As the Countess of Chester NHS Foundation Trust (COCH) embarks on a new workforce strategy, supporting staff well-being and better patient care, Dr Nigel Scawn, Executive Medical Director, was the key speaker at a workforce planning webinar. He shared how strategic workforce planning has unlocked real-time insight and proactive forecasting to anticipate future staffing needs based on demand pressures.

Partnered with SARD JV, the joint project has transformed long-term job planning and resulted in 97% of consultant job plans signed-off (from just 18.5%). What started as a deep dive into the job planning process became the catalyst for changing how the trust could be better equipped to manage clinical capacity and demand.

It was a necessary exercise because every speciality runs differently across the trust. Information was gathered from 303 job plans across the Trust’s 30 specialities. By working with clinical consultants to make enhancements to job plans and processes, this became more streamlined. According to the NHS England Medium Term Planning Framework, 95% of medical job plans should be signed off by the end of 26/27. With the expectation from NHS England that job plans will be linked to capacity and demand, the onus is on trusts to understand how they allocate resources.

At COCH, there was a need to align job plans to clinical need, for example, in ophthalmology, the cataract waiting list is non-existent because that goes out externally, when what is needed is glaucoma outpatients. They are faced with demand for glaucoma outpatients and operating lists for cataracts which are unfilled because there isn’t a waiting list to do it.

Dr Scawn makes the point of ‘the necessity to plan around local pressure points which exist in the NHS and to factor in expectations and demand of the population. That way, the trust aligns its resources to the local service demand which improves patient care. But we need to know how much Direct Clinical Care (DCC) there is for emergency and planned care (the time consultants spend on patient based activities in their job plans) and how much Supporting Professional Activities (SPA) we have to understand what our capacity to deliver work looks like, and not base it around trying to manage what comes through the door.’

The trust suffered from poor compliance. On the NHS England advanced level of attainment, the trust was at Level 0 (on a scale of 0-4) early last year. But soon moved up to Level 3 on completion of the programme.

Lots of consultants had input activity which wasn’t signed off. They were still using paper spreadsheets and with no evidence that annual planning had been taking place. Staff were inconsistent with how they completed job plans, using generic language e.g. different descriptions for the same unit of activity, making it difficult to measure. SARD enabled a set generic language which could be measured and audited.

They procured a new job planning system, and chose SARD JV who worked with consultants, ran specialty specific training for clinicians and supported the drafting phase. After running diagnostics on the old job plans, the trust reassured staff that this wasn’t a cost cutting exercise to keep them engaged with the process. The trust had a cost pressure of 1.4m putting them in the bottom tier for finance which resulted in the urgency to manage capacity demand. Whilst job planning identifies inefficiencies in clinical planning, going through the process allowed the trust to make comparisons across specialities to better understand inconsistencies in staff capacity, which led to the overspend.

There was ambiguity over how to complete job plans such as multi-tasking instead of declaring each activity separately. SARD worked with consultants to fill in their job plans and prepared job planning templates. In the NHS, general surgeons do a “hot week” or “hot activity’. This refers to periods when consultants are rostered to be on call to deal with emergency cases or inpatient care every ten weeks and so templates were pre-built to incorporate this, making it easier for specialities.

They established a job planning consistency panel to refine what was allowed on the SPA, whilst ensuring they were clear and challenged on hours worked and staff allocation. Where staff were on three different pay scales, the job planning policy was applied to define roles and correct levels of pay. Dr Scawn identified that ‘the actual job plan needs to be done by the divisional clinical leads but they require baseline data about capacity demand.’ By knowing what has changed within the trust – for example, five years ago an average ED attendance was 170 patients a day, now it’s over 300 patients a day – job plans can align to the capacity. Equally, systems must be installed which can be interrogated without reliance on spreadsheets.

Dr Scawn explained that ‘it’s about analysing data to be able to forecast – how many PAs we have for theatre or for ophthalmology and to discuss with consultants the decrease of theatre time or increase of outpatients time – using the example of glaucoma, in a year’s time, that might reverse and glaucoma may be under control but we need to analyse the job plans as a system. It doesn’t solve everything but job planning needs systems to get a fuller picture annually of what is or isn’t working and requires more resources.’

Disclaimer: This information is provided for general guidance only. It may not reflect the most up-to-date NHS policies or local Trust practices. Always refer to current NHS guidance and your organisation’s policies for definitive information.