All NHS employing organisations have the same overarching legal, regulatory and national policy framework when employing staff. Each organisation must satisfy themselves that individuals being employed are who they say they are, are fit to be employed and competent to fulfil the role offered to them.
However, employing organisations interpret national requirements slightly differently, resulting in marginally different policies, processes, practices and standards which lead to unwarranted variation, as highlighted in Lord Carter’s report Operational productivity and performance in English NHS acute hospitals: unwarranted variations.
In 2019, we undertook our first doctors in training survey to ask them about their experiences in relation to employment, deployment and induction during training rotations. Almost 10,000 trainees from a range of specialties, grades and regions responded and the main summary responses can be viewed here. You can also watch our video below:
Doctors’ rotations represent approximately 20-25% of all staff movements, as they rotate around trusts at least once annually. To enable us to tackle the issues around ease of staff-mobility within the NHS and drive forward improvements to the pre-employment experience of staff, our initial scope of work concentrates on resolving issues for the doctors in training, and thereby unblocking the systemic issues that all staff groups face.
Enabling Staff Movement Strategy
The aim of the Enabling Staff Movement Strategy is to improve the experience of staff when they move between roles in the NHS, reducing the duplication of form filling, employment checks and mandatory training so that they can spend more time with patients.
There are three strategic pillars:
- Optimal employment models - reducing the need to transfer employment (e.g. lead employer models)
- Interoperable workforce systems - Enabling data to flow between systems driving up data quality
- Digital staff passports - Enabling person-centric passporting across multiple issuers and verifiers
Unpinning each of these pillars are three fore foundations:
- Cultural and process change
- Trusted frameworks
- Data standards and interoperability
Further details on these can be found below
The aim of our work here is to define ‘optimal’ (what good looks like) lead employer models for doctors and dentists and expand the use of these models across England.
We do not anticipate a single model will work for all specialties, grades and regions, and so are looking to define and potentially expand the optimal models for doctors and dentists.
There are approximately 30 active lead employers in England, responsible for approximately 16,000 (31%) of the 53,000 doctors and dentists in training nationally. The Lead Employer Model is designed to be a collaborative operating model, with the responsibilities of the traditional employer shared between three major stakeholders, who are:
Lead Employer – Overall employment responsibility including e.g., contracts of employment, employment checks, pay, restrictions/exclusions and disciplinary matters etc. The Lead Employer itself offers a single point of contact, coordinating with all stakeholders including third party agencies e.g., Police, Safeguarding etc.
Host Organisation – Provides day to day management, and day to day supervision of training by clinical & educational supervisors during the period to which the trainee is based in this location.
Health Education England – Responsible Officer, supervision of training & progress in training. HEE ensures consistency with the handling and resolution of concerns raised relating to capability and health matters.
The primary function of a Lead Employer arrangement is to provide a single employer for the trainee for the entirety of their training programme, to ensure that trainees complete their training satisfactorily, have a positive experience, and in doing so provide an excellent service to the NHS and its patients.
The current employment landscape for doctors and dentists in training involves a mixed economy of operating models which means that there is no consistent approach to the employment of doctors and dentists in England, which presents the following challenges:
• Trainees have a range of experiences depending on the employment model, the presence or otherwise of a Lead Employer and its specific deployment model.
• Regional coverage is variable: the most material numbers of doctors in training employed via a Lead Employer Model are based in the North East and the North West of England, in contrast there are some regions with no coverage.
• Training programme coverage is variable.
• There is significant variation in the scale and service offering of current active Lead Employers.
• There is a lack of consistency in contractual arrangements, deliverables, and reporting.
• Lead Employers are aligned on different geographical bases and do not all align with HEE Local Offices or the flow of doctors through their programmes.
• There are different workforce IT systems being used and limited interoperability between the different systems.
Work to date
We have co-created & consulted on a draft set of 12 principles for good practice for Lead Employer models, drafted a service catalogue and started to explore the expected benefits. In getting to this point, we have already engaged with approximately 80 stakeholders from HEE, NHSE/I, Lead Employer organisations and NHS trusts through a series of workshops in 2020.
Work Programme for 2021/22
Our priority this year is to develop a toolkit for any regions interested in implementing a lead employer arrangement for doctors and/or dentists. A task and finish group has been set up to develop the toolkit, which will cover all the areas to consider when seeking to implement a lead employer arrangement, template specification and contracts and case studies on some of the models we already have in place in the North West, North East and London.
The toolkit will be developed during the summer and should be published by Autumn 2021. If you want to find out more or get involved in the task and finish group please contact Emma Turner, Programme Lead for ESM on firstname.lastname@example.org.
Alongside the development of the toolkit, we will look to scope the feasibility and appetite to increase the use of optimal lead employer models to cover all doctors and dentists in training in England. This is a significant piece of work and will require much engagement across 2021/22. By 31st March 2022 we hope to have a clarity on whether it is feasible, if it is, how we might achieve it, and over what timescale.
HEE will also be working closely with NHS England and NHS Improvement on the potential of optimal employment models for other staff groups within Integrated Care Systems.
To find out more or get involved
Please contact Emma Turner, HEE Programme Lead for ESM on email@example.com.
The aim of interoperating various workforce systems is to automate data sharing between applications, databases and workforce systems so that workforce information is available where it is needed, without delays or need for manual entry from anybody.
There are several workforce information systems in use across our various NHS organisations which is leading to repeated manual entry of data, data quality issues and limited visibility of workforce information which is impeding the speed at which staff can move from one NHS organisation to another.
Although, the Electronic Staff Record (ESR) is the integrated workforce system used across the NHS, it does not hold complete set of data required for staff moving from one organisation to another. To make the process of staff movement more efficient, it is therefore important to increase the completeness of essential information on ESR to avoid unnecessary repetition of employment checks and training, which will enable Doctors in Training (and all staff) to more easily move from one NHS employer to another, through IAT or digital staff passports.
Work programme for 21/22
Prioritising doctors in training, NHS England and Improvement is funding a pilot of interfaces between ESR, Lead employers of doctors in training and their learning management and occupational health management system to develop and implement interfaces that will enable automated exchange of information between these systems.
As part of this work, data and interoperability standards will also be developed and published to guide and support other NHS trusts and their learning management and occupational health system suppliers to develop interfaces that enable seamless and automated exchange of information between their systems and ESR.
To find out more or get involved
For general information, please visit the NHSEI Futures website here
For specific questions, please contact Farouk Lawal, Improving Employment Models Lead for NHSEI via F.firstname.lastname@example.org
The aim of digital staff passports is to support an adaptable and agile workforce that will move seamlessly between providers enabled by a digital passport allowing data to transfer securely between different employers and into their respective workforce systems automatically, further safeguarding patients. Ultimately, it is envisaged that NHS staff will hold a verified record of their professional registration, employment history, training, and skills, leading to a much better experience when moving between health and social care organisations. Organisations should be able to spend less time onboarding new staff and focus more on value added activities and better talent management, not just within individual organisations but across the wider NHS and health and care sector. In parallel, NHSX are developing the digital passport technology so that it can also be used to sign on to clinical and workforce systems, as authorised, and even as the building and facilities access pass, thereby reducing time spent logging into systems or issuing building passes.
Further to the Secretary of State for Health and Social Care’s consultation outcome paper on Busting Bureaucracy which stated an ‘ambition for all (Doctors in Training) to have access to staff passports in 2021/22, our joint aim with NHSE/I and NHSX is to ‘design, develop and deliver a private Beta version of the Digital Staff Passport for Doctors in Training’ by end of March 2022. There will be an initial private launch of this strategic staff passport that will invite expressions for a limited number of (potentially) early adopters to test the new product, before making it available to the broader audience, i.e., all 53,000 doctors in training.
Work to Date
COVID19 Digital Staff Passport
During the COVID-19 pandemic, NHSE/I and NHSX in partnership with Blackpool Teaching Hospitals and technology partners successfully and rapidly developed and deployed the ‘COVID-19 Digital Staff Passport’ to support the temporary deployment of NHS staff to be safely and swiftly shared between NHS employers to best support the response to the pandemic. This first of a kind national employment passport was built on user research from doctors in training which was gathered by the Enabling Staff Movement programme during workshops and via the survey. A summary of the responses can be found here.
It should be noted that the COVID-19 Digital Staff Passport can only be used to support temporary staff moves where employment remains with the substantive employer and the staff member is ‘shared’ (with the staff member’s agreement) with another NHS trust who agree to ‘host’ the staff member for a temporary period.
This passport is currently live and available to NHS employers.
To find out more visit the COVID-19 Digital Staff Passport website.
Strategic Digital Staff Passport
In December 2019, NHS England and NHS Improvement in partnership with HEE and NHSX undertook a ‘discovery’ phase for a digital staff passport for doctors in training. The discovery report was completed in April 2021.
It should be noted that the strategic digital staff passport will be used to support all staff movements, including permanent staff movements, where staff are changing their employer in the NHS.
To find out more or get involved
Please contact Emma Turner, HEE Programme Lead for ESM on email@example.com or
Charlotte Dainter, Improving Employment Models Lead (NHSE/I) on firstname.lastname@example.org
The aim of NHSX is to evolve data and technical standards that will improve the interoperability of workforce systems to meet the needs of NHSE/I programmes including doctors in training, Collaborative Banks, and Digital Staff Passports.
Many workforce systems lack the level of interoperability required between systems to meet the operational demands of workforce managers and the expectations of end-users.
The definition of data and technical standards is an important prerequisite for improving interoperability along with clear business drivers and a collaborative approach across suppliers and healthcare bodies.
Work to Date
For the COVID-19 Digital Staff Passport, NHSX supported the definition of a credential scheme that defined the employment attributes to be used to support the movement of staff from an employer to a host organisation.
NHSX also worked with BSA on the design of an ESR API that enabled HR teams in employers to retrieve the employment details for each staff member who volunteered for temporary deployment.
Work programme for 2021/22
NHSX will lead the work to procure resources to assist in the definition of data and technical standards, and to establish a collaborative approach for co-design and implementation of these interoperability standards with workforce systems suppliers.
Our aim is to evolve existing key national ‘standards and frameworks’ relating to essential employment information and training into ‘trusted frameworks’.
A ‘trusted framework’ is a shared set of “definitions, requirements, standards, specifications, processes” which act as the guides for different processes or ways of describing things. A trusted Framework contains the tools, rules and accreditation criteria which provides the required structure and controls to deliver confidence to those participating that all recognised and involved have met their accreditation obligations and as such may be considered trustworthy.
These trusted frameworks enable all those who participate to accept the work already completed by others, with appropriate warranties and indemnities, thereby helping build trust between employing organisations and eliminating the need to repeat identified processes such as employment checks and certain statutory and mandatory training. The trusted frameworks underpin any method of passporting personal, employment and training records, whether that be digital staff passports, ESR’s inter-authority transfer (IAT) or paper-based approaches.
The focus of this enabling workstream involves the following three current standards:
NHS Employment Checks
Occupational Health Immunisations and Vaccinations
Work to Date
The programme, in partnership with NHSX, have been involved in the development of the first UK trust framework on digital identity and attributes. This framework will help facilitate a clear understanding between people using identity products, the organisations relying on the service and the service providers, letting each party know data is being used appropriately and kept safe.
Work programme for 2021/22
NHSE/I will lead on the procurement of an expert in trusted frameworks in July/August 2021. The expert will produce a report with recommendations on an approach to developing frameworks from the three current standards (outlined above) by the end August/September 2021. From this approach a roadmap will be developed for the programme to undertake the work required to develop the three standards into trusted frameworks by the end of March 2022.
A review of the Core Skills Training Framework (CSTF) will also take place in 2021, findings and recommendations from the expert report will be factored into the CSTF review.
To find out more or get involved
To find out more about the work on trusted frameworks contact Nicola Fowler, Improving Employment Models Lead, NHSE/I Nicola.email@example.com.
To find out more about the CSTF review please contact Emma Turner, HEE Programme Lead for ESM on firstname.lastname@example.org
The aim of the Core Skills Training Framework (CSTF) is ‘To enable consistency in the core content of statutory / mandatory education and training.’
The Core Skills Training Framework (CSTF) was written and launched by Skills for Health (SfH) in 2013, it is used by healthcare organisations to help guide and standardise the focus and learning outcomes of key statutory and mandatory training skills for all NHS staff. The framework is updated annually and there are now two versions of the framework, a CSTF for England only, jointly developed by HEE and Skills for Health, which will be in scope for this review, and a separate framework which can be used by all 4 nations of the UK, which is not in the scope of this review.
The main benefits of the framework are:
- Ensure achievement of an agreed standard of knowledge and behaviours.
- Reduce duplication in training delivery.
- Enable portability of training data.
- Provide a benchmark for the design and development of training.
- Provide minimum standards for commissioning of training.
The CSTF currently contains 11 core subjects to which the majority of NHS organisations within England have declared their alignment. to a greater or lesser degree. The 11 core subjects are:
- Equality, Diversity and Human Rights
- Health, Safety & Welfare
- Conflict Resolution
- Fire Safety
- Infection Prevention & Control
- Moving & Handling
- Safeguarding Adults
- Preventing Radicalisation
- Safeguarding Children
- Information Governance
The framework sets out the key learning outcomes for each subject, i.e. what the learner will know, understand and be able to do following the learning. The framework also provides supporting guidance on the frequency of refresher training, standards for training delivery and links to current policy/legal guidance, where available.
In order to achieve the portability of training, national CSTF ‘competencies’ have been developed and added to the NHS Electronic Staff Record (ESR), the NHS’s workforce information system. ESR has functionality, the Inter Authority Transfer (IAT), which enables transfer of employees’ learning records/competencies as they move between NHS organisations. Where learning is up to date, and where the competencies are accepted by a receiving NHS organisation, the NHS employee moving does not need to repeat training in those subjects, however, not all trusts who are aligned to the CSTF will send or receive these.
The CSTF as provided by Skills for Health has gone a long way in achieving its original aim and the benefits outlined above. Currently there are 199 out of 221 NHS Trusts aligned to a version of the CSTF and many are sending and accepting the national competencies. However, there are still some challenges, which have been around since the framework was launched. These challenges have prompted the Enabling Staff Movement programme to instigate a full root and branch review of the framework and how it is governed and operated.
The current known challenges with the use of the CSTF are:
- Not all NHS organisations within England are aligned to the CSTF.
- Alignment is voluntary and via a self-assessment process with no external verification process to quality assure or to test these alignments.
- There are no standardised mechanisms to measure the efficacy of training, the levels of knowledge acquisition or that behavioural changes are provided after training.
- Those NHS organisations that are aligned are using the CSTF in different ways and in many cases only partially aligned to either some and not all of the subjects, or, some and not all of the refresher periods for the subjects.
- The lack of trust in parts of the NHS system and a lack of complete compliance by all NHS organisations with the CSTF creates problems for staff moving between NHS organisation, as they are still often made to repeat some or all of their statutory and mandatory training unnecessarily.
- NHS organisations are not required to provide evidence in support of their individualised training requirements or their divergence from CSTF guidance.
Objectives of the CSTF Review
The England only CSTF framework is the only framework to be reviewed. The review will not include any other learning frameworks.
The objectives of this review are:
- To test the current scope and effectiveness of the CSTF with stakeholders and assess associated knowledge transfer.
- To understand the barriers to alignment/adoption of the framework and how to best achieve the consistent use of the CSTF by all NHS organisation within England going forward.
- To ensure the current core subjects, levels and refresher periods are applicable and/or appropriate to the needs of all NHS organisation in relation to their statutory and mandatory skills and knowledge obligations.
- To provide insights that will both provide standards for and allow better standardisation of the learning outcomes and delivery of training for the core subjects:
- To consider and make recommendation on quality assurance, management and oversight (governance) of the framework going forward.
Steering the work
A national CSTF Steering Group has been established steer the review and the work on this framework on 2021/22.
To find out more or get involved
To find out more or to express interest in getting involved in the CSTF review please contact Emma Turner, HEE Programme Lead for ESM on email@example.com