality information updates and clinical exposure are key to maintaining the confidence of new qualifiers as they make the transition from student to healthcare employee.
Recommendation 23: SHAs and HEIs should work together to provide update opportunities for new qualifiers seeking employment and to enhance their employment opportunities in the primary and social care sectors.
Recommendation 24: Employers to work together and with trade unions to develop keeping-in-touch schemes, including opportunities for work shadowing for the newly-qualified healthcare professional to facilitate ongoing familiarity with clinical work, with agreement on how the required capacity will be put in place across health economies.
Recommendation 25: Employers should work together to offer new qualifiers access to in-service training programmes, working in partnership across health economies.
Health and wellbeing strategy
The White Paper Our Health, Our Care, Our Say sets out a desire for improved access to general practice and delivery of care outside hospital, as one of its main objectives. Healthcare professionals are critical to the delivery of this objective and can make a significant contribution to the choice policy. For example, enabling self-referral by patients directly to services delivered by the allied health professions, healthcare scientists, midwives and nurses will help achieve better access to general practice by reducing the workload of GPs, and provide employment opportunities for healthcare professionals.
Recommendation 26: NHS employers and staff organisations to develop the business case to demonstrate how the role of the different allied health professionals can help achieve better health and well-being across the population and tackle health inequalities.
18-week workforce capacity mapping
The NHS Improvement Plan set a target of eighteen weeks or less wait for treatment from GP referral. Achievement of the 18-week target can be achieved through expanding services provided by allied health professionals. In so doing, there will be the opportunity for these staff to begin treatment immediately or to give advice as appropriate to patients without further need for onward referral. Expanding services delivered by healthcare professionals can therefore also help achieve the aims of improved access to healthcare services, by reducing waiting lists for hospital consultants.
Recommendation 27: NHS employers and staff organisations to develop the evidence base for how such solutions could work to support the delivery of the eighteen weeks target and to raise the profile of the AHP workforce to service commissioners.
Occupational health
The White Paper Choosing Health identifies improving workplace health as a priority, with sickness absence costing up to £30 billion per year. It is evident that individuals with long term musculo-skeletal disorders, which account for a significant proportion of sickness absence, are less likely to achieve a successful return to the workplace. This picture is mirrored in the NHS with a sickness absence level of 4.5% in England during 2005. This equates to NHS employees taking an average of 12 days off sick a year. Furthermore, back problems and musculo-skeletal disorders remain the major cause of sickness absence in the NHS. To combat this trend the use of experienced physiotherapists in developing and contributing to occupational health services, both within and outside the NHS, needs to be advanced. It is also possible to deploy newly-qualified physiotherapists within this area, providing appropriate systems of supervision and support are in place. Making maximum use of the skills of physiotherapists in this way will facilitate a faster return to work after injury and will fulfil the dual purpose of reducing sickness absence in the workplace and open up employment opportunities for the newly qualified physiotherapists.
Recommendation 28: NHS employers to work with the Chartered Society of Physiotherapy (CSP) to develop a business case on how the role of physiotherapists can help in the delivery of occupational health services.
Managed migration
There are still workforce shortages in other healthcare markets across the world. This provides the prospect of exploring short term employment opportunities for staff from England to the parts of the world experiencing shortages. Managing the migration process will enable individuals to fulfil the personal objective of gaining experience in other health systems whilst enabling employers to benefit from the learning that returning healthcare professionals bring with them on their return.
Recommendation 29: NHS employers to work with staff organisations to explore the potential for developing a suitable mechanism to support a managed migration scheme as described above building on the NHS's long history of such programmes of education and collaboration.
NHS employers and the NHS trade unions will continue to work together nationally to facilitate the recommendations made in this action plan and will formally review this within the next 6 months. Activities will also focus on supporting the respective constituents at regional and local level to maximise employment opportunities for newly qualified healthcare professionals. Through the Social Partnership Forum, progress made on the recommendations in this action plan will be kept under review, to ensure delivery.
Conclusion
NHS employers will develop online resource of information to support SHAs and health and social care employers to maximise employment opportunities for healthcare professionals. This will be based on the recommendations in this action plan and there will be links to other relevant websites including those of staff organisations. The available information will share experiences of approaches taken within and across a range of health economies.
