8 Min In Analysis
It’s time to delve deeper into health discussions. Broaden your understanding of a range of pharmacy news and topics through in-depth analysis and insight.
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In November 2021, the NHS Confederation jointly published a report1 with the Civic University Network on reimagining the NHS/university relationship. The word ‘reimagining’ was important, signalling the need to go further than simply resuming the relationship post-pandemic, ensuring ‘place’ occupied a much more intentional and explicit role.
The last Government’s NHS Long Term Workforce Plan (LTWP) is a fascinating lens through which to assess the role of place in the NHS/university relationship. Set over 15 years, the plan committed, among many other things, to expanding domestic education and training by up to 65 per cent, trebling to 22 per cent the proportion of all training through apprenticeships and doubling the number of medical school training places.
The plan contained over 200 actions, delivered through over 60 programmes of activity across three themes (‘train’, ‘retain’ and ‘reform’) and seven key priority areas – all supported by newly established governance structures. Irrespective of geography, scale, focus or specialism, or even the intentions of the new Labour Government, there is a good chance that its broad intentions will, in time, touch on your local university.
With workforce being a particular issue for the NHS, the plan received widespread support but there was always confusion about how it would be funded. The early consensus which secured its publication is now in danger of splintering with, for example, growing opposition to expanding apprenticeship routes and roles such as physician associates (PAs). There are certainly no grounds for complacency and local discussions run the risk of becoming bogged down in operational challenges.
Why does it matter?
The timing of the 2021 joint report was significant, pointing to what many vice- chancellors and NHS chief executives felt was
a critical moment in how they work together. The pandemic revealed fragilities and exclusion in local communities and exposed the interconnected nature of the challenges institutions faced.
Those areas with an element of ‘place maturity’, where leaders supported each other across sectors and worked together on a shared vision, tended to find it easier to adapt and respond.
The original report highlighted five principles for rebuilding this relationship. There is an opportunity now is to test and refine these principles as the sectors collectively seek to deliver on the promise of the LTWP.
“The more organisations engage with and through communities, the more leaders understand their priorities”
Thoughts on pharmacy workforce planning
The NHS Long Term Workforce Plan (LTWP) marked a vital milestone for pharmacy planning,
setting out an ambition which included increasing training places for pharmacists by nearly 50 per cent to around 5,000 places by 2031/32.
However, having a plan does not automatically result in the desired impact – and pharmacy should be a vocal part of any local conversation. Community pharmacy is not only an important part of the health and care system but also a visible symbol of our high streets. This breadth is exactly why we argue that for workforce planning to succeed and generate a positive wider impact, it needs to be both people-centred and place-sensitive.
This leads us to a simple question: how could this place-based thinking manifest itself in the pharmacy context? Perhaps by explicitly focusing on those places deemed ‘left behind’ when deciding where new medical and pharmacy schools should be based. Or in developing new models of pharmacy training and care that are predominantly high street or town centre-based.
Further to this, primary care more broadly should work with universities to prioritise diversity and equality, offer opportunities to learn and develop, and advocate for social justice and, vitally, mental well-being. The LTWP is perhaps the most important opportunity yet to show what local university and NHS relationships can and should achieve, and how leaders should go about fulfilling the opportunity. Pharmacy leaders need to use the plan to balance new ideas for local practice with learnings for national policy.
Testing out the five principles
1. Collaborate & co-develop consistently
A key question when there is any form of collaboration is ‘what are we committed to do together?’. For any workforce plan to succeed and generate a positive wider impact, it needs to be both people-centred and place-sensitive.
The current context requires people who think beyond their institution about the communities they serve, and with the transferable skills to engage with many sectors within a place. In a world of increasing specialisms, how are universities developing future generalist place-leader roles?
The new health and care structures can help. The 42 integrated care systems (ICSs) are responsible for health and care planning across populations ranging from around half a million in Shropshire, Telford and Wrekin to over 3 million in North East and North Cumbria, and with an average annual budget of £2.7bn.
The voice of higher education needs to be heard around the ICS table in relation to workforce, of course, but vice-chancellors need to join, stretch and magnify this. While there are a range of sub-national university groupings in England, it is still not clear as a partner whether collaboration or competition is the main driver of behaviour in the higher education sector. This will be a direct challenge in making engagement consistently place-based, not just project-based.
Working together locally can also influence national implementation. How can a national workforce plan possibly account for England’s urban, rural and coastal split? The Chief Medical Officer’s 2023 annual report made a feature of the skewing of the geography of older age in England away from large urban areas towards rural, coastal and other peripheral regions.
When mapped together, these areas show very little overlap with the sites of the most well-resourced universities. The gap between health demand and labour supply will be starkest not just in deprived coastal areas but in relatively well-heeled retirement destinations like North Yorkshire and the South West.
What if place, and thus social and economic development, could be brought explicitly into conversations about where new medical and pharmacy schools should be based? The NHS/university relationship, particularly when targeted through emerging civic university agreements, will be critical in ensuring national policy grapples with wider civic impact.
2. Being part of an anchor network
The idea of institutions as local anchors beyond their core function has become mainstream. Since the 2021 report, there has been both a deepening and a broadening of networks of local anchors. Whether in Leeds, Birmingham or London, for example, NHS organisations and universities are working closely with local authorities, colleges, VCSE organisations, sports clubs and businesses to make local populations both better and better off.
These emerging anchor networks should be the foundation on which the longer-term vision for a health and place strategy builds.
There are four core purposes of an ICS:
- Improving population health
- Enhancing efficiency
- Tackling health inequalities
- Helping the NHS support broader social and economic development.
This fourth purpose is particularly relevant to anchor networks. Were universities and NHS organisations jointly to run educational facilities or broker new approaches to integrating public services in empty units, shopping centres or department stores, they could actively support the social and economic viability of their places.
They could also adapt new approaches that remodel how teams work, creating changes in working patterns, supporting new role development, enabling better use of AI and digital advancements, and bringing a broader focus on health creation.
Local collaboration between stakeholders is key to effective workforce planning
3. Commit to building the future
It is hard to think of anything that speaks more strongly to this principle than the LTWP. Parts of the NHS have repeatedly sought to develop deep and embedded links into communities through which to inspire people into the sector, but the internal cultural shift necessary to realise this often falls short. Approaching this principle through local discussions around workforce planning can bring both specific benefits but also a much broader understanding.
Firstly, universities and NHS organisations through anchor networks should connect a more nuanced, data-rich understanding of trends in health and care demand with the many and varied local routes for labour supply.
Depending on the context, this might mean prioritising retaining students – particularly in those places consistently seeing the largest graduate outflow – and retraining those over 50 years so that population ageing is an asset. Providing health and care support to enable people to train and get work in the sector can also generate a benign feedback loop for local planners to draw on, using the extensive research and digital expertise of most universities.
How much further can this principle be pushed? As successive governments experiment with varying forms and degrees of decentralisation, it is the NHS/university relationship that can grasp the nettle.
4. Prioritise inclusivity
The ICS focus on health inequalities can bring inclusion centre stage of any workforce planning. Providing equitable access, ensuring organisations reflect communities, tackling discrimination and supporting evidence-based decisions lead to thriving workforces.
Such micro level work can also play a key role in framing and evidencing new approaches to some of the more salient political issues such as migration, showing the broad value of and need for immigration in real terms through the place lens. Collectively, this will lead to stronger community relationships, increased trust and take-up of services – and better levels of care.
As two of the most significant employers in almost every locality, NHS organisations and universities need to prioritise diversity and equality, offer opportunities to learn and develop, and advocate for social justice and, vitally, mental well-being. This direct role extends to staff and students, for whom their experiences should be a central rallying call. Attrition is particularly high for students transitioning into the NHS workplace, with up to a third of nurses, for example, leaving courses before completion.
The more organisations engage with and through communities, the more leaders understand their priorities. The South London Listens programme has seen extensive community interaction over several years, pushing housing, migration, employment, mental health and young people to the top of the ‘to do’ list for local partners. Rather than focus on these issues in isolation, many of which do not have an obvious lead, these are the cross-cutting themes on which to develop and deliver a workforce plan.
Similarly, the joint work by NHS London and the capital’s universities in developing an industrial placement scheme for non-clinical roles is important. Focused on students who stand to benefit the most from social mobility, this will open NHS roles, and potentially careers, to those studying the breadth of higher education courses, and is also stretching the parameters of traditional widening participation approaches taken by universities.
5. Measure impact
The final principle was measurement. Addressing workforce planning nationally will likely focus outcomes on the hard currency of numbers in training and subsequently employment. A civic approach would be much clearer on the economic and social impact. Locally, there is a need to build into the approach of the LTWP some of the potential outcomes discussed throughout this article and to evidence them over a longer period, understanding what can be done best at what geographic footprint.
This long-term impact is important. There are clear overlaps with the broader devolution agenda and skills forms a critical part of every deal struck with government. There is a desire from health leaders for ICSs to become the default level for future workforce decision-making.
This would enable increased autonomy over the development of local system architecture, responsibility for managing strategic external relationships and, critically, control of dedicated funding streams. It would also truly help reimagine the relationship with universities.
Reference
- Reimagining the relationship between universities and the NHS: a guide for building and sustaining local, place-based collaborations. nhsconfed.org/publications/reimagining-relationship-between-universities-and-nhs
Matthew Taylor is chief executive of the NHS Confederation. Michael Wood is head of health economic partnerships at the NHS Confederation.
This essay was originally published as part of a collection from over 40 leading thinkers across different sectors outlining the economic and social benefits universities have on their local communities. The collection was published in memory of Lord Bob Kerslake, chair of the UPP Foundation’s Civic University Commission (2018-19), who sadly died last year.
Analysis
In Analysis
It’s time to delve deeper into health discussions. Broaden your understanding of a range of pharmacy news and topics through in-depth analysis and insight.