Pathology workforce skill-mix review at Portsmouth NHS Trust


16 / 02 / 2012

The organisation 

Employing approximately 5,800 staff, Portsmouth Hospitals NHS Trust is a large District General Hospital in Hampshire, with an embedded Ministry of Defence Hospital Unit. The trust serves around 800,000 people in South East Hampshire, providing specialist, tertiary and district hospital services.

Portsmouth pathology service provides diagnostic services, specialist regional screening and general practitioner services with around 380 staff. The service is centralised in a new purpose-built pathology centre at Queen Alexandra Hospital where they have invested heavily in automation and new technology.

What we did and why

As part of a wider programme of work to optimise the pathology workforce in line with modernising science careers (MSC) and their role as an early adopter, Portsmouth Hospitals NHS Trust conducted a skill-mix review of their pathology workforce.

Advances in scientific knowledge and technology require the healthcare science workforce to adapt and adopt new knowledge and skills. Balanced with the need to make the workforce affordable, this prompted the trust to look at the skills of the pathology workforce.

How we did it

Initially the trust developed a project plan to define service needs. Using a workforce planning tool they mapped the workforce that would be required to deliver services whilst assessing the knowledge and skills of existing staff.

This information enabled the trust to identify the numbers of roles required at each grade within each discipline.  The trust was also able to identify current gaps where new roles could emerge, for example sample handling supervisor and associate practitioner roles. The information allowed the trust to plan for future roles including haematology and cellular pathology/infection scientists.

Portsmouth then carried out an exercise matching the tasks required to deliver the service to the career framework level appropriate to those tasks using a workforce planning tool. Numbers of staff at each career framework level were determined and job descriptions were re-written and developed to capture new and changed roles. New associate practitioner roles were introduced in blood sciences, cellular pathology and microbiology along with a sample handling supervisor and night duty support technician.

To ensure the training programmes for the new roles were fit for purpose, the trust worked with their local education and training providers and the internal pathology National Vocational Qualification (NVQ) centre. They were able to deliver in-house and external training programmes to increase the knowledge and skills for support staff outside of the traditional educational provision, including provision for staff in roles that have changed such as  the NVQ3 in leadership for sample handling supervisors.

Portsmouth pathology service NVQ centre provided level 2 and 3 NVQs, as well as the new qualifications and credit framework level 2 NVQ diploma in laboratory science and the level 3 diploma in pathology support, which are more flexible and adaptable to fit staff roles. Provision of these qualifications has now extended to neighbouring trusts.

The trust built capacity and expertise in the provision, management and delivery of education and training at all levels, using strategic health authority (SHA) and trust resources effectively. This included the use of  trained NVQ assessors, internal verifiers, training supervisors and supernumerary funding available from the SHA.
Most recently, the trust has altered the grade mix and working patterns in blood sciences to better align workforce capacity with the daily workload such as a move to a 12 hour shift pattern.

Results and next steps

The skill mix review has enabled staff across bands to work at a level appropriate to their skill mix and grade.  By identifying tasks which can safely be carried out by lower banded roles, senior staff can concentrate on tasks appropriate to their knowledge and skill level, and focus on advances in technology.  Going forward the trust recognises the importance of continuing to optimise the use of skilled staff within bands 6, 7 and 8.

Other workforce benefits include a reduction in the use of temporary staff and a consistent skill-mix across shift patterns. This has made a positive impact on service provision in terms of meeting turnaround targets. Cost savings in the region of £1 million on the establishment budget of £13.6 million and clearing the cost improvement programme (CIP) pay target for pathology have been achieved. 

The trust found that having the support of a learning and development lead, also responsible for training within pathology, made the training and development aspects of the project seamless. With their involvement, they could ensure complete understanding of the needs of service and staff.

Support from HR was critical in terms of facilitating change, ensuring compliance with employment law through the planning and implementation stages and to their knowledge of electronic staff record (ESR) and coding of this group of staff.
The biggest challenge was planning and implementing the phasing of restructuring, redeployment and recruitment to new roles and training. All of this had to be undertaken whilst maintaining workforce capacity and service levels.

Further monitoring of the impact associated with the skill-mix review is now underway and the trust has plans to repeat the exercise as part of an ongoing workforce and quality improvement programme.
The trust also plans to implement other aspects of MSC including the scoping of new scientist roles in various disciplines in addition to scientist training programme roles within clinical biochemistry.

Tips for other trusts

  • Establish an oversight group with executive HR involvement to agree work plan and provide support.
  • Seek staff side engagement in the planning and delivery of the project and maintain communication throughout the process.
  • Align your objectives to all four QIPP elements.
  • Ensure staff are correctly coded on ESR to have an accurate picture of the scientific workforce. In Portsmouth, corporate HR had the important knowledge and understanding of ESR and coding to support this process. 
  • Ensure you have the capacity and expertise for the provision of education and training. Portsmouth has an internal pathology NVQ centre. Other trusts may need to identify this provision externally.
  • Build effective, positive working relationships with SHA learning and development leads to identify available financial support.
  • Recognise other potential sources of support, for example SHA lead scientists will be aware of national initiatives, can be a source of encouragement and be an important external point of reference.
  • Careful planning, phasing and implementation of role changes, redeployment, recruitment to new roles and training are essential to ensure workforce capacity and the quality of services are maintained. Ensure your plan incorporates additional leave requirements, for example,  maternity and long term sickness.
  • Finally, it is essential to approach the skill-mix review as a continual process as part of an ongoing workforce and quality improvement programme and not as a one-off exercise.

Further information

Robert Simpson, pathology manager  
Barry Hodgson, head of education – training and development for healthcare science and allied health professionals

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