Mental health Workforce Plan for England - Royal College of ...

Mental health Workforce Plan for England A briefing on the plan published by Health Education England and the implications for psychiatrists and the Royal College BACKGROUND On 31st of July 2017, Health Education England (HEE) published a national plan to expand the mental health workforce: Stepping Forward to 2020/21: Mental Health Workforce Plan for England. This plan sets out:

The overall numbers, skills and location of the current workforce in mental health.

The underpinning assumptions and modelling about the overall number and types of skills required to provide mental health services in the growth areas, whilst ensuring the service as a whole is maintained and improved. Who needs to do what and when to achieve the net growth in staff – with clear actions for local and national partners. OVERALL COMMITMENT The NHS will establish 21,000 posts and providers will employ 19,000 additional members of staff by 2020. 11,000 of these will be drawn from the ‘traditional’ pools of professionally regulated staff, and 8,000 will be moving into new roles (e.g. peer support workers, personal wellbeing practitioners, call handlers, or nursing associates). CURRENT PICTURE The NHS currently funds over 214,000 posts to provide specialist mental health services in England. Just over 20,000 of these are vacancies meaning that approximately 194,000 people are substantively employed by the NHS. FOCUS ON PSYCHIATRY There are currently 11,400 medical posts in mental health services of which 5,400 are consultants. Of these 1,400 (12%) are vacant including 700 (13%) consultants. In addition to filling the high levels of vacancies in current services, the plan identifies the need for an additional 570 psychiatrists to be employed. The plan identifies some key problems in relation to the psychiatric workforce, including:  The lack of qualified doctors choosing to train in psychiatry (in 2016, only 349 of the advertised 417 Core Psychiatry Training places were filled by a trainee), (2) the low direct transition rates from Core to Higher Specialty Training and (3) the number of qualified consultant psychiatrists who are not employed by the NHS.  The psychiatric workforce relying heavily on non-consultant, non-training grade (SASG) doctors (24% of the psychiatric workforce), and non-UK doctors in training.  Geographical variations, with some areas failing to attract and retain doctors in psychiatric training1. In 2017, by HEE region, the South West fills almost 100% of Higher Specialty Training posts in General Psychiatry, and in London and the South East 78% of all higher training posts are filled, but in other parts of the country such as the North, the ‘fill rate’ can be as low as 38%. 1

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WHAT THE REPORT CONCLUDED The key actions different organisations will take to increase workforce supply are set out in a table in Annex 1. In a nutshell, these actions will aim to:  ‘Produce’ good mental health / prevent mental illness  Retain and support existing staff, and ensure clinical staff to get more time for patients  Encourage qualified staff to return to practice in the NHS  Support international recruitment to help fill short-term gaps  Develop new skills, roles and ways of working and expand the talent pool of future staff  Attract more people to work in mental health, and increase the number of applicants for clinical training courses  Support and retain trainees  Collect better intelligence about the mental health workforce  Create a compendium of ‘best practice’  Develop local workforce plans THE ROLE OF THE ROYAL COLLEGE OF PSYCHIATRISTS 1. Influencing the content of the plan Dr Simon Wessely (immediate Past-President), Kate Lovett (Dean) and Dr Aideen O’Halloran (College Lead on Workforce), with the support of the College’s NCCMH 2, Training & Workforce and Policy teams, played a key role in influencing the content of the final plan. This involved gathering views from College members widely and representation on various roundtables and senior meetings in order to provide expert opinion and advice. As a result, the plan includes the majority of the proposals we advocated for:

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Acknowledgement of the extent of the problems and the urgent need to recruit/retain staff

Recruitment of an additional 570 psychiatrists (including 100 Child and Adolescent psychiatrists)

Recruitment of Personal Assistants and Physician Associates to enable psychiatrists to use their specialist knowledge more effectively

National programme of mental health staff retention

Plan to encourage GPs to enhance primary care mental health skills

Major Return to Practice campaign for psychiatrists and mental health nurses

Programme of work to ensure that psychiatry has a significant share of the Medical Training Initiative (MTI)* allocation

Programme of work to explore changing entry requirements so that Psychology ‘A’ level is considered of equal merit

Work to ensure the priority of mental health is reflected in the UK Medical Licensing Assessment

Work to explore the development needs of SASG doctors working in mental health

Work to ensure that the allocation of the extra 1,500 medical student places is to universities with a proven track record in producing psychiatrists

Appointment of a senior leader within each STP to lead the development and delivery of a delivery plan for mental health

National Collaborating Centre for Mental Health.

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However, the plan does not give due attention to all mental health services. For instance, it does not cover the workforce to support older people, people with intellectual disabilities or with addiction problems, despite the assessment and management of mental health problems in each of these groups requiring bespoke skills. The plan also does not include requirements for core adult services, such as community mental health services and rehabilitation services, or in children’s services to the extent that the college feels it is needed. 2. Running a recruitment campaign In addition, the Royal College of Psychiatrists continues to actively campaign to recruit trainees into psychiatry through a multipronged approach, which will include a short advert to be launched in September 2017 in line with the 2018 National Recruitment Round. We are also increasing our social media presence alongside the careers work of the Training and Workforce Unit, which includes engaging students, medical students and Foundation Doctors at Careers Fairs and events, supporting Summer and Autumn Schools, considering innovative routes into training and regularly sharing careers advice. We will continue to develop our recruitment campaign in the next few months and will keep members updated about progress. 3. Workforce planning In order to be on the front foot as demand for mental health services rise, we need workforce planning that thinks in terms of decades, not just the next few years. The College’s Training and Working Unit, based in the Professional Standards Department in the College, works closely with the Centre for Workforce Intelligence (CfWI) and HEE on the future workforce needs in psychiatry. The Unit is currently conducting the workforce census, which is a biennial survey of the psychiatric workforce in the UK. The Unit also supports the network of College Regional Advisors, who have a crucial role in approving NHS job descriptions for psychiatrists. If you want further information about this work, please visit our workforce webpage. NEXT STEPS 1. Supporting the implementation of the plan The Royal College of Psychiatrists is determined to work, in partnership with other Royal Colleges, the third sector, central bodies and local NHS to ensure the success of the plan. 2. Inform the longer-term strategy The College successfully advocated for the need for a long-term comprehensive mental health workforce strategy. The proposal has been accepted by HEE, and a clear commitment has been included in the five-year plan. In order to inform this strategy, we will work closely with members, Faculty and Division Workforce and Recruitment leads. Our key objectives will be to ensure an increased psychiatric workforce beyond 2021, especially in those areas that have been neglected in the five-year plan, as well as a more equitable distribution of psychiatrists across the country. For further information If you have any comments or questions on the College’s work on workforce and training, please direct them to [email protected]. If you have any comments or questions on the College’s policy and campaigns work, please contact Zoé Mulliez, Policy and Campaigns Officer, at [email protected] Please contact us if you would like this briefing in another format.

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ANNEX 1 - Agreed actions included in the Health Education England workforce plan Objective

Producing good mental health

Identifying and responding as soon as possible to mental and physical health issues

Retaining and supporting our existing staff

Agreed action To use the emerging findings of their Prevention Concordat to support implementation and improve the mental health promotion and prevention training of the public health workforce To use the imminent employer review as a basis for honest board-to-ward discussions about how to support staff, as well as those who access mental health services, drawing on the success of the dementia awareness campaign. To sign up to Time to Change or similar. To support mental health professionals to have the skills and confidence to raise physical health issues with their service users, through Make Every Contact Count (MECC). To work with the RCGP to encourage GPs to enhance primary care mental health skills by doing a year postqualification in psychiatry. To work with employers to expand the use of MECC in mental health services. To implement a national programme of mental health staff retention, which is part of a comprehensive program of work with providers. To support improved retention by exploring the creation of a dedicated workforce development budget to help employers retain and develop and reskill their existing staff in mental health services and other Five Year Forward View for Mental Health priority areas. To explore the opportunities from the Naylor Review and the potential to improve access to NHS accommodation for mental health staff. To better understand sickness rates and work with mental health charities to improve the mental health of the mental health workforce. To consider the roles of carers and how the NHS might better support staff with caring responsibilities. To work with providers to encourage and support more flexible approaches to retirement, offering more flexible arrangements so that the NHS can retain most of its skilled and experience staff. To examine the impact of the end of Mental Health Officer status and make recommendations on how to draw on the skills of the recent retirees to enable them to form a considerable ‘transition bridge’ of expertise.

Employers supporting clinical staff to release more time for those who access mental health services.

To develop and spread solutions to improve productivity and release more time for consultants to provide skilled care for patients at most risk

Encouraging qualified staff to return to practice in the NHS

To co-ordinate a major Return to Practice campaign for psychiatrists and mental health nurses to support local employers.

To explore support for other qualified staff who may wish to develop a career in mental health

Stakeholders involved HEE Public Health England NHS organisations

Employers HEE HEE RCGP HEE NHS Improvement HEE

The Department of Health NHS Employers NHS Improvement

NHS Employers

The National Mental Health Nurse Directors Forum RCPsych RCN NHS England NHS Improvement HEE RCPsych NHS Employers HEE (lead) NHS Improvement NHS Employers RCPsych Mental health charities HEE NHS Improvement

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International recruitment to help fill short-term gaps

New skills, roles and ways of working

Expanding the talent pool of future staff

Attracting people to work in mental health

Increasing the number of applicants for clinical training courses

To take forward a number of international workforce initiatives including recruitment from overseas, focusing initially on the four key priority areas, mental health, primary care, urgent care and cancer, building on recent successes such as with nurses and urgent care. To ensure that psychiatry has a significant share of the Medical Training Initiative (MTI)* allocation which helps skill up overseas doctors wanting to improve their knowledge and skills as well as supporting domestic programmes. To ensure commissioned pathways and guidance work reflect more modern diverse and highly multi-disciplinary teams. To work with partners to continue the expansion of recently created roles in mental health services. To work with partners to consider the creation of new roles such as: Early intervention workers focussed on child wellbeing as part of a psychiatrist-led team. The Leadership Academy will develop and deliver leadership training courses for Consultant Psychiatrists, Nurse and AHP Consultants, Consultant Clinical Psychologists and others to enhance and support their skills as team leaders. To explore changing entry requirements so that Psychology ‘A’ level is considered of equal merit to increase the pool of applicants likely to go on to become Psychiatrists. To ensure the priority of mental health is reflected in the UK Medical Licensing Assessment. To explore the development needs of SASG doctors working in Mental Health, in order to ensure they are equipped to deal with current and future patients. To develop an urgent action plan to attract and retain more clinicians to work in mental health services and psychiatry. To commission focus groups and polls of potential and existing trainees so we can better understand the obstacles, increase the support offered to them and increase the profile and attractiveness of careers in mental health. To develop a major campaign in advance of the 2018 recruitment round to help attract newly qualified people to training courses, as well as recruiting qualified staff from other sectors. To develop and publish a clear career pathway that supports and attracts individuals from wide ranging backgrounds (with a broad range of skills, clinical, research, management etc.). To widen participation through local recruitment drives to support the attraction of a representative workforce but crucially, service providers have to ensure that there are mechanisms and training in place to enable individuals/practitioners provide non-discriminatory care. To work to ensure that the allocation of these places is to universities with a proven track record in producing psychiatrists. To increase the exposure to psychiatry during training (which can help increase applications for the specialty). HEE has already increased the number of doctors in the Foundation Programme doing a four-month psychiatry post to 50%. The RCPysch will complete the review of this expansion with a view to HEE commissioning a further expansion from 2019.

HEE

HEE RCPsych

NHS England HEE HEE HEE

HEE Medical Schools Council HEE GMC HEE HEE Royal Colleges Trainees Mental health charities

HEE RCPsych Partners

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To ensure all doctors in the Foundation Programme will be required to undertake a ‘taster’ 2-week attachment in Psychiatry unless they are doing a four-month post from 2019. To explore bursaries (learning from the GP Target Enhanced Recruitment Scheme (TERs) scheme, funded by NHS England), and opportunities in academic training to increase the popularity of the speciality. To understand what makes trainees leave/stay throughout the course and attract more trainees for mental health during key transition points, such as from core to higher points. To develop ‘run through’ training for Child and Adolescent Psychiatry, and explore how best to scale this up. To reduce attrition rates from training programmes, including ensuring that all trainees get the agreed one-hour direct supervision per week. Supporting and retaining our trainees

Better intelligence about the mental health workforce A Compendium of Best Practice

Robust local workforce plans to grow and transform the Mental Health workforce, aligned with finance and service plans

Building on the Enhancing Junior Doctors’ Working Lives report - to explore flexibility within training and to examine different training options including run-through. To work on the Accelerated Return to Training programme. To develop alternative training support for those doctors not in training programmes and who are not consultants. To consider board level leadership and support for all trainees and existing staff. To review rotas so that doctors in training get access to training episodes and are supported by the appropriate clinical team out of hours. To secure access to workforce data from non-NHS sectors as soon as possible to aid more effective workforce planning. To establish a Compendium of Best Workforce Practices, to support employers and teams to achieve workforce transformation and growth. To appoint a senior leader (Chief Executive or Executive Director) to lead the development and delivery of a delivery plan for mental health, that ensures ongoing alignment between the funding, policy commitments and workforce availability and actions. To lead on the workforce element of the plan, supporting each STP lead with data, analysis. To help them understand their current labour market and develop robust plans for developing new services within the funding envelope available. To include workforce plans as part of their finance and service submissions. To ensure plans include how they intend to re-skill the existing workforce to help transform services. Ensuring equal opportunities for career progression and set out how local providers will use this opportunity to ensure our workforce is more representative of the communities they serve. To review regional and local governance, resources, and data collections, to support alignment of finance, policy and workforce in mental health, whilst reducing duplication and maintaining their statutory accountabilities.

HEE RCpsych HEE HEE RCPsych Employers

RCPsych HEE RCPsych HEE Employers

HEE NHS Digital ALBs HEE Royal Colleges Providers STPs

HEE’s Local Workforce Action Boards (LWABs) STPs STPs

National ALBs

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