Published: 03/02/2005, Volume II4, No. 5941 Page 34 35

A growing population needs a larger healthcare workforce. HSJ finds out what is being done to attract and keep it

Simply recruiting more staff is no longer the answer to workforce shortages in the east of England. Instead, regional human resources teams are placing greater emphasis on retention, the introduction of new types of job and attracting new blood - both domestically and from overseas.

Each of the area's three strategic health authorities is adapting this approach to address its problems. In Norfolk, Suffolk and Cambridgeshire, a growing population places additional pressure on services. In Leicestershire, Northamptonshire and Rutland, their challenge is to develop flexible roles for mature workers. Meanwhile, the focus in Trent has been the use of overseas recruitment for hard-to-fill vacancies.

In East Anglia, huge annual increases in workforce numbers are required just to maintain the ratio between staff and the growing population. 'In the year ending March 2004, the total number of staff grew by 5 per cent and we are predicting a similar rate of growth over the next few years, ' says Norfolk, Suffolk and Cambridgeshire SHA strategic human resources manager Jill Offley.

There are currently 53,000 people working across the region, but each year an additional 2,500 whole-time equivalent posts are required. 'That is why we have to retain better and develop new roles, ' says Jill. The SHA has devised an approach it hopes will both reduce vacancies and boost health equality. In January it launched a sixmonth project to bring refugees into the NHS. The programme will draw up guidance on how to encourage these members of the community into the workforce.

The recruitment of allied health professionals has been a particular problem and the SHA has set up a project to ensure that good candidates are not lost. 'It is getting the simple stuff right, ' she says. 'We share applicants across trusts, so if there are three good candidates for one position, one will get the job, but the other two will be put forward for other vacancies in the region.'

And Jill and her colleagues have devised a monitoring system for those leaving the service. 'We are following leavers and identifying if people are leaving because there are problems.' Further north, in Lincolnshire, a growing population - including a large number of retired people - places pressure on the NHS. Trent workforce development confederation associate director of workforce development Jane Johnson puts dentists at the top of her wish list: 'There is a national shortage, and we are now unable to offer NHS dentistry in certain areas, ' she says.

But going abroad to recruit has paid off. 'Eight Spanish dentists will take up posts in the county, ' says Lynne Moody, lead for international recruitment at Lincolnshire South West teaching primary care trust. 'We placed a nationwide advert in Spain and interviewed 13 people for posts.' The new posts will go live in April.

This is unlikely to be the last group coming to the region, which has a formal link with a Spanish academic institution.

To date, the international co-operation has brought eight GPs to the area. 'We have a franchise agreement between Lincolnshire and the Asturias region of north west Spain, ' says Lynne. 'It is a kind of twinning.' Bringing staff here may be the easy bit, employers need to make a real effort to ensure they are encouraged to stay in their new posts. 'It is important to encourage them to stay; that means providing an induction, linguistic support and pastoral care, ' explains Lynne.

In the neighbouring district, they have distilled their problems down to a single issue. 'If we could keep people aged 5065, we would solve our problem, ' says Trish Knight, director of workforce development and commissioning at Leicestershire, Northamptonshire and Rutland workforce development confederation.

But how can the WDC overcome such an acute problem? Its own research shows an exodus of experienced (non-medical) staff. It currently employs 3,800 workers aged 40-44, 2,300 55-59-year-olds and only 700 workers in the 60-64 age range.

'Leaking that number of experienced staff is ridiculous.' The key, ' she adds 'is taking each person on an individual basis. Some people are just tired after working in their job for 20 years. In that case maybe we can offer a two-day-a week job. This is preferable to having them leave completely.' However, she is aware of the cultural obstacles to this approach. 'People in these circumstances may already be financially secure and their motivation for working may be different, ' she says. 'Also, the approach needs to be right. If it is perceived as a way to help them [the staff], That is one thing, but if they see this as them solving our problem, the view will be different.' The strategy has not yet been introduced to the region's trusts and Trish cautions that it will not be mandatory.

The WDC is also looking in some innovative places for new staff. 'We have a support workers project looking at attracting people in deprived areas. So far more than 40 have been recruited.' Posts filled this way include administration, laboratory posts and positions in ambulance services. 'Everybody [on the programme] receives a short training course, including literacy, numeracy, details of the NHS, health and hygiene. They are also guaranteed an interview, ' says Trish.

Refugees and members of minority ethnic groups are among those who have already benefited from the scheme.

While many trusts struggle to attract returners, Leicestershire, Northamptonshire and Rutland WDC has been successful. In the six months ending 30 September, 62 nurses, three midwives and three healthcare scientists took up posts after a career break. A further 18 allied health professionals also returned.

'The problem is where to find the people, but we distributed leaflets to libraries, pharmacies, GP surgeries and supermarkets, ' says Dianne Panter, the WDC's recruitment, retention and return manager. 'Anywhere we thought we would find them.' The WDC also attempts to capture nurses and midwives who didn't complete their pre-registration courses. 'Under the Lost Performers project, those who have not completed their courses are given information packs outlining other ways they could work in the NHS.' She says this approach has particular advantages.

'Although they have not finished their training, they will be more experienced than people off the street and we are helping them to get a job - they may not want to be a nurse, but they may want to be a secretary, for example.'


Kerri Ellis's boss describes her as the world's first diabetes care technician.

A bold claim, and one Kerri is not entirely sure is true. But she is 100 per cent certain that the role, which Greater Peterborough Primary Care Partnership began three years ago, is making a massive difference to the treatment of people with diabetes.

It is also providing a huge help to GPs and nurses in the Peterborough area. 'I do about 200 patient annual diabetes reviews a month across seven GP surgeries and two hospital clinics, ' she says. 'This frees up doctors and nurses to do things their expertise allows. I am not a specialist, but I know my stuff. It is not necessary for surgery staff to do these checks when they can be done by a B-grade.' In her experience diabetes care is an area some surgeries can struggle to manage. 'Before I started, some surgeries were way behind with their reviews and others had nothing at all.' She adds that at first some staff had reservations about the scheme, but now 'nobody has anything negative to say'.

During the checks, every patient has a 20-minute session, during which their weight, blood pressure, blood sugar and urine are checked. She also examines their feet to check circulation. 'There is a lot of responsibility there. If you do not spot something, then the patient may have to wait another year, ' she says. 'We provide advice and if more intervention is needed, we refer patients to a dietician or a podiatrist.' A former outpatients healthcare assistant, she began a pilot of the role three years ago and 18 months later started the clinics. Demand for the services has grown and last year Greater Peterborough appointed a second care technician to share the workload.

The success of the scheme means the partnership is considering extending the technician role to other areas, particularly coronary heart disease and asthma. 'Around 70 per cent of people with diabetes have CHD too, ' she says, 'so it would save people being seen twice.'