Hundreds of band 5 nursing, social worker and therapist posts could be cut in Nottinghamshire as part of the county’s sustainability and transformation plan (STP).
An appendix published alongside the STP includes what is described as an indicative proposal to change the workforce skill mix over the next five years to reduce the pay bill by £12m.
“The overall skill mix shows an increase in advanced and enhanced levels”
This would be achieved through a 12% reduction in “core” skills staff, which the plan identifies as band 5 nurses and similar roles. The plan also suggests a 24% increase in staff working in community services and primary care.
A spokeswoman for the organisations behind the STP said the proposals were an illustration of the direction of travel and not a final plan. She said work was ongoing to develop the detailed plans and staff would be part of this process.
The appendix states that the core skills group would have a net reduction of more than 640 posts, with the largest falls in urgent and planned care, which would drop by more than 400 posts. There would also be a drop of 116 mental health and learning disability posts but an increase of 38 in primary care.
Within the illustrative example there would also be a net reduction of foundation skills staff, typically bands 1-4 staff, which would drop by more than 200.
There would be growth in what the STP calls “enhanced” and “advanced” staff, which it defines as bands 6-7 staff and junior doctors and consultants, GPs and advanced nurse practitioners. Bands 6-7 posts would grow by 2% and the other roles by 7%, an increase of almost 300 posts.
“These are not planned changes at this stage but one of a number of scenarios”
Across all staff groups, the example suggests there would be a net reduction of 562 staff – 2.7%.
The appendix said the effect of the STP would result in a 10% reduction in accident and emergency attendance and emergency admissions; a 12% reduction in elective admissions and outpatient activity; and a 10% rise in primary care and self-care activity.
It said: “The resulting illustrative future skill mix projection indicates a growth in our primary and community care workforce of 24% over the next five years, but with a potential £12m savings on future pay costs.”
These savings were accounted for in organisational plans, it said. “Significant reductions elsewhere are indicated that will contribute to closing the financial gap based on the assumption that primary and community care or self-care will increase in capacity and capability,” it said.
It added: “The overall skill mix shows an increase in advanced and enhanced levels, and reductions in other skill levels, the largest being the group in the core skills group. Further efficiencies could be achieved by reducing agency costs and non-patient facing staff who have not been included in the model to date.”
Earlier this month, it was revealed that the Buckinghamshire, Oxfordshire and Berkshire West STP said it would save £34m through a “reduction in nursing grade input” and greater use of “generic support workers”.
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A Nottinghamshire STP spokeswoman said: “The appendix is a worked example and is not intended to represent the actual future workforce numbers.
“These are not planned changes at this stage but one of a number of scenarios that will be modelled over the next few months to develop our plan. We are committed to ensuring that we do not compromise patient safety when we develop our detailed workforce plans and the modelling tool will support us to do this.
“In Nottinghamshire, we are rolling out our holistic/generic worker where we have up-skilled our care workforce at all levels in disciplines outside their normal professional boundaries to enable a more person centred approach to the assessment of care needs. This has led to fewer visits, a more personalised approach and improved outcomes.”
The plan also revealed the intention to cut 200 hospital beds over the next two years at Nottingham University Hospitals Trust. This is almost 12 per cent of its total bed base.
Activity and beds will shift to the community to make Nottinghamshire clinically and financially sustainable over the next five years.
Nottingham trust chair Louise Scull wrote on her blog: “Without different community services being in place as an alternative to hospital care and without work to reduce demand on our hospitals, this won’t be achievable.”
Information supplied to HSJ