National health and social care workforce plan: part three

Introduction

As set out in the Health and Social Care Delivery Plan ^[1] , the Scottish Government's vision for the future of primary care is for enhanced and expanded multi-disciplinary community care teams, made up of a variety of professionals each contributing their unique skills towards delivering person-centred care and improving outcomes for individuals and local communities. This vision closely reflects the 21 underpinning principles on the future of primary care set out by Scotland's health professional groups in 2016 ^[2] .

We have established six long-term outcomes that support the delivery of our vision:

• We are more informed and empowered when using primary care
• Our primary care services better contribute to improving population health
• Our experience of primary care is enhanced
• Our primary care workforce is expanded, more integrated and better co-ordinated with community and secondary care
• Our primary care infrastructure – physical and digital – is improved
• Primary care better addresses health inequalities

Delivering these outcomes, and the wider aspirations set out in the Delivery Plan, will take time and will involve significant challenges. Nevertheless, we are committed to investing in primary care and focusing on new models of prevention and self-management. Getting primary and community care right is an essential component of ensuring the whole healthcare system is sustainable. It will deliver the best outcomes for patients, in line with our vision of care being provided at home or in a homely setting, and help ensure rewarding, well-supported careers for our community healthcare workforce.

Committing to the future of primary care

With our local and national partners we have already embarked on an ambitious programme to support and build primary and community care. The First Minister announced in October 2016 an increase in funding in primary care of £500 million by the end of this Parliament. This investment will see at least half of frontline NHS spending going to community health services, and will enable us to significantly expand the primary care multidisciplinary workforce. This includes training an additional 500 advanced nurse practitioners across acute and primary care, 250 more community links workers in practices by the end of the parliamentary period to address patients' wider needs, training an additional 1,000 paramedics to work in support of general practice, the expansion of mental health workforce, and enhanced roles for Allied Health Professionals ( AHPs) in delivering person-centred care. General Practice will further be supported by ensuring all practices are given access to a pharmacist by the end of this parliamentary period.

The new General Medical Services ( GMS) contract, jointly negotiated by the BMA and the Scottish Government, sets out a refocused role for GPs as Expert Medical Generalists ( EMGs) and recognises the GP as the senior clinical decision maker in the community. This role for all GPs will be supported through service redesign and the expansion of the multi-disciplinary workforce. The Cabinet Secretary for Health and Sport recently committed to increasing the number of GPs by at least 800 (headcount) in the next 10 years through an ambitious training, recruitment and retention programme.

NHS Boards are responsible for allocating resources to ensure that people are able to access quality healthcare services both in and out of hours. We recognise the particular challenges faced by out of hours services and remain committed to having a high-quality service which fully meets patient needs. That is why we invested £10 million in 2016-7 and provided further investment as part of the £23 million Primary Care Transformation Fund ( PCTF) in 2017-8, to deliver the recommendations in Sir Lewis Ritchie's report Pulling together ^[3] . Going forward, we expect Boards to maintain and develop a resilient out of hours service that builds on the recommendations in Sir Lewis's report, ensuring effective links and interface between in and out of hours GP services. This is also reflected in further work undertaken by Sir Lewis through Improving Health and Social Care Service Resilience over Public Holidays, published in December 2017 ^[4] .

Alongside the expansion of the multidisciplinary workforce, we are currently implementing significant changes in how primary care will be organised. Our historic Memorandum of Understanding ( MoU) ^[5] with Integration Authorities, the British Medical Association, NHS Boards and the Scottish Government sets out the principles underpinning primary care in Scotland, including respective roles and responsibilities. It provides the basis for the development by Integration Authorities ( IAs), as part of their statutory strategic planning responsibilities, of Primary Care Improvement Plans ( PCIPs), clearly setting out how additional funding will be used and the timescales for the reconfiguration of services currently delivered under GMS contracts.

Workforce planning

The publication of National Health and Social Care Workforce Plan: Part 1 – a framework for improving workforce planning across NHS Scotland ^[6] last June signalled the beginning of a process to further improve workforce planning across health and social care. It set out new approaches to workforce planning across Scotland, within a framework for wider reform of our health and care systems. Part 2 of the Workforce Plan – A framework for improving workforce planning for social care in Scotland ^[7] – published jointly by the Scottish Government and COSLA – sets out a whole system, complementary approach to local and national social care workforce planning, recognising our new integrated landscape. The publication of this primary care workforce plan marks an important further step in that journey.

Part 3 does not restate the range of actions already underway to improve workforce planning as set out in parts 1 and 2, but focuses on how we will support the primary care workforce deliver improved outcomes for Scotland's people. It is recognised however, that to deliver integrated services and continuity of care for patients across community-based health and social care services and acute services, good interfaces based on shared understanding and trust, and supported by robust data and intelligence, are essential. Effective workforce planning needs to acknowledge interdependencies across the different parts of the system and take an iterative approach to planning across the wide range of skilled professionals involved in its delivery. The next stage in this process therefore builds on the actions taken to deliver the recommendations across the three parts of the workforce plan, with publication of a single, integrated national Workforce Plan later in 2018.

This plan is split into seven chapters. Chapter one sets out the role of primary care services in effectively responding to the changing and growing needs of our population, alongside the evidence of the significant benefits that will be delivered through focusing our workforce on prevention and supporting self-management. We set out the shape of the existing primary care workforce, including recent trends in workforce numbers, in Chapter two, before describing the anticipated changes in the way services will be developed to meet population need in Chapter three. Chapters four to six set out how the MDT will be strengthened to deliver an enhanced and sustainable workforce to improve patient outcomes. Chapter seven outlines how we will work with partners to ensure that better quality and more timely data is developed to drive effective local and national workforce planning.