Integrated care boards (ICBs) – particularly their chief people officers – have a huge challenge ahead to ensure there are enough primary care professionals to change how care is provided in a health and care system out of hospital.
Alice McGee, chief people officer for Leicester, Leicestershire, and Rutland ICB, which covers a system that employs around 76,000 health and social care workers, says her remit is ‘to oversee how we support, develop, retain and attract the workforce for health and social care’.
‘A challenge for ICBs is that there isn’t a direct hierarchy – it’s around connecting, influencing and making sure we’ve got a common vision about what we’re going to tackle together – that’s all parts of health and social care,’ she says.
She says the ICB looks at the workforce in the same way as patient flow. ‘We need to think of the workforce in its totality because fixing one part won’t fix the problem,’ says Ms McGee.
Overall, the ICB’s workforce across the system has grown by 3% during the past three years. However, demand for primary care has grown by about 15% in the same period. Increased demand is driven by an ageing population, a growth in the number of people coming into the area, and rising patient expectations, says Ms McGee.
But the challenges the ICB faces are not just about increasing their numbers of health and care staff. It is also ‘how we use our workforce’, she says. For example, she says the traditional model of ’a patient wanting to see their GP’ is no longer sustainable.
‘One of our challenges is: how do we create new roles [via the additional roles reimbursement scheme (ARRS)], and how do we use them to supplement our direct patient care? How do we use our receptionists to become care navigators, and how do we skill them up so they don’t just manage appointments but become part of managing care? And how do we consistently – in a quality way – support primary care teams to transform to meet demands? Because the workforce isn’t there at the same rate as that demand is rising,’ says Ms McGee.
Another challenge, particularly in primary and community care, is that the deprived areas where care is most needed are also where it’s hard to attract healthcare professionals. ‘So, as an ICB, we’ve got to look at our solutions through a couple of lenses. The first is the system picture across the two million people, and the second is what we do in our places, which are very different and need different interventions,’ says Ms McGee.
Despite these challenges, she remains optimistic because ‘this is the first opportunity for integration to be at the heart of what we’re doing. We’re in this together’.
‘When I go to GP practices or primary care networks (PCNs), I’m not going as a commissioner – though there still is an element of that – I’m going as an ally, looking at how we are going to fix things together, and that’s a very different relationship,’ she says. In just a short time – ICBs were formally established in July 2022 – the ICB has brought about ‘some real changes in relationships, and in its approach to solving some of the workforce issues’.
The narrative that the ‘NHS is broken’ impacts the morale of staff, she says. ‘So it’s about how we avoid or recover from “morale injury” and how we instil hope.’
There have been, she believes, ‘some really positive system responses’ to workforce challenges. The ICB has 12 programmes that the workforce can access, focusing on areas as diverse as leadership and reverse mentoring. ‘We’re taking things back to being about job satisfaction. There’s a causal link between job satisfaction and retention. But if you can increase job satisfaction through leadership development, then you are more likely to stay and tell your friends – so you’re also attracting new people. And you’re more likely to deliver better care,’ says Ms McGee.
Individuals’ evaluations of the programmes have been ‘incredibly positive’, she says. ‘What we want is for people to feel like they’ve got a purpose, to feel valued, and to want to stay.’
The ICB is working with its training hub to help people’s career development in primary care, such as programmes for GPs with special interests or an interest in leadership. Ms McGee has also set up a primary care clinical leads network for women ‘to encourage and support primary care female leaders’.
To tackle workforce shortages, the ICB also makes professional interventions; for example, it has developed a pharmacy network led by the ICB’s chief pharmacist. ‘The network brings colleagues together to discuss issues, such as how to move between sectors in a seamless way without constantly recruiting from within our own pool,’ says Ms McGee.
For Ms McGee, ‘numbers and statistics’ are one part of the workforce solution. ‘They can help you prioritise and put your energy in the right place.’
However, she says there is ‘no silver bullet – you have to look at the whole picture’. ‘And while we have to think about the “here and now”, we also need to put enough energy into making solutions for the future’.
Ewan Maule, director of medicines and pharmacy for North East and North Cumbria ICB, and a member of the Royal Pharmaceutical Society (RPS) English National Pharmacy Board, says the crux of what is needed to tackle the workforce crisis is ’a strategic workforce plan across the system so that we’re not always “robbing Peter to pay Paul”, and to prevent people moving about the system in an unplanned and unsupported way’.
To help recruit and retain staff, it’s important ICBs support the development of clinical specialities, he says. ‘For example, we should be able to support pharmacists with an interest in diabetes or respiratory medicine, creating a business case for a higher level role for them, rather than seeing them go to work elsewhere. PCNs might struggle to do this development on their own, so ICBs should give this support.’
He says there are some areas where all of the pharmacists in new roles have come from community pharmacy, which, as a result, has become reliant on locums in order to operate. ‘So the ICB is trying to encourage all the different sectors to work collaboratively together, rather than taking staff from each other.’
To tackle workforce issues, he says the ICB ‘hasn’t gone down the road of quick fixes to recruitment and retention’. ‘We’re keen to make roles more satisfying. For example, we’ve developed a new service to diagnose and treat urinary tract infections in community pharmacy. We believe these sorts of services will make the job more clinical and therefore more satisfying to work in while, at the same time, relieving pressure on other parts of the system.
‘Rather than paying someone a ‘golden hello’, we believe in taking a strategic role to make the primary care roles more fulfilling, and that this will have knock-on benefits to the quality of patient care and relationships in the local healthcare system,’ he says.
The ICB is starting to make approaches to schools’ to make careers in healthcare more appealing’, he says. And it is also looking at addressing recruitment and retention across healthcare. ‘It’s very easy to take a single sector approach to recruitment and retention, but that won’t work – it destabilises all the other sectors, and the quality of care doesn’t improve. That’s why taking a strategic approach is very important,’ says Mr Maule.
NHS Greater Manchester ICB’s People and Culture Strategy focuses on a “one workforce” approach, supporting people to live well, empowering them to manage their health at home, and to take the lead on early detection. This strategy will be supported by a primary care workforce plan, which will include improving employment standards, ensuring more consistent employment practices and access to robust wellbeing provision. In addition, the workforce plan will support primary care employers to utilise the ARRS funding and strengthen the multi-disciplinary approach in primary care.
There will be targeted action to recruit and retain key primary care roles, including GPs, nurses, community pharmacists, NHS dentists, and dental nurses working in partnership with Health Education England. And the ICB will be looking to improve workforce data in areas such as primary care to support better workforce planning.
Pharmacy, optometry, and dental commissioning were delegated to Greater Manchester as part of its devolution agreement in 2016. The ICB continued with this arrangement – a formal delegation from NHS England to the newly formed NHS Greater Manchester ICB took place on 1st July 2022. This has allowed the ICB to continue with its integrated primary care commissioning model and to build on the already strong relationships with the contractor groups in these areas.
Janet Wilkinson, chief people officer for NHS Greater Manchester Integrated Care, says: ‘As an integrated care partnership, we are committed to taking action now to tackle our workforce crisis.
‘The challenges we face are not unique to Greater Manchester. However, we are able to build on the strong collaborative working we have established over the last seven years to take a more integrated approach.
‘We are working to tackle the challenges across both health and care – to create the conditions to allow our people to provide the best possible care within the financial envelope. It is important that the action taken is effective, coordinated and sustainable – so that the changes we make can support our workforce and our services in the years to come.’