Heart disease: action plan

6. Priority 3: Workforce

We will ensure appropriate staff resource and training to deliver timely and equitable services across Scotland for people with heart disease.

Ensuring equity of access to timely diagnosis, treatment and care for people with heart disease depends on having the appropriate staff resource and on the provision of appropriate education and training to ensure that health care professionals have the information necessary to support people with heart disease.

To inform our understanding of what staff resource is required across services for people with heart disease in Scotland, it will be necessary to conduct a gap analysis, informed by the nationally agreed pathways of care. This gap analysis will take account of the key aspects of the cardiac workforce, including cardiologists, cardiac surgeons, cardiovascular perfusionists, specialist nurses, cardiac physiologists, clinical pharmacologists, clinical psychologists and specialist pharmacists. Addressing the key issues highlighted by a gap analysis will be vital to ensuring the appropriate staff resource to deliver timely and equitable services across Scotland.

There are also some additional actions that we will take to address particular concerns around workforce capacity. These include:

• Training pathways for cardiac physiology
• The development of a competency framework for specialist roles relating to cardiac services, to support advanced practice training.

6.1 Cardiac physiology

There are crucial workforce issues relating to diagnostic services. A shortage of cardiac physiologists impacts on the ability to deliver timely diagnosis, treatment and care for people with heart disease.

Work carried out by NES Healthcare Science Team^[38] highlighted that over the last 5 years there has been a 46% increase in the demand for cardiac physiology services in NHS Scotland, but vacancies in half of cardiac physiology units across Scotland is at 15%, with a comparable fraction within five years of retiring. Most departments (70%) have 1 or more vacancies. There are particular challenges around training routes into cardiac physiology, which need to be addressed.

In addition to the wider work in understanding and addressing the gaps in the cardiology workforce, we will also take a nationally coordinated approach to specifically address the challenges facing physiology. We will develop a 'Once for Scotland' approach to cardiac physiology which will encompass recommended models of care, workforce planning and the establishment of a sustainable training and educational pathway.

6.2 A Competency Framework to support Advanced Practice

Cardiology is a multi-professional discipline with care provided by cardiologists, cardiac surgeons and increasing roles for specialist nurses, cardiac physiologists, cardiac scientists, clinical pharmacologists, pharmacists and clinical psychologists.

There are many examples of nurse led models of specialist care for people with heart disease. For example, people with heart failure are supported by heart failure specialist nurses, many rapid access chest pain clinic services across Scotland are nurse-led, and a genetic testing service for hypertrophic cardiomyopathy (HCM) is supported by specialist nurses. There are also examples of nurse-led models of care for arrhythmias, valvular and congenital heart disease in some health boards in Scotland. There are also examples of pharmacist led clinics^[39] and cardiac physiology led clinics.

To inform our gap analysis and future workforce planning for cardiology, it is important to be clear about opportunities for advanced practice and to set out the competencies of such roles. This helps to ensure that the work of the multi-disciplinary team is as seamless as possible, that there is opportunity for career advancement for a range of health professionals working within cardiology, and to ensure that people with heart disease can see the right person, at the right time.

A number of competency frameworks have been established at UK and European level. It is important that we map these to identify where competencies have already been clearly established, and use these as a basis upon which to learn from and to support implementation within the Scottish context.

The pathway development work is an opportunity for clarity on the competencies and roles of a range of health care professionals working within cardiology and their interfaces and channels of communication with the wider multi-disciplinary team including those providing generalist care.

6.3 Training

To support the maximisation of roles identified as part of the approach to workforce planning requires a co-ordinated effort to identify and develop appropriate training opportunities for healthcare professionals in line with the needs of people with heart disease. The competency framework outlined above will support us in understanding and shaping those training opportunities and we will work closely with NES Scotland to identify and address any gaps in training and education provision.

6.4 Actions

1. We will undertake a robust workforce modelling of the cardiac physiology workforce in Scotland in 2021.

2. We will develop a sustainable training and education pathway for cardiac physiology in Scotland.

3. We will produce a nationally agreed competency framework for health care professionals working to provide care for people with heart disease in order to support nationally agreed pathways of care. This will include consideration of the integral role played by cardiologists and cardiology trainees, specialist nurses, specialist pharmacists and cardiac physiologists, the interplay between specialist and generalist care, and identify opportunities for advanced practice in all sectors of care.

4. We will carry out a gap analysis of the cardiology and cardiac surgery workforce informed by the nationally agreed pathways and the developed competency framework.

5. We will work with NES to ensure education and training related to heart disease adapts as changing models of care (including more widespread provision of technological models of care) are implemented.