Croner provides advice on the key considerations on staffing for organisations working
at scale.

In accordance with the aims of the NHS Five Year Forward View, a number of new care models have been developed and each have different implications for staffing which require consideration and careful management to ensure a smooth transition. While many of the models support acute care collaboration or the integration of health and social care, this article focuses on the models which recognise the benefits of ‘scaling up’ to support the integration of primary healthcare (namely GP federations and superpractices), and the likely staffing issues GP partners and practice managers will need to consider. 

Key staffing issues/opportunities

Not all of the resulting staffing implications carry risk; in fact many provide positive opportunities. The level of legal risks/staffing implications will depend on the specific changes being proposed or implemented, which will impact on any existing employment relationship or working arrangements. 

Managing change/staff engagement

Irrespective of the new care model being implemented, a staffing issue which impacts across the board is the critical need to manage change effectively and engage and empower staff to lead the development and delivery of new care models. As summarised by Samantha Jones, Director of the New Care Models Programme, in New Care Models and Staff Engagement: All Aboard, the core principles for success identified from the work of the vanguards were:

• Enable different groups of staff across health and social care to work together
  • To ‘break down barriers’ between existing organisations and professional groups and break out of old working patterns.
  • Leaders can set the example by investing in relationships at the highest level, with partners across the local health and care system so staff at the front line are inspired to do the same.
• Put staff at the heart of designing and implementing new care models
  • Share leadership and responsibility, talk and most importantly listen, to unlock the ambition and harness the energy of staff.
  • Staff on the front line of care often have the best ideas how to improve it, but need to feel empowered to do so.
• Communicate
  • A clear, shared vision delivered via a consistent message across all in the leadership team, so people want to see change happen and see themselves as part of it.
  • The details of the change effectively, including the benefits it can bring, the underpinning strategy and the details of the action plan to make it happen.
    The opportunities to get involved, provide different opportunities to do so and make it easy for busy staff to join in where possible.
• Value the contribution of staff
  • Ultimately if staff feel their contribution is valued they will want to do all they can to make new care models a success.

GP Federations

The key staffing issues and/or opportunities for GP federations are likely to be:

• Redesigning staffing arrangements
  • Implement the federation leadership structure, following discussion with practice partners to ensure there is the capacity and capability to lead the federation within member practices, or determine whether leadership skills are required from external sources.
  • Review existing support function staffing and system requirements to identify what, if any, practice resources could be pooled (for example, shared back office functions such as HR/ Payroll/Procurement).
  • Review the feasibility of sharing delivery/use of education and training resources throughout the member practices with a view to reducing clinical variations.
• Job design/job description and recruitment
  • Across member practices, share existing job designs and job descriptions with a view to identifying best practice and opportunities to reorganise tasks and responsibilities as appropriate to improve efficiency.
  • As a result of the strengthened capacity of practices to develop new services, review whether to introduce new or extended roles in any individual practice. Arising from revised job descriptions, there will be the need for a recruitment exercise and the issuing of relevant contractual documentation to the successful candidate for new roles. If unable to fill the new vacancy internally then extend the opportunity to other member practices prior to advertising externally. Where it is proposed that existing roles are extended, such a change will trigger the need for informal consultation with affected staff to ensure the extended responsibilities are reasonable, understood and agreed, and any resulting training needs are identified and managed. 
• Updating/sharing policies and procedures
  • Review the practices’ key policies and procedures and consider standardising across the locality. Any subsequent revised policies will need to be clearly communicated to staff and any training undertaken to ensure consistent understanding and application.
  • Identify opportunities to standardise performance management/ staff development systems at practice level to share best practice, specifically relating to staff appraisal systems, delivery of training, reward and talent management.
• Data Protection
  • Any sharing of personal data with the GP federation will require the federation to register with the Information Commissioner’s Office and an understanding of the rules of dealing with personal data.

Super-practices

The key staffing issues and opportunities for super-practices are likely to be: 

• Redesigning staffing arrangements
  • Implement the new leadership structure. Ensure discussion with all parties to ensure there is the capacity and capability for the new partnership board to lead the super-practice. Ensure fair representation of partners on the board and ensure all are aligned with the vision and agree the strategy and action plan.
  • Identify a proposed new structure across all areas of the superpractice to ensure the right skills mix; staffing levels and flexibility to deliver effective population based health approach. This may result in the creation of new and/or extended roles and will result in the establishment of centralised support functions.
  • Look to improve training and education, and nurture talent through the establishment of a dedicated central training and development team.
• Transfer of Undertakings (Protection of Employment Regulations 2006)
  • Assess the need for the application of TUPE Regulations, and the associated obligations relating to information and consultation processes, and post transfer limitations on contractual changes. Each branch surgery will be required to provide employee liability data to the super-practice in advance of any transfer of staff (see ‘Data Protection’ below).
  • Plan and implement a post-merger staffing integration plan.
• Contractual changes
  • Staff will transfer to the super-practices under TUPE on their existing terms and conditions of employment which are protected under the TUPE Regulations. Therefore there will be requirement to manage differing contractual obligations. 
  • Under the TUPE Regulations, any contractual changes post transfer are only permitted where there is an “economic, technical or organisational” (ETO) reason entailing changes to the workforce (such as changes in headcount, job function or to change work location). Where there is an ETO reason, the proposed contractual change will trigger the requirement for consultation with all affected staff in order to obtain express agreement to implement the proposed change. The consultation methodology and legal requirements will depend on the numbers of staff affected and may require either individual or collective consultation.
• Job design/job description and recruitment
  • As a result of the strengthened capacity of the super-practices to develop new services, review whether to introduce new or extended roles, either at branch surgery or central support level. Arising from this, for new roles there will be the need for a recruitment exercise and the issuing of relevant contractual documentation. Vacancies should be advertised internally to all existing staff in the super-practice, providing the benefit of career development opportunities; new career pathways and opportunities for staff to specialise. Where it is proposed that existing roles are extended, such a change will trigger the need for informal consultation with affected staff to ensure the extended responsibilities are reasonable, understood and agreed and any resulting training needs are identified and managed.
• Policies and procedures
  • Standardisation of non-contractual policies and procedures across the locality. Any subsequent revised policies and procedures will need to be clearly communicated to staff and any training undertaken to ensure consistent understanding and application.
  • Standardisation of performance management/staff development systems, specifically relating to staff appraisal systems, delivery of training and talent management.
• Data Protection
  • Any sharing of personal data with the super-practice by branch surgeries will require the super-practice to register with the Information Commissioner’s Office and an understanding of the rules of dealing with personal data.