Genomic medicine strategy 2024 to 2029

11. Whole system workforce and education

Whole system workforce and education

We recognise that the knowledge and expertise of our workforce is our greatest asset. As genomic medicine becomes an integral part of the health and social care system we must ensure that we retain this knowledge and expertise to support the changes needed through service redesign. We must develop a fit-for-purpose sustainable genomic workforce for the future which is supported by robust education that also spans the wider healthcare profession to better help them support patients and families.

Background

The genomic workforce is diverse encompassing healthcare scientists; including bioinformaticians, data scientists and genetic counsellors, specialist pharmacists, clinical geneticists and genetic nurses. In addition, there are numerous professional groups that interact with, and increasingly overlap and support, genomic medicine. These are outlined in Figure 6 and described in more detail in Annex 1.

In addition to the core groups described above, there are a wide range of healthcare professional groups and disciplines who need to engage with genomic medicine but require defined career pathways that are supported by access to educational resources to equip them with the knowledge and skills to enable them to undertake their roles within the genomic medicine landscape. We are aware that in some areas roles are being expanded to include genomics, and training has been developed and we need to ensure that these are brought together as part of a comprehensive workforce model for Scotland’s genomic medicine service.

Where we are now

Current workforce data for healthcare science disciplines across NHS Scotland indicates that there is a developing crisis in both recruitment and retention. Scotland is not alone in this: international data indicates shortages of trained professionals with the necessary expertise and skills and there is a very real risk not only to the expansion of genomic medicine but also to the sustainability of existing activity. The number of new staff entering services through existing training and professional registration routes is not on track to keep pace with the rate at which staff are leaving through retirement, ill health or for alternative sectors, and this comes as demand for these services is projected to expand significantly. We also need to acknowledge that our workforce, both in and outwith the NHS, has also changed with more people opting for part-time or flexible working patterns, or roles that accommodate remote or hybrid working.

Where we want to be

For genomic medicine to embed into and across the wider health system we require a fit for purpose sustainable workforce which is supported by transparent career frameworks underpinned by robust education and training provision.

The Genomic Workforce

To be able to achieve such an ambition requires a whole system workforce model which will inform the skills and expertise^[2] needed to develop and sustain genomic medicine in Scotland. Our future model must align with the wider healthcare science strategy; NHS Scotland workforce plans; the PHS Pathogen Genomic Strategy; and must be developed in collaboration with the Scottish Deanery and service users.

An important element within workforce modelling and resource planning will be factoring in the upstream and downstream impact of an expansion in genomic medicine service activity and technologies. We know, for example, that increased requirements around solid tumour testing will impact on pathology teams particularly around the time-intensive sample preparation favoured for sequencing technologies. We will engage with pathologists through the Scottish Pathology Network (SPAN) and the Scottish Strategic Network for Diagnostics (SSND) to ensure that requirements for additional resource are communicated and planned.

We also recognise the downstream impact of genomic testing in terms of the identification of germline variants (inherited changes) and incidental findings in patients that have implications for other family members and for the workload of clinical genetics services and oncology teams. Although the development of targeted screening and screening based on germline findings is outwith the scope of this strategy, we are committed to exploring with partners such as Public Health Scotland how to support this activity in terms of data infrastructure, data collection and information governance.

The ‘mainstreaming’ of genomic testing and the delivery of targeted precision therapies in cancer also requires a larger oncology and haematology workforce with more specialist genomic training. We are committed to working with the Scottish cancer networks, and the Haematology and Transfusion Scotland Network (HaTS), the Royal Pharmaceutical Society and NES to develop, signpost and support access to targeted training.

Career Framework

We want to promote genomic medicine as a rewarding career option with clear progression and prospects within a Scottish genomic medicine service. Given the pressures on existing staff and services, and universal concerns around staff recruitment and retention, there is a need to ensure that there is a requirement to address these challenges whilst ensuring that we have a robust career framework in place to attract our future workforce.

As part of this strategy and in line with the healthcare science strategy, we will develop a career pathway that is underpinned by accredited training programmes, competency models and educational support. This will be done in conjunction with the NHS Scotland Academy, NES, the Scottish Deanery and professional bodies.

To strengthen the position of genomic medicine in the wider healthcare system we will explore opportunities and models for partnership working across different sectors outwith the NHS, particularly with Scottish universities on joint clinical academic research positions as a mechanism for embedding research and innovation into service whilst providing opportunities to support staff recruitment and retention.

We will also look to explore joint roles that cross over disciplines as a mechanism for mainstreaming genomic medicine, and develop new roles and training routes, such as genetic nurses and genomic champions, to better support genomic medicine going forward.

Integration of genomics into education programmes

Ensuring that genomic medicine is well represented at undergraduate level in particular and that curricula for medical doctors, nurses and pharmacists is regularly updated to incorporate new technologies, tools and knowledge is vitally important not only for our long-term workforce planning but also to improve the genetic literacy of the wider workforce and preparing HCPs for the expansion of genomic medicine and precision medicine.

We will, in collaboration with NES and partners across UK policy teams, academia and the third sector, engage with higher education and professional bodies to ensure that appropriate training is incorporated into undergraduate, graduate and specialist professional training for medicine, nursing, biomedical scientists and pharmacists. In doing so we will seek to learn from examples of best practice across other organisations including the NHS England Genomics Education Programme and GeNotes resources, the European Reference Networks and the US National Institutes of Health (NIH).

Improving genomic literacy and expertise across the wider workforce

As well as developing innovative ways to train and develop new staff, we also need initiatives for existing health and care staff to improve their knowledge of genomics in healthcare. In terms of the clinical workforce, this is crucial to improve the confidence of staff in understanding and explaining genomic information and adapting to changes in service delivery and, in doing so, improve the experiences of service users.

We will work with NES, the academic sector, and colleagues within the Pathogen Genomic Service to develop and adapt educational resources and training materials, working in collaboration with NHS England Genomics Education Programme, the outputs of the Beyond 1 Million Genomes (B1MG) project, the European Society for Human Genetics and professional bodies both in the UK and internationally. We will also explore other methods including the use of cross-disciplinary genomics competency frameworks, for example Health Education England’s Facilitating Genomic Testing: A Competency Framework and clinical decision support tools.

Signposting to information and resource

Aligned to our building block on patient and citizen engagement, we will work closely with third sector parties to maximise the availability and access to resources and educational materials for HCPs, in both primary and secondary care, and service users. We will also engage closely with existing initiatives such as The Health Literacy Place and NHS Inform to better signpost genomic medicine service resources and support, and encourage conversations about what it means for people both within the NHS workforce and across the wider population in Scotland.

Communication and Collaboration across Scotland

As part of the development of this strategy, the SSNGM is building relationships with stakeholders across Scotland. These connections will be strengthened through a range of activities including newsletters tailored for professional networks and services, engagement activities in collaboration with NES and forums to bring together professionals across the NHS, academia, industry and the third sector. It is also important that we connect with PHS and NHS colleagues on the Pathogen Genomics Strategy and the Pathogen Genomic Oversight Group (PaGOG), as well as the Rare Disease Implementation Board (RDIB) recognising the common aims of their respective strategies around workforce and education and the collaborative approach needed to develop sustainable and vibrant pathogen genomics and human genomic medicine services in Scotland.

Figure 6. Professional groups working in and around genomic medicine services.

Genomic Medicine

• Genetic Counsellors
• Clinical Geneticists
• Genetic Nurses
• Oncologists and Haematologists
• Pathologists
• Pharmacistse-Health
• Information Governance

• Primary Healthcare Professionals
• Community Pharmacists
• Secondary Healthcare Proffessionals

• Clinical Scientists
• Laboratory Technicians
• Biomedical Scientists
• Healthcare Science Assistants and Practioners
• Bioinformaticians
• Data Scientists

Where we want to be

We want genomic information to be provided to people in a way that is meaningful, accessible and easy to understand, and helps them to make the right decision for them. We want people in Scotland to have an understanding of the use of genomic medicine and how it might impact them and we are committed to exploring how people in Scotland wish to access genomic services and information, recognising the need for targeted and sustained engagement with different groups.

What will this mean for people of Scotland?

By establishing a workforce that has the right skills and competencies, this will ensure that the potential set out in this strategy will be translated into practice providing a high-quality service to the people who require it.