National health and social care workforce plan: part three

Part three of the plan sets out how primary care services are in a strong position to respond to the changing and growing needs of our population.

Conclusion and Next Steps

We are rightly proud of the many achievements our primary and community workforce have delivered to improve Scotland's health, which is recognised in the continuing high levels of patient satisfaction with the care they receive. Whilst the workforce has continued to respond to increasing demand for services, we recognise that change is needed to ensure continued sustainability.

Getting primary and community care right is an essential element of ensuring the whole healthcare system delivers the highest quality care for its patients and promotes health and wellbeing among its staff. This plan therefore focuses on developing, building and expanding multidisciplinary teams, made up of professionals each contributing their unique skills to managing care and improving outcomes. The key principle underpinning the reform of primary care is that patients receive the most appropriate treatment in the most appropriate setting, when they need it.

To deliver this vision we have set out a series of ambitious commitments to significantly increase the primary care workforce, backed by a historic increase in investment in primary care. This is supported by the reshaping of roles and responsibilities as set out in our historic Memorandum of Understanding with Integration Authorities, the British Medical Association, NHS Boards and the Scottish Government. This plan begins to outline how we intend to deliver these pledges. What is clear however, is that we are already seeing considerable benefits from enhanced MDT working and new models of care across Scotland. This will gather pace in the coming years through the initiatives we and our partners are taking forward. Table 7 below summaries the commitments we have set out in this plan.

Leadership capability and capacity is fundamental to the effective organisation and nature of MDTs and the wider reshaping of primary care in Scotland. The re-focused role of the GPs as an Expert Medical Generalists will ensure strong connections to, and coordination with, the enhanced primary care team, health and social care community based services and with acute services where required.

We recognise the continuing need to improve the quality and breadth of data available to local and national planners. Going forward, the NES data platform will be crucial in supporting more integrated local, regional and national workforce planning in health and social care. This plan sets out a number of specific additional actions that will improve the data we have on the primary care workforce.

Integrated and collaborative workforce planning will become increasingly important in the period ahead. An integrated workforce plan will be developed later in 2018, bringing together progress on workforce planning, and allowing us to move towards a better articulated, holistic vision for the totality of the health and social care workforce. The establishment of the National Workforce Planning Group, involving representatives of health and social care workforce staff, employers and policy development, will provide a strategic focus for workforce planning. Ministers are clear that the Group has an important role in contributing to promoting change in workforce planning to ensure that the NHS and social care sectors in Scotland can continue to meet the needs of service users and provide rewarding careers for staff.

Table 7: Key recommendation and actions in reforming primary care services


Supporting Actions

Facilitating primary care reform

1. Reform of primary care is driven by developing multidisciplinary capacity across Scotland. Workforce planners including NHS Boards, Integration Authorities and General Practices will need to consider the configuration of local multidisciplinary teams that offer high quality, person-centred care.

2. In recognition of an ageing workforce, local planners have responsibility for workforce planning and managing anticipated levels of staff turnover.

3. The implementation of the new GP contract will require services to be reconfigured to maximise workforce competencies and capabilities, and ensure people see the right person, at the right time and in the right place.

4. The National Workforce Planning Group will play a strategic role in implementing the recommendations of part three of the plan, and strengthen the development of approaches for the primary care workforce.

5. An integrated workforce plan to be published later in 2018 will move towards a better articulated joint vision for health and social care workforce planning

  • Increasing in funding in primary care by £500 million by the end of 2021-2, including £250 million direct support of general practice. This investment will see at least half of frontline NHS spending going to community health services.
  • Implementing the terms of the MoU over the next three years through the development of local Primary Care Improvement Plans.
  • Establishing a National Oversight Group to support service change over the next three years to ensure that patients receive the right service at the right time from the right profession. First meeting of Group in Spring 2018.
  • Three year Primary Care Improvement Plans to be submitted by Health and Social Care Partnerships ( HSCPs) by July 2018 setting out proposals to transform and improve local services.
  • Working with partners to support the health and wellbeing of the workforce.
  • Continuing to help local partners test new ways of delivering primary care services through the Primary Care Transformation Fund. Publication of evaluation report by end 2018.
  • Publishing an integrated workforce plan later in 2018 bringing together progress on Parts 1-3, allowing us to move towards a better articulated, holistic vision for the health and social care workforce.

Building primary care workforce capacity

6. Significant investment will be made available over the next 3-5 years, as part of the First Minister's commitment to an additional £500 million for community health services, to plan for, recruit and support a workforce in general practice, primary care and wider community health, including community nursing.

7. Scotland's multidisciplinary primary care workforce will become more fully developed and equipped, building capacity and extending roles for a range of professionals, enabling those professionals to address communities' primary healthcare needs.

8. As part of national, regional and local activity to support leadership and talent management development, planners will need to continuously consider staff training needs in their workforce planning exercises; invest appropriately so that leaders in primary care are fully equipped to drive change; and enhance opportunities for the primary care workforce to further develop rewarding and attractive careers.

  • Delivering an additional 2,600 nurse and midwife training places over the life of this Parliament, including a 10.8% increase in places for 2018/19, to ensure we can recruit and train the next generation of staff.
  • Investing £3 million to train an additional 500 advanced nurse practitioners by 2021.
  • An investment of £3 million over three years into training and education needs of general practice nursing.
  • An additional £3.9 million over three years into training and education needs of the wider community nursing team, including district nurses.
  • By September 2018, we will work alongside partners, including the Royal College of Nursing, to better understand the requirements and investment necessary to grow the District Nursing workforce.
  • Increasing the number of health visitors by 500, supported by funding which has increased over four years to £20 million annually, recurring.
  • Working with our partners to deliver our commitment to expand medical school and training places, helping deliver a commitment to recruit at least 800 (headcount) additional GPs over the next 10 years.
  • Investing in the Scottish Graduate Entry Medicine ( ScotGEM) programme, a new four year course in medicine focused on general practice and remote and rural working commencing Autumn 2018.
  • Recognising the unique recruitment and retention challenges, offering a package of enhanced support for GPs working in remote and rural areas.
  • The establishment in Spring 2018 of an Increasing Undergraduate Education in Primary Care Working Group to consider ways of increasing undergraduate education in primary care settings.
  • Delivering a marketing and recruitment campaign in 2018-9 to promote Scotland as a great place to work as a GP, and to attract individuals into nursing and midwifery careers.
  • A marketing campaign to attract individuals into nursing and midwifery, allied health professional and other health and social care careers.
  • Delivering on our commitment that all GP practices to have access to pharmacist support by the end of 2021.
  • Increasing the mental health workforce in A&Es, GP practices, police station custody suites by 800 by iinvesting £12 million in 2018-19, with annual investment thereafter rising to £35 million by 2021-22.
  • Developing an enhanced role for allied health professionals in supporting patients' needs, including promoting prevention and self-management with improved access.
  • Recruiting 250 Community Links Workers by 2021 to help address patients' holistic needs.
  • Training 1,000 paramedics to work in the community, helping to reduce pressure on A&E services.
  • Enhanced training and support for practice managers and practice receptionist to develop their roles, supported by continued investment.

Improving data, intelligence and infrastructure in primary care

9. More integrated workforce data for primary care is required, in the context of the workforce data platform being developed by NHS Education for Scotland.

10. Local planners should consider workforce planning tools (such as the six step methodology) in developing their workforce strategies to address local population needs.

11. Planning for future staffing in primary care should identify and make use of available guidance and intelligence on local recruitment and retention issues, and of wider developments in workforce data and scenario planning.

12. The Scottish Government will publish the Primary Care Monitoring and Evaluation Strategy 2018-2028 by June 2018.

  • Enhancing workforce data across three broad GMS contract areas: workforce, GP income and expenses, and quality improvement. Submission of enhanced data to commence by end of 2018.
  • Improvements underway in collection of AHP, pharmacy and optometry workforce and activity data.
  • Developing the NES workforce data platform and supply modelling during 2018 to drive more integrated workforce planning.
  • Delivering the next generation of GP clinical IT systems in Scotland by 2020 to help enable facilitate efficient and effective working.
  • The Primary Care Digital Services Development Fund, 2016-2018 delivering a wide range of systems enhancements, infrastructure improvements and innovative trials of new tools and technologies.
  • Investing in local analytical ( LIST) capacity to inform and drive service design; 65 analysts ( WTE) in place by April 2018.
  • Continuing to support the roll out of the Scottish Primary Care Information Resource, with 85% of GP practices able to use SPIRE by the end of June 2018 with the remainder able to use it by December 2018.
  • Publishing a monitoring and evaluation strategy to capture and share learning from the reform of primary care in by summer 2018.



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