20 / 8 / 2012 10.07am
Trusts are finding the current economic climate increasingly challenging and are looking at innovative ways to deliver the high standard of services required. The development of the support workforce and assistant practitioner role is being used to both create career pathways and deliver the service needs of trusts.
Based on feedback from employers in March 2012 we set up and ran a survey asking employers what further information they would like in relation to developing assistant practitioners. Responses indicated that guidance on how to develop business cases for the introduction of assistant practitioners would be useful.
Preparing to develop a business case
Business cases do not have to follow a strict format but must identify and demonstrate the project aims, benefits, how the project will be delivered, the resources needed and the risks associated with not carrying out the project. Some organisations may have their own template but within them they will include the areas we have listed. Above all the business case should provide accurate and comprehensive information to ensure the individuals responsible for approval of the business case has all the information to make an informed decision.
The following is a checklist that will assist with the development of a business case:
- Identify the key stakeholders who will be responsible for the delivery of the project including mentors, managers, trainers and project coordinator from within your trust
- Ensure you engage and communicate with all concerned to gain insight into their expectations of the project and to gain valuable knowledge to shape the overall aims
- Identify project aims and clearly set out the expected benefits such as, development of a career pathway for support workers, better retention of staff and releasing registered staff to deliver other clinical tasks
- Identify an education provider and training programme that will meet the needs of the project
- Assess and quantify the resources required, including training costs and a cost /benefits analysis
- Carry out a skill mix profile to identify which areas would benefit from the introduction of an assistant practitioner role
- Present evidence that shows that there are candidates within the trust who want and are capable of the career progression to assistant practitioner. This could be obtained from issuing a questionnaire or survey designed to extract information on support worker numbers, experience, previous access to training and current competencies
- Consider other alternate sources of candidates if you cannot fill from within the trust.
Elements of a business case
It is generally recognised that a business case should always contain certain elements which convey the purpose and outcomes of the project. These include:
This should summarise the content of the business case, identifying the key elements and specific goals in a clear and informative way. These sections will contain the business /service needs and the drivers that have lead to needing to develop the role. Some of these could be:
- Provide a career pathway for the support workforce
- Working with the education provider to ensure the education programme fits service needs
- Delivery of a flexible support workforce that enhances service delivery and increases productivity
- To meet some or all of the elements of the Quality, Innovation, Productivity and Prevention (QIPP) agenda.
You should also include details of the responsible stakeholders and their roles along with who they are accountable to. This will help demonstrate to those responsible for approval of the business case that you have a clear and robust system to manage the governance of the project.
Business cases need to demonstrate that the employer has considered all the options available to deliver the project objectives. One option that should always be included is what the consequences of doing nothing would have for the trust. This should be followed by assessing the viability of each option by using any data collected. This data could include staffing numbers, ratios of patient to support worker and evidence from other projects that show increased productivity including costs. There are also various other methods that could be used to assess viability, including using stakeholder groups to assess the options or workforce planning tools to assess the areas most in need of development.
These actions should identify the options that best meet the project objectives and also identify your preferred option. The next stage would be to set out the options as accurately as possible and put forward a strong case for taking your preferred option forward by demonstrating why it meets the objectives better than the alternatives. Details of why the alternatives were ruled out should also be presented.
Cost and resource analysis
The type of analysis undertaken will be driven by the aims of the project and is essential to demonstrate the viability of the project. An example would be to show the investment in terms of cost and commitment to be balanced or outweighed by the benefits gained from the outcomes of the project. In the development of assistant practitioners you will need to factor in training of the support staff and in some cases mentors, internal and external staff costs associated with management and delivery (trainers, education providers) of the project. It should also demonstrate the benefits to the trust as a whole, by department, patients, service users and staff.
Risks associated with not taking the project forward
The risks will vary from case to case, and will need to be identified and linked to the goals that employers want to achieve. Examples of risks could include not meeting service delivery targets, poor patient care, unable to meet changes to national policy and regulatory directives, poor retention of staff and increased costs.
Start and finish dates should be identified and where relevant, any key milestones which occur throughout the process. Employers will need to demonstrate they have considered ways of assessing if the project is running on track and what measures they intend to put in place to make adjustments if there is slippage. This could be done in a number of ways such as:
- Liaison with HEI to set up training programme and start and finish timeline
- Appoint an HEI co-ordinator to be the trusts point of contact
- Set up a steering group to develop or commission resources (job descriptions, induction packs, set up recruitment process if required)
- Periodic assessments of progress of the student against achievement timeline
- Feedback from students about delivery of training and availability of work based activities - for example, have they been given the right number of placements within the training period
- Feedback from mentors and managers on progress of training and any difficulties with placements for student
- Timeline for overall evaluation of the implementation process.
Evaluation is vitally important, as it helps to build the evidence to demonstrate the benefits of a project. Although it is not essentially part of a business case it should be at least referenced at this stage and could include what resources you need, at what stage this will be carried out and how it will be delivered. Overall evaluation of the project could mainly take place at the conclusion but it could be beneficial to build in staged assessment during the implementation to help identify if adjustments need to be made. Further information on evaluation can be found on the 'Evaluating an assistant practitioner project page'.
Conclusions and recommendations
This should contain the key elements and identify where you are starting from, where you need to get to and how you are going to achieve this. It could also be used to stress the benefits the trust will gain from implementing the project. Any specific recommendations that may have been reached should be set out in this section. These could include:
- Where you source your student cohort from, as it may not be practical to create too many vacancies at one band within the trust
- A rollout plan to ensure the areas with greatest need is targeted first.
One of the most important things to remember is that the business case sets out the project in clear and accurate terms. If available, use examples to demonstrate this type of project has been successfully implemented elsewhere
We have put together a number of documents for reference purposes that you may find useful. These include job descriptions for various assistant practitioner roles and reports on projects undertaken to develop the support workforce.
South Staffordshire and Shropshire Healthcare NHS Foundation Trust (SSSFT)- have created a career and development framework for support staff, part of which was developing an inpatient assistant practitioner role.The case study can be found in our shared learning section.
West Yorkshire Lifelong Learning Network (WYLLN) – Supported a collaborative project involving health and social care organisations and education providers in West Yorkshire. The aim of the project was to produce a toolkit to address workforce needs and development of the assistant practitioner role.
Sandwell & West Birmingham Hospitals NHS Trust – The trust has developed a learning agreement that sets outs the responsibilities and expectations for both the individuals delivering/supporting assistant practitioner training and the student.
NHS Tayside – Over a period of 23 months the trust worked closely with staff and partners to look into the development of an assistant practitioner role across their services. They produced a report outlining the project and their recommendations for implementation.
Job descriptions – We have included sample job descriptions from trusts including trainee assistant practitioners and qualified assistant practitioners in radiology (anonymised) and a ward based assistant practitioner.