Healthcare Science National Delivery Plan for Healthcare Science Professionals in Scotland 2014-2017

5. WORKFORCE REPROFILING/COMPETENCY FRAMEWORK

The workforce is NHSScotland's greatest resource. It is also its greatest expense, accounting for 69% of running costs.

Efficient use of the workforce is essential to any plans for quality improvement and service efficiency. HCS roles have expanded considerably in the last 10 years. Areas traditionally the domain of medical staff are increasingly being filled by scientists working in extended-practice roles, with numerous examples of HCS staff supporting sustainable, effective service delivery. Cytology services, for example, have led the way in deploying HCS staff in interpretive roles, with great benefit to clinical outcome measures and cost-effectiveness.

Biomedical scientists have been involved in reporting abnormal cervical cytology smears for many years, a service developed with full medical consultant support in participating departments and following a formal assessment and examination structure run jointly by the Royal College of Pathologists and the Institute of Biomedical Science. This has brought tremendous value in releasing consultant time and enhancing the HCS role. Highly trained and experienced scientists have added tremendous value in laboratory services and are pivotal in delivering high-quality service at reduced cost (Appendix 1). Departments that have utilised this role extension tend to benchmark well without reduction in quality. However, deployment of this grade of staff varies across Scotland and often reflects historical practices.

Histopathology dissection has similarly been developed as an extended-practice role in a number of NHS boards, freeing up a great deal of consultant histopathologist time (Appendix 2).

Examples of diagnostic departments being clinically led by HCS staff can now be seen around the country. These developments have obvious benefit in disciplines such as haematology, in which medical consultants are usually fully occupied in providing patient services.

Clear routes to accrediting professional practice at consultant level exist for some HCS disciplines. Fellowship of the Royal College of Pathologists, which is generally recognised as a requirement to work at consultant level, is available to scientists in a range of pathology disciplines and diplomas of expert practice are available to biomedical scientists working towards extended roles.

Recognised qualifications such as these are nevertheless not universally available across HCS disciplines. Suitability for senior positions in physical and physiological sciences is assessed largely by length and depth of experience. While this has merit, it makes structured workforce planning difficult. Ongoing work being taken forward by the Modernising Scientific Careers team and medical royal colleges aims to address this through the introduction of standardised curricula for higher specialist training for all HCS disciplines.

Achieving the goal of improving service quality in a difficult financial environment requires that increasing number of highly skilled HCS staff be deployed in advanced and extended roles. This is a very challenging ambition: ever-increasing demands on services mean staff are busy 'delivering', with often limited opportunities for creative thinking and service transformation. More efficient ways of delivering current services are needed to free staff to assume extended-practice roles and new roles in demand management and at the secondary-primary care interface.

Like the rest of the UK, Scotland is moving towards a four-tier HCS workforce structure with assistant/associate grades, practitioners, scientists and consultant scientists. Greater use of assistant/associate grades has significant potential to release more highly trained colleagues to take on advanced roles. Safe and effective ways of working for unregistered staff groups need to be found, with appropriate mechanisms for supervision and career development.

Our question is - how might the knowledge and skills of the HCS workforce in existing roles be more effectively utilised, and how can roles be extended to work with medical colleagues?

Our proposals are set out below. Are these the right actions? What else could we do?

5.1 Proposals

• National HCS leads will work with NHS board leads and professional bodies to identify examples of good practice in HCS extended roles and examine their effects on quality and efficiency of service delivery.
• National leads will work with professional bodies, service managers and NES to agree national competency frameworks and scopes of practice for assistant/associate-grade staff.
• NES will explore how the education needs of HCS assistants can be met as part of the support worker education stream.
• NES will explore education solutions to support HCS staff who may be required to supervise HCS assistants.
• NES will work with the National School of Healthcare Science, medical royal colleges and professional bodies to establish a robust training programme for higher specialist scientists that can then be used as the standard for consultant-level appointments.
• The CHPO will work with colleagues in workforce planning to ensure that medical workforce planning takes account of the potential for HCS to play a significant role in supporting busy clinical teams.
• The CHPO will pilot/support the development of extended interpretive roles in laboratory medicine.
• HCS leads will work in partnership with analytic and research colleagues to grow the health economic base for HCS extended-practice roles.