General Practice has a workforce crisis Dr Hari

General Practice has a workforce crisis. Dr. Hari Pathmanathan Chair East & North Hertfordshire CCG

East & North Hertfordshire CCG • • 60 member practices 572, 846 patients Budget £ 566, 000 362 GPs (284 WTE) ENHCCG LAT NHS Patients per FTE GP 2019 1982 1600 % FTE GPs aged > 55 24. 4% 22. 9% 22. 7%

The problem is that there is a shortage of GPs in East & North Hertfordshire CCG. This makes the local health economy unsustainable. GPs are essential for a UK style healthcare system. Gatekeeper role that ensures cost effective healthcare. Ageing population and rising demand Government policy to deliver more care in the community. Data shows that there is a retirement time bomb and we are currently under doctored. To reach England’s average list size, we need an extra 74 FTE GPs. The objective is to recruit and retain an additional 74 WTE GPs to East & North Hertfordshire CCG by August 2017.

Root Cause Analysis Policy Premises Early Retirement Poor primary care estate, space. Burnout due to targets, hours, changes Lack of respect for profession. Tax and pension changes. High buy in costs, outdated partnership model. Greater female workforce (PT work) Isolated, silo working. 24/7 culture High property prices in Herts. and buying into partnership. Trainees move to London or Australia. Retirement of overseas doctors who worked in deprived areas Demographics GP Workforce Crisis Be part of a larger organisations. Lack of personal and career development Poor pay. Workload, visits, OOH. Recruitment Retention

Strategy Selection Root Cause Strategic Options Timely Resource Impact Premises New, purpose built. Health Campus N N H H Policy Patient education N L L Early Retire Retain, pay, models Y H M Demography Salaried, Large employer Flexible working, Rotations Y L H Recruitment Advertising Incentives Salaried Schemes Y Y Y L H L M M H Retention Pay, Incentives Rotational job plan with variety Salaried Schemes Y Y Y H L L M H M

Strategy The CCG as an employer will recruit salaried GPs, predominantly from local training schemes. The GPs will have the following job plan for 3 years: 4 Clinical sessions in practice with CCG Board GP mentor 2 sessions in OOH/AIVS/UCC/Hospital Clinics 2 sessions in commissioning/GP education (working towards a qualification e. g. MBA) The doctors we hope to attract will be like the HIV virus infecting our organisational cells and be the catalyst to a change in culture.

Implementation Plan Project Group of key stakeholders -CCG, LMC/GP Federations, HEEo. E, University, Hospital, HUC Business Case June 2015 Pilot 24 posts August 2015 (4 in each locality) Evaluate March 2016 (future employer) Further 24 posts August 2016 Full staff numbers August 2017 Replacement posts 2018

Evaluation Plan Uptake of posts Wave 1 August 2015 (process) Retention, effectiveness at 6 months: soft intelligence and appraisals (process) Staffing levels at August 2017 (outcome)

Progress • Draft business case discussed at CCG Board • Escalate to CCG priority but deliver as part of CCG Primary Care Strategy, so tackle both GP and nursing recruitment and retention. • Project group involving stakeholders to be led by Board GP and Director of Nursing. • Delivery vehicle will be new Integrated Provider Board, longer term and sustainable. • Concerns of future provider size, market in NHS, can of worms!

Leadership lessons Multifactorial problems across organisations do not have a simple solutions. I felt the need to make a start rather than wait for political masters to come up with the wrong solution. Leadership is about engagement and a shared approach to problem solving. Working in groups, tackling the group dynamics (organisational boundaries) and a degree of flexibility are key. Don’t meet resistance with resistance!