Plans to grow emerging roles within the primary care workforce may be jeopardised by over-stretched services and a lack of capacity in the education sector, according to a report.
The report, called In the balance, by think tank the Nuffield Trust, looked at how healthcare roles, such as physician associates (PAs), had been embedded into primary care.
It found that the expansion of roles had failed to consider lessons from history about how to embed and integrate effectively, such as for advanced nurse practitioners.
While it noted the ‘huge shift’ in the balance of roles in the NHS in recent years, which has been ‘particularly stark’ in general practice, ‘accelerated’ by the additional roles reimbursement scheme (ARRS), it highlighted concerns that this increase in staff would not necessarily help deliver the government’s workforce plans to address staff shortages, financial constraints and changing health needs.
‘There are risks that the supply of more staff jeopardises workforce plans,’ it said. ‘Ambitions around increasing annual education and training intakes – including a doubling of medical school places and nursing associate training places – are bold.
‘However, concerns have been raised that capacity for educational and practical learning opportunities, employers’ demand for and sponsorship of trainees in these roles, and the supply of trainees could be bottlenecks when scaling up certain roles.
’Evidence suggests that the educational content and experience for those in training for specific roles may not always adequately prepare them for the tasks they will be expected to perform,’ it stated.
The report also highlighted that while regulation was now being rolled out for PAs, the previous lack of this had been a concern for staff, and that ongoing clinical supervision, mentorship and peer support would be important for the successful embedding of additional roles, as well as careful planning.
The Nuffield Trust called on NHS England to openly outline governance arrangements for new roles and to publish up-to-date guidance on their scope and development.
It also said failing to address inconsistencies in pay across professions would also risk tensions between existing staff and new roles.
The report said: ‘The lack of attention to fairness in pay across professions, with some new roles having relatively high starting salaries compared with established professions, even if their subsequent pay progression opportunities are lower, risks worsening tensions.’
Commenting on the report, Nuffield Trust senior policy fellow, Dr Billy Palmer, said: ‘Introducing new and different staff roles to work alongside doctors and nurses has been a well-worn path for the NHS for decades. But in recent years, there has been a particularly dramatic shift in the size and shape of the NHS workforce, and future plans to expand staff numbers rest heavily on new and emerging roles.
‘This report shows that there are big challenges to overcome in bringing on any new role –ensuring existing staff have time to supervise them, having clarity on the scope of the new role, having the right checks and balances in place if things go wrong, to name a few.
‘These challenges can be overcome with careful planning, time and attention at all levels in the health system. But the NHS must take heed of the well-established lessons from history. The government’s review of physician and anaesthesia associates, and its wider refresh of the Long-Term Workforce Plan provide an important opportunity to set out some clarity over the transition and avoid further repeating the mistakes of the past.’
Caroline Waterfield, director of development and employment at NHS Employers, said: ‘Over recent years there have been many changes to roles and the composition of teams delivering patient care. Change has been evolutionary over several decades, rather than a recent phenomenon, and we expect to see this evolution continue. It is therefore critical to understand what has worked well, what has not been implemented well, and why.’
She added: ‘As the NHS develops a 10 year plan and revises the workforce plan to support it, it is critical that the findings from this work are central to the current design work and any future implementation plan.’
It comes after it was suggested last year that general practice had reached a ‘tipping point’ where most appointments are no longer delivered by a GP but by other direct care staff.
The Nuffield report was commissioned by NHS Employers, used data from the NHS in England, the Organisation for Economic Cooperation and Development (OECD), a literature review, focus groups with NHS employers and a survey.
