Place-based partnership working requires new and optimised services that focus on the best, most seamless care for patients and service users. Leaders engaged through this programme consistently articulated that this requires them to work with their teams to re-imagine the skills, knowledge, and expertise required to deliver outstanding care, and leverage innovative digital solutions to help them achieve even greater impact for people. It can involve their teams working in ways which redefine organisational boundaries.
Achieving this often requires significant changes in how teams work together, moving skills to different settings in the community, and addressing funding and other resources (such as estates) between organisational and system budgets. These moves have been cited historically as a significant barrier to the success and pace of change.
In the current economic context, health and care workers are under immense pressure, juggling high workloads, partly due to high staff vacancy rates, increasing demand for care, and seeing their remuneration fall in real terms. Leaders have signalled that partnership working will require them to be even more creative, bold, and courageous in their aspiration and actions to build the health and care teams of the future.
What is the reality? The challenges being felt by local systems
- New ways of working are likely to require additional skills, roles, and ways of working to those historically used in the NHS.
- There is a general workforce challenge across systems. There is considerable pressure on several skillsets, for example, therapists and community nursing as well as HR staff, estates, IT, and ambulance call handlers. This is compounded by gaps in long-term strategic workforce planning at a national level.
- Workforce and financial data are held by different organisations across different systems and formats, and are not structured in a way that is easy to join up across place.
- Existing workforce roles may not sit neatly with one place. Instead, they may be spread across many organisations. For some skillsets, there may not be the scale required to operate efficiently at an individual place level.
Shared learnings on practical tools and approaches
The following learnings have been drawn together based on the engagement and input into this programme of work.
Consider the nature of care that is required, both currently and over the next 5-10 years. Undertaking a strategic workforce planning assessment may be a helpful mechanism to understand some of the long-term changes to the types of role, skills, and the capability and capacity that will be required.
With this information, a clear plan for recruitment, retention, training, and education can be deployed to deliver the workforce roles and teams of the future. This could also help inform national level interventions on workforce supply.
In thinking about a team’s capacity to provide care, explore and identify any waste. Sub-optimal systems, processes, and planning can often mean that teams spend time on activity other than delivering care and contact with people using the service. Understanding the drivers of these drains on capacity and eliminating them where appropriate, guided by the teams themselves (who often have the deepest understanding of where and why inefficiencies develop), can help to release capacity.
While focusing on making teams as efficient and effective as possible is important, investing time to understand the drivers of demand on services is critical. A continued focus on consistent decision-making, preventative care, and effective intermediate care can reduce pressure on services as much as finding more capacity in the workforce.
Thinking creatively about how patients can be treated, successfully and sustainably, in lower acuity pathways, is a win for the patient, while also releasing resources to benefit those most in need of the services.
We hope that this publication will not be the end of the programme, but the beginning of a conversation. A series of events will be available to attend to explore the themes in greater detail and share experiences.
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