A competence based approach piloted by NHS North West is showing great potential to achieve affordable workforce planning, as the authority’s assistant director of workforce strategy Robert Sumpter reports.

Competence based workforce planning is an approach being piloted and developed by NHS North West and shows enormous potential as a “bottom up” approach to affordable workforce planning for individual services, pathways or departments within NHS organisations.

Anita Marsland is chief executive of Knowsley Health & Wellbeing, one of the organisations piloting the competence based planning approach in the North West. She explains:

“We were very keen to participate in the pilot as it was an approach we were seeking to develop for commissioner led strategic workforce planning. The competence based planning methodology has enabled us to map our future workforce needs to the end of life and long term conditions care pathway models, thus facilitating workforce planning which is linked clearly to the needs of the service users, commissioning intentions and financial viability.”

The key objectives for Knowsley are:

  • To establish workforce competence profiles for each of the eight care pathways which will feed into workforce and education commissioning planning.
  • To achieve cost efficiencies by basing workforce models on the needs of service users rather than traditional roles/professions.
  • To explore skills and band/grade mix through competence sampling activity.
  • To establish a more flexible and further integrated workforce within and across organisational boundaries.

“We have found the methodology adaptable to our needs as an integrated health, social care and leisure and culture organisation,” continues Ms Marsland.

“The board and the commissioning team are fully committed to this work and the inclusive approach has ensured support from our workforce and staff side colleagues. We have also had involvement in the project from local GPs and private, voluntary and independent sector colleagues which has ensured inclusion of the wider community workforce considerations.”

There are three main phases of work:

  • Competence mapping
  • Competence sampling
  • Modelling possible workforce options for the future and then decision making

The competences for undertaking mapping exercises are readily available from Skills for Health via their website.  These competences can then be mapped to the individual requirements set out in job descriptions; and then organised into a manageable number of “clusters” which relate to the same broad area of a postholder’s responsibility per the job description – e.g. “care planning”. The exercise does depend on accurate and up to date job descriptions being available.

Competence sampling is what most vividly distinguishes competence based workforce planning from other approaches to workforce planning. Many previous initiatives have used competences to help design individual new roles; but have not attempted to quantify the amount of time that is spent by all the members of a team in each competence area to deliver a service. Without this quantification, it is difficult to see how competences can be used as a basis for workforce planning.

There are several methods which can be used for collecting this data – including using a specialist contractor, hand held data recorders and diary sheets.  The resultant data will give a very good picture of the competences deployed by members of a team, providing an evidence base for the modelling and planning work; and is a huge advance on the pre-existing situation whereby there is no such data to inform the options for job design and workforce planning.

The information can then be used to begin generating possible future workforce models.  There are two important factors which will normally become very apparent at this stage.  Firstly, there are many competences that are shared by different members of the team of varying grades.  It may be appropriate for these competences to be shared – but it is also reasonable to question whether the degree of overlap needs to be so great. 

Secondly, there are many competences that are shared by members of different professions – and others which could be if members of the team were developed in this way.

Taken together, these factors open the way to new workforce models based on patient needs and affordability. In particular, the door is opened to much of healthcare being delivered holistically by a team member with the competences the patient needs without recourse to input from a series of members of different professions.

Registered professionals will still have key roles to play in areas such as assessment, supervision and specialist skills; but much of the day to day input can be provided through roles such as assistant practitioner.

Furthermore, for the really ambitious, the door is open to developing whole teams around particular services or pathways. As well as assistant practitioners in, for example, end of life care; why shouldn’t there also be support practitioners, registered practitioners, senior practitioners and advanced practitioners?

Such fundamental change would take time to implement – and it would be dependent on the availability of and funding for appropriate education, training and assessment programmes.

Nonetheless, the prize is great. The exercises that have been done so far have all generated perfectly viable future workforce models which show financial savings between 10 per cent and 24 per cent when fully implemented. Such exercises should probably also be integrated with the workforce implications of any service and/or process redesign initiatives which are planned. 

Given the lead times to develop the new shape and size of workforce, competence based workforce planning needs to be viewed as part of the longer term affordable workforce strategy; and implemented in timescales which are calculated to avoid redundancies by using natural wastage and redeployment policies sensitively.

Whatever individual elements are included in individual affordable workforce strategies, care should be taken to ensure balance against a number of axes including:

  • Cash releasing vs. maintaining/improving quality, patient experiences, coherence with other priorities;
  • Workforce redesign vs. service and process redesign;
  • Top down initiatives vs. bottom up initiatives;
  • Commissioner responsibilities vs. provider responsibilities;
  • Short term actions vs. short term payback;
  • Short term actions vs. longer term payback;
  • Long term actions with long term payback.

The time and effort needed to prepare and implement a viable affordable workforce strategy may well be considerable. However, the option of not doing so is simply not tenable given the financial constraints the NHS faces.