Reflecting on 2016, Wendy Reid highlights HEE's successes and future opportunities

This is my last communication of 2016 and the end of the year is traditionally a time to look back and reflect. Reading the Sunday papers reminds me of some tumultuous times at home and abroad. Picking across the headlines -  we have seen industrial action from doctors in training, a vote to leave the EU and change in Prime Minister, the appalling events in Syria and the election of a new type of President in the USA. Change is continual and in HEE we have to not only met the challenges that politics and society gives us but also lead where change is necessary. We have an opportunity through our increasingly close links with colleagues in NHSI, NHSE and other bodies to support the values of the NHS through our work training and developing staff and offering innovative solutions to time-immemorial issues. 

It’s great to see that despite some challenges this year, particularly with our medical trainees, that the overall fill rates for entry into postgraduate medicine have remained constant, and—best of all—this year we posted the highest GP fill rates in history, including in some of the hardest to recruit areas of the country.

This enormous success is thanks in part to our partnership working with NHS England, the Royal College of General Practitioners and the BMA and the national marketing campaign which raised the profile of general practice and encouraged medical students to choose GP as a career. Professor Val Wass has also written a report on how our medical schools ensure General Practice has the profile and the respect it deserves for our undergraduates. I am delighted with the positive reception for this publication as HEE is committed to a future medical workforce much more focussed on primary and community care and for that we need academic primary care doctors, more community specialists and of course more General Practitioners.

But although the hard work has paid dividends, it is not enough for us to encourage our doctors to apply for training in General Practice and other specialties if we cannot retain them for the long term or indeed if they are disengaged and unhappy. That’s why the Secretary of State for Health announced that we would also be undertaking a review of the Annual Review of Competence Progression (ARCP) process for assessment and appraisals to make it simpler, less stressful, and more helpful and more inclusive for our doctors.

This review will begin in January 2017 and run for a year – we will publish a report with recommendations for change in January 2018. We’re currently working to organise a governance structure for this review, which will comprise a number of work streams. They are:

• ‘Appraisal Approach’ and ‘Assessment Methodology’, two strands which have significant overlap and interdependencies. This work will seek to develop a more reflective, developmental approach to appraisal and a clear, consistent, efficient and well-understood approach to assessment.
• ‘Individualised Training Pathways’, which will explore the barriers and opportunities to achieving greater flexibility within training pathways.
• ‘Wider workforce’, exploring opportunities to consider whether elements of the process could be made available to the wider workforce e.g. advanced roles supporting medical and multi-disciplinary teams.
• ‘Resources and Feasibility’, which will look at the support infrastructure as well as the practical, logistical and financial impact of any proposed changes within the review.

It’s also worth noting that this review will introduce more flexibility into these processes and help us to support career progression on the basis of competency, rather than time served. It will also consider how the NHS can best support the career aspirations of those doctors who are not in formal training programmes.  As the NHS is one of the largest healthcare learning organisations in the world this is one step to ensuring that the medical element of that workforce has support and educational opportunities to develop their professional life.

Nursing Associates

Almost a year ago to the day, the Government announced plans to introduce a new nursing support role, the “Nursing Associate”. This new role will provide fundamental care to patients and the public in primary, secondary, community and social care. Crucially, Nursing Associates will work under the direction of Registered Nurses to deliver high quality person centred care and enable them to advance their practice.

Since January, we have worked closely with stakeholders to develop the role and have recently announced 35 test sites across England that will test the Nursing Associate education and training model, underpinned by a draft national curriculum framework, and deliver 2,000 Nursing Associates by 2020. The first wave of 11 test sites are recruiting the first 1,000 trainees now and there has been huge interest. Our second wave of 24 fast follower test sites will train a further 1,000 trainees from Spring 2017. I wish them all the very best.

In addition to this, the Secretary of State’s recent speech at the NHS Providers conference confirmed that statutory professional regulation is a necessary requirement for the Nursing Associate role and has asked the Nursing and Midwifery Council to consider the formal regulation of this new role. This is good news for patients and the public and will ensure consistency and quality in the standard of care they receive from Nursing Associates.

In the same speech, the Secretary of State announced that there will be a new nursing degree apprenticeship programme to offer staff from all backgrounds, regardless of whether they are currently working as healthcare support workers or already working towards higher level qualifications, an opportunity to train flexibly for a career in nursing.

All of these developments will yield benefits for the care and nursing workforce and the NHS, creating flexible career progression routes into Registered Nurses, increasing capability and capacity across these professions to deliver safe, responsive high quality care and enabling Registered Nurses to advance their practice.

This is a major step forward for nursing and for the NHS, and I would like to extend my sincere thanks to all those at HEE whose commendable work has made this possible.

We need to link this work to all the other initiatives in the allied healthcare specialties and the continuing work with doctors so that HEE really does deliver in a multi professional way.

Thank you for your continued support throughout 2016 and I wish you all a very merry Christmas and a Happy New Year.