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The Future of Primary Care - Is there one? 

HealthChat with Mike Bewick, Clare Gerrada and James Kingsland.

19th January - HealthChat evening - details here 

Grow my own
News and Comment from Roy Lilley

The press have just woken up to the fact that NHS Trusts are recruiting nurses from overseas. It's not really new news. Here is a story from last year.


The panic is based on an HSJ story (good graphics); they did a write-round to ask how many overseas nurses had been hired. Aside from the fact that I should have thought Trusts are quite busy enough without having to count nurses to help polish-up old stories, I don't see that this maters?  In fact the HSJ later, sensibly, published a clarification, demurring from the more lurid conclusions.


The HSJ tells us, last year, about 120 'foreign' nurses a week (5778 in total) were shipped-in to add to the compliment of 370,327 nurses working in the NHS; mainly from Portugal (where there health services are in meltdown) and Spain and Italy... both places in not dissimilar dire-straits. There are a good few from the Philippines where the authorities over train nurses numbers expecting them to go overseas and send money back home to look after families. Just like Irish pubs; there are Philippine nurses all over the world.


The story sub-text; are 'foreign' nurses any good? By all accounts the Portuguese nurses are trained to a higher level than ours. Spain and Italy? If they are good enough to look after their own grannies why wouldn't they be good enough to look after ours?


Language, conversion; familiarity with 'our ways' will be an important issue but at one Trust I visited (I won't name them, they don't want the press camping on their doorstep), the induction was terrific, thorough and ongoing. Young nurses being home-sick seemed to be the biggest danger, coming a close second to explaining what 'spending a penny' really meant! Competency levels were very high.


EU rules facilitate the free movement of labour and Ministers are tightening the rules to allow the regulators to introduce language tests... more bureaucracy. Trusts, the employers, should do it and be held to account for it.


Today's 'panic buying' of overseas nurses has an interesting root cause. Most explanations stop at the Francis report; better nurse-patient ratios were needed. NICE produced fatuous guidance (Wait for something to go wrong, wave a red-flag and ship-in some more nurses), publishing nurse numbers became de-rigour and the search for nurses was on.


The root-cause predates Francis. Trusts, desperate to balance their books to achieve Foundation Status, deliberately under-estimated staff numbers. Staff are the biggest cost centre and trimming numbers can be the difference between balance and not. That rolled into nurse recruitment forecasts made by the health education authorities and the under estimate cascaded into planning and commissioning training places. Hence today's shortages; an endogenous cause.


What to do? Better workforce planning, obviously.  That's the real story; HEE's Workforce Plan for England has emerged. This is a draft (Version 14); full of really interesting numbers and analysis. They recognise workforce planning is in two, mother-of-all-messes. The mess we are in now (not enough of anyone) and the mess we are likely to be in the future.


If the NHS 5YFV redesigns services then the staff roles, jobs, locations, skills and training will change, too. We don't want to be locked into the work and training patterns of the past.


HEE describes the problem and rakes over the past. Their three key objectives are summarised on page 5. One; there's not much they can do about the present problems except 'be supportive'; two, in the interim 'more of the same'; and three, 'invest in service transformation'.


The nurse numbers (page 9) are worth a good look. Page 11 is a really interesting peep into the future: physician associates and assistants; broad based training pilots; changes to the Foundation Programme; discussion around the complex, interconnections of change and new demands.


This is an ambitious, thoughtful document that is destined to fail. Fail for no reason other than it tries to write the future, today. My concern is they don't have enough wriggle room and the training system won't be nimble enough to respond.


If I was running a Trust I'd set up my own Super-HCA training scheme, based on the enrolled nurse curriculum. I'd find a friendly Uni to credential it and call them St Agnes FT Certificated HCAs. I'd stop short of calling them nurses and avoid palaver with the NMC. I'd have control over a flexible and trained-for-the-job workforce.  I'd use existing freedoms to establish my own pay scales.


I'd do what Dad did, in the war, when the good stuff was in short supply; I'd grow my own. 


What's the future for primary care?

If you want to know, too, join me, the NHSE Primary care Tsar and Deputy Medical Director Mike Bewick, leading GP Dr Clare Gerada and the president of the NAPC and former policy advisor Dr James Kingsland, at the Kings Fund for a night of

 The Big Conversation about Primary Care. 

  Details here. 


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