The CfWI produces quality intelligence to inform better workforce planning that improves people’s lives

Planning your workforce for future uncertaintyPrimary Care & Public Health Conference22 May 2013

Greg Allen, COO CfWI

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The new healthcare system in England

Our Mission To become the

primary source of workforce

intelligence for health and social

care

We produce quality intelligence to inform better workforce planning that improves people’s lives

Our vision

To be the national authority on workforce planning and development, providing advice and information to the NHS and social care system.

Our values

Everyone working together

Quality counts Respect Improving lives Dignity Compassion Care

The care and health workforce in England is significant…...because of its size

...over 1.4 million people in the NHS

...1.63 million adult social care workers

...and also because of the work itself

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Demands on the healthcare sector...... will evolve with changing demographics and societal shifts. How can we plan for and develop the healthcare workforce to meet these demands?

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The future of primary care & general practice

Those starting training now will still be in practice in 2050

The pace of change is increasing

The NHS is facing unprecedented challenges

We will be working differently in the future

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Some statistics about primary care

• 90% of all patient contact is in primary care

• The NHS Budget is expected to be under significant pressure despite being “ring-fenced”

• Spending on primary care rose by 1.3% last year compared to 5.1% for secondary care

• 22% of GPs are aged over 55

• 20% of Practice Nurses are aged over 55

• 10,000 GPs intend to retire in the next 5 years

• Doubling in demand for consultations in the next ten years

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GPs as a proportion of all NHS doctors (England)

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Our workforce planning frameworkImproving the quality of workforce intelligence

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Macro-level research

Horizon scanning

Scenario workshops

Parameters defining possible futures

Workforce model

Forecast supply and

demand

Sensitivity analysis to

identify critical parameters

Workforce data and

assumptions

Delphi

Micro-level research

Policy interventions

Our horizon scanning work aligns with wider scenario generation and workforce modelling. Our outputs inform later research activities to produce workforce intelligence.

From horizon scanning to final report...

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Scenario generation workshop

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Our medical workforce supply model

medical school

Foundation 1

Career post

Foundation 2

Core training

Run-through training

GP training

GP

Higher specialty training

Hospital consultan

t

Consultant to GP training

Not shown but modelled

• Attrition from stocks• Exits out of system• Inflows from overseas and

re-joiners• Re-sits

1. Highly configurable

2. Ageing in one-year bands

3. Migration can be modelled (but we lack data)

4. SAS doctors data and modelling need improving

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What is our review seeking to address...

Considering the likely changes to service delivery and the role of GPs over the next

20 years, how do we ensure sufficient supply for the future general

practitioner workforce?

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How are we addressing this?

Review current workforce capacity issues in general practice

Assess the current GP recruitment target for England and review options for GP training and recruitment targets beyond 2015

Understand the likely impact of possible future shifts in care in the medium and long term

Develop and refine the CfWI’s GP system dynamics model

Make recommendations, if appropriate, on GP service delivery models and affordability of different options

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Sources: NHS HSCIC 2006a, 2006b and 2012a

GPs (excluding retainers and regis-trars)Practice nursesDirect patient carers

0

5,000

10,000

15,000

20,000

25,000

0

1

2

3

4

5

6

7

8

Practice nurses headcount (left axis)

Practice nurses FTE (left axis)

Ratio GP: practice nurse (right axis)

Nu

mb

er

of

pra

cti

ce n

urs

es

Rati

o G

P:

pra

ctic

e n

urs

e

The general practice workforce

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1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

0

20

40

60

80

100

120GPs per 100,000 population (right axis)

GPs, headcount basis* (left axis)

GPs, FTE basis* (left axis)

Num

ber

of

GP

s

GP

s p

er

100 0

00 p

opula

tion

Source: NHS HSCIC 2012a and ONS (2012a and 2012b *Excluding GP registrars and retainers

The GP workforce 1995-2011

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Source: NHS HSCIC 2011

Under 25 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70 and over

Unknown0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

Men Women

Age band

Headco

unt

GPs by age band and gender

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Source: GP National Recruitment Office (2012), Health Education England (2013a)

2009-2010 2010-2011 2011-2012 2012-2013 2013-20140

1,000

2,000

3,000

4,000

5,000

6,000

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

Applicants (right axis)

Vacancies (right axis)

Accepted offers (right axis)

Competition ratio (left axis)

Recruitment year

GP

tra

inee n

um

bers

Com

peti

tion r

ati

o

GP postgraduate trainee recruitment

(left axis)

(left axis)

(left axis)

(right axis)

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• CfWI’s analysis points to a GP workforce under strain. GP workforce numbers need to be lifted to more sustainable levels

• If the recruitment target of 3,250 GP trainees per year in England is achieved by 2015 and maintained it will result in an increase of about 15,300 GPs by 2030 compared with 2011 levels

• If this boost in GP training is coupled with other measures to improve supply and manage demand, it may be sufficient to meet expected patient demand to 2030

Preliminary findings I

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• By 2030, we expect women to be the majority of the GP workforce

• Our projections suggest the average age of GPs will be lower, and the number of GPs in their thirties will have doubled

• There are fewer ‘single-handed’ practices; very large practices now see around one in seven patients and are growing rapidly

• There has been a shift towards more salaried GPs and fewer GP partners, which is likely to continue

Preliminary findings II

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2010 2015 2020 2025 203030,000

35,000

40,000

45,000

50,000

55,000

Demand - baseline GPs

Supply - baseline GPs

Fu

ll-t

ime

eq

uiv

ale

nt

Source: CfWI system dynamics medical workforce model for England

GP supply and demand baselines

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2010 2015 2020 2025 203030,000

35,000

40,000

45,000

50,000

55,000

Demand - baseline GPs

Supply - baseline GPs

Demand - scenario 1 - 6

Fu

ll-t

ime

eq

uiv

ale

nt

Source: CfWI system dynamics medical workforce model for England

With demand scenarios added...

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• Scenario 1: ‘Happy GPs, excellent patient care’

•Scenario 2: ‘GPs good, commissioners bad’

•Scenario 3: ‘Right plan, but wrong tools’

•Scenario 4: ‘Meltdown in care’ • Scenario 5: ‘Technology through regulation’

• Scenario 6: ‘Rise of the machines’

The six scenarios

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2010 2015 2020 2025 203030,000

35,000

40,000

45,000

50,000

55,000

Demand - baseline GPs

Supply - baseline GPs

Demand - scenario 1 - 6

Supply - scenario 1 - 6

Fu

ll-t

ime

eq

uiv

ale

nt

Source: CfWI system dynamics medical workforce model for England

and supply scenarios

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• Work to achieve the recruitment target for England of 3,250 GP trainee places per year by 2015 and maintain training at that level

•A substantial share of this workforce increase should go towards improving support for under-doctored areas

•Other measures to improve workforce supply and manage demand

•Regular reviews of the GP workforce at least every 3-5 years • More frequent data on GP activity and consultation

rates

Emerging recommendations I

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Source: NHS HSCIC (2011) and the CfWI system dynamics medical workforce model for England

20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 70 to 790

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

2000 2010 2020 2030

Nu

mb

er

of

GP

sAge of GPs - 2000 to 2030

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• Action needed to improve the attractiveness of general practiceand to retain the existing workforce

• More flexible and open ended medical career pathways

• NHS commissioners to encourage more innovative and collaborative approaches to primary care delivery

Emerging recommendations II

Preliminary findings

http://www.cfwi.org.uk/publications/gp-in-depth-review-preliminary-findings

• We look forward to hearing the views of GPs, other health professionals, professional bodies, employers, patients and the public

• Please email your views or evidence, or contribute to our LinkedIn online forum:

• http://www.linkedin.com/groups/Friends-Centre-Workforce-Intelligence-CfWI-4274008

• The Preliminary findings report

can be downloaded from:

Centre for Workforce Intelligence209 – 215 Blackfriars Road, London SE1 8NL T +44 (0)20 7803 2707General enquiries E enquiries@cfwi.org.uk www.cfwi.org.uk

www.cfwi.org.uk