HSR UK and The Shelford Group Webinar Two: Reform

To deliver the best care for patients, current workforce issues need to be addressed – the NHS needs more people, with the right skill sets, in good physical and mental health. Latest NHS workforce and vacancy statistics show that there are over 112,000 vacancies across the NHS. With demand on healthcare services predicted to grow, the lack of a sufficient workforce, in number and mix of skills, is already impacting on patient experience, service capacity and productivity and constrains our ability to transform the way we look after our patients.

The NHS Long Term Workforce Plan highlights the need for the NHS to work differently -by enabling innovative ways of working, with new roles as part of multidisciplinary teams. The plan commits to growing the proportion of staff in newer roles such as enhanced, advanced and associate roles from around 1% to 5% by the end of the Plan. Applied correctly, workforce research and data can help us to better understand some of the opportunities of new roles and how to optimise their position within multidisciplinary teams.

Held on 22 May 2024, this webinar held in partnership with HSR UK and The Shelford Group was an opportunity for healthcare service leaders to hear directly from workforce researchers about their latest insights into skill mix and implementation of new roles across the NHS. Colleagues from across the Shelford Group and beyond were joined by Dr Mary Halter, Associate Professor Emergency Cardiovascular and Critical Care Research at Kingston and Professor Damian Hodgson, Professor of Organisation Studies at Sheffield University Management School.

Research into non-medical practitioners

Dr Mary Halter presented evidence threads from her research into non-medical practitioners. With the decision to implement new roles driven by a number of factors including rising patient demand, workforce shortages and career advancement, the studies showed:

Quality and safety: Comparable patient care and performance against standard measures such as re-consultation rates in primary care or ED. A study of Physician Associates (PAs) in secondary care also showed that the PA role can provide continuity and stability, free up junior doctors for training and relieve the medical workload.

Mixed views and contested boundaries: There can be confusion around roles and professional identity with evidence of negotiated, accepted and contested boundaries of jurisdiction.

Scope of practice and regulation: An absence of regulation means that some new roles are working within constrained scopes of practice – for example Physician Associates (PA) are unable to prescribe leading to double handling of task management and a lack of clarity around responsibility. In fact, the research showed this to be the chief inhibiting factor to PA employment.

Staff, patient and public role understanding: Patient participants did not clearly understand the PA role, and most were unaware they had met a PA or still referred to them as a doctor, even when clear explanations were provided.

Independence, supervision and interdependence: There are varying levels of supervised or autonomous working between organisations. A hidden cost of supervision for senior clinicians was also identified.

To view Dr Mary Halter’s presentation click here. 

Research into primary care and mental health settings

Professor Damian Hodgson shared research that he has conducted in primary care and mental health settings about skill mix and implementation of new roles in the NHS. Key lessons from his primary care research includes that while the motivation for new role introduction is typically vertical substitution (i.e. delegating some of the work of clinicians to more junior colleagues to free up senior clinician time), the reality is that the introduction of new roles comes with an increased workload for training and supervision, where accountability remains with the senior clinicians – and the need for service or process redesign is often neglected.

Initial findings from Professor Hodgson’s mental health research have identified a number of key internal and external enablers to new role implementation. Internal enablers include having a strategic approach, clear communication about what a role can and cannot do, presence of a clinical champion and sharing examples of successful implementation. External enablers include having national guidance and frameworks in place, creating opportunities for shared learning and having good communication as well as adequate, sustained funding in place. For a full list of enablers please view Professor Damian Hodgson’s presentation here.

As an area of the NHS which has more vacant positions than the rest of the NHS, the next phase of Professor Hodgson’s mental health research will look at how new roles are implemented and integrated in practice, and how this affects staff experience and care for patients/service users.

Connecting research and practice

Following the presentations, attendees had the opportunity to explore whether the research resonated with practitioner’s experience on the ground, and to share reflections that built on the collective knowledge of the two communities.

Specific areas of focus included:

• The importance of sharing and disseminating research into new roles and skill mix: Colleagues welcomed the opportunity to hear more about the evidence for introducing new roles in the NHS, given national policy drives to increase the proportion of staff in newer roles.
• Potential to co-create future research priorities: As well as broadening practitioners’ knowledge of some of the latest workforce research, colleagues were able to identify areas which would benefit from further research in this area. This included a call for further qualitative research into the impact of the introduction of new roles on patient care.
• The importance of ongoing dialogue between research and practitioner communities: The webinar reiterated the value of connecting research and practice communities – service leaders are eager to hear more about the research available and researchers want to utilise this relationship with frontline professionals to help prioritise their research and ensure it adds value to the field of health and social care.

This webinar is the second in a series of events intended to provide a platform for continued dialogue between academics and practitioners, bridging the gap between research, policy and practitioner communities. For more information please contact [email protected].

Ellie Carter

Senior Policy Fellow and Associate Director of Operations, Shelford Group