Hospital thinks outside box to solve staffing crisis

There were fears that, if key posts could not be filled, Whitehaven’s West Cumberland Hospital could lose key services.

But doctors and nurses have taken the initiative, coming up with a new way to staff - and ultimately safeguard - A&E services.

The “composite” staffing model - which has seen nurses, paramedics and therapists train up to take on senior roles - is the first of its kind in the country, and has already won a national award for innovation.

Dr Katie Poulton, acute care consultant at North Cumbria University Hospitals NHS Trust, said it is still a work in progress but is already showing real signs of success.

She explained why a new approach was necessary. "There's a national disaster from a medical staffing point of view,” she said.

“(Nationally) we do not really make enough of our own doctors, plus lots go abroad and lots are also leaving medicine.

"It is particularly an issue here in west Cumbria because we have struggled to recruit at consultant level. To have juniors with adequate supervision you need to have seniors in post.”

In August 2015 trainees were pulled out of the hospital for this reason, so Whitehaven had no training doctors apart from GP trainees.

Being so far from medical schools was also an issue, so the trust has forged strong new links with both the University of Central Lancashire, which has a new medical campus in west Cumbria, and the University of Cumbria.

Dr Poulton added: "We feel the same pressures as the rest of the country, but they are magnified here because of our difficult geography and because we are not near a medical school.

“People tend to settle near to where they go to medical school. It's a long training process and by the time they finish they've likely got a mortgage, family, kids at school. Asking someone to move at that stage is a big ask in many cases.”

They therefore decided to challenge the traditional medical hierarchy, to see if things could be done differently without affecting care.

"We have been finding it difficult to keep that going so we had to start thinking differently, to think of other ways we could make sure patient care was safe and that there was continuity,” said Dr Poulton.

"We had quite a big reliance on locum staff. That's how we've been trying to exist. That's not only expensive but also not sustainable, and continuity is an issue because they can leave at short notice. We've had some very good long term locum doctors but that wasn't the only answer.”

Workshops were set up, via the Success Regime and northern senate, to look at possible solutions.

Dr Poulton: "We came up with this idea for a composite workforce, using skills from lots of different places.

"Our aim was to put together a team that would work together, enhancing each other's abilities, but with less focus on the doctor-only model. It's still in progress but we are getting there."

The new workforce model combines:

*Trust doctors: Several of who have recently been appointed on long term contracts

*GP trainees: Taking on new and exciting posts, working across A&E, the emergency assessment unit, ambulatory care and other areas they may have a special interest in

*Advanced clinical practitioners: Nurses, physiotherapists, occupational therapists, paramedics and others who train to a higher level so they can take on some roles traditionally carried out by doctors

*Physician associates: New training posts created for people with a postgraduate degree in a science-based subject who want to make the transition and work in the health service.

Together this composite workforce is already helping to secure emergency and urgent care in Whitehaven, and there is a potential similar models could be used in other specialties.

In terms of advanced clinical practitioners, these were already working in the hospital and in other parts of the NHS.

But Dr Poulton said nowhere else have they been used on the same scale as they are at the West Cumberland Hospital.

She explained why they are so valuable.

"They come from a specific background, often with 10 years or more experience, then go on to a Masters, through the University of Cumbria, in advanced clinical practice, learning about things like prescribing.

"They really are essential to our service. They are fantastic. Some people say they are cheap doctors but they really are not. They work to a very high clinical level and are rewarded adequately for that.

"You can't underestimate their previous clinical experience. It brings a different point of view as they look at things from a slightly different perspective. It's really great for joint learning" she said.

Dr Poulton added: "We have created a new workforce with a new hierachy structure. What we have done here that nobody else has done is made a career structure for the practitioners.

"We are also in the middle of developing a different kind of Masters with the University of Central Lancashire, developing their clinical knowledge and practice another step up.

Most of those currently in post were already working here, but wanted to enhance their role and gain new qualifications

"We are now trying to say to nurses that if they come to Cumbria, we can offer them these type of opportunities," she added.

Karen Burns, a long-serving nurse from Whitehaven, is in the final year of her training as an advanced clinical practitioner.

In the past she has worked all over the hospital in different roles and was keen to move back into a patient-centred post.

"It's a new challenge. We all want to be part of a different way of working," she said.

Gail Mitchell, a senior advanced practitioner, added that ,many nurses already have strong roots in the local area, so the trust is training up people who are here to stay.

Lisa McAvoy is going into her third year on the advanced practitioner training programme.

Originally from Whitehaven, she recently moved back to west Cumbria from Blackpool after seeing the post advertised. She said it has meant she can be nearer her family, who can help with childcare.

"It is quite hard work, because it is a very demanding role. It's different from the role of a nurse," she said.

"You have to learn a lot and really move out of your comfort zone. I've now passed all my prescribing so I can now make clinical decisions, but I can still speak to a consultant for advice if I feel I need it."

Leanne Armstrong, from Workington, recently qualified as an advanced practitioner with a special interest in acute medicine.

She said she had reached a stage in her nursing career where management was the obvious progression, but this didn't interest her. She found that the advanced practitioner role gives her that extra responsibility, but in a far more hands on way.

"Some people like being a nurse, others like to specialise. This just seemed like a great opportunity for me," she said.

Claire Penn, deputy ward manager on the emergency assessment unit, said so far the new staffing model is working well, with everyone playing their part across the emergency units.

The physicians associate model is commonly used in some other countries, including the USA. The first cohort is currently being trained up via the new west Cumbria medical campus.

Matthew Mustain is a qualified physician associate from America who both works at the hospital and trains the new recruits.

He believes that once fully trained, they will be incredibly beneficial to the West Cumberland Hospital. "With current staffing issues in areas like this, they are a really valuable asset," he said.

The team at North Cumbria University Hospitals NHS Trust recently won the Award for innovation in HR at HMPA Awards 2017