A hospital trust is planning to bump up its nursing skill mix ratio with assistant practitioners, while using specialist nurses to do tasks normally done by doctors.
Under plans set out by Royal Cornwall Hospitals Trust, the 4,650 strong workforce will be cut by up to 14% over the next five years.
The trust’s “Our People Strategy for 2013-2018” sets out an ambition to achieve a ratio of 60% registered to 40% unregistered nursing staff by the end of this year – up from 55% to 45% currently.
By April 2015 the trust plans to increase the ratio to 65:35. However, the 65% would include assistant practitioners who, although more highly skilled than other HCAs, are not registered with the Nursing and Midwifery Council.
Sue Matthews, Royal College of Nursing regional officer for Plymouth and Cornwall, said she was “extremely concerned” by the proposals.
“The RCN recommend a ratio of 65% registered nurses to 35% non-registered nursing staff, which the trust say they are working towards. However, assistant practitioners would be non-registered staff and should not be counted in the 65% as they are in this paper.
“Studies show that where there is a low ratio of registered staff quality care is care is compromised,” she said.
The strategy was approved by the trust’s board on Thursday and a consultation will now begin with staff. Interim nursing director Andrew MacCallum told the meeting he was committed to a 60:40 ratio of registered to unregistered.
The strategy proposes band 3 healthcare assistants step up to train as band 4 assistant practitioners or step down a band to the newly-created roll of “nursing assistant”.
Doctors’ job plans are to be redesigned to allow more work to be done by nurses and other non-medical professionals. For example, advanced nurse practitioners will run clinics currently delivered by doctors.
The trust wants to reduce the proportion of its income spent on pay from 65% to 59%. Its managers claim low staff turnover means a higher proportion of nurses and other staff have reached the top of their Agenda for Change pay band than at comparable trusts – pushing up the overall pay bill.
The trust says the extent of the headcount reduction will depend on the extent to which the pay bill can be reduced.
The strategy also sets out detailed plans to set up a “talent pool” for nurses and other staff who are judged to have the most potential and to improve staff development. Clinical simulation training will be rolled out to at least 70% of staff by 2018.
In addition, an employee reward scheme is to be developed, which could include sharing profits with staff.
But Ms Matthews said: “[While] the trust has made assurances that patient safety and quality care remains their priority… this paper does not convince me that they intend to employ appropriately qualified staff and with the expertise to the deliver safe, quality care that Cornwall residents deserve.”