Workforce NHS Highland As at 14Th March 2018

Workforce | NHS Highland | As at 14th March 2018

NHS Highland employs around 10,000 staff across many professions including but not exclusively (alphabetically)

• Administrative Services: Technical, Secretarial and Clerical professions including IT, Finance, Medical Records and Service Administration delivered in both office and health care settings.
• Allied Health Professionals: Services include Radiology, Physiotherapy, Speech and Language and Occupational Therapies and deliver direct patient care, rehabilitation, treatment, and diagnostic and health improvement to patients in hospital and community settings.
• Health Sciences: The Professional, Scientific, Technical and Healthcare Support workers within Laboratories, hospital and community settings who perform diagnostic tests and deliver therapeutic services such as renal dialysis or cardiovascular perfusion.
• Medical & Dental: Doctors and Dentists working within hospital and community settings; including dental nurses and dental technicians.
• Nursing & Midwifery: Registered Nurses and Midwifes, Nursing Assistants and Healthcare Support Workers who deliver direct patient care in hospital and community settings.
• Other Therapeutic: A range of disciplines which deliver therapies and health care including Pharmacy, Optometry and Psychology in hospital and community settings.
• Support Services: The services common to any large organisations and including Mechanical, Electrical and Engineering professions, Porters, Domestics, Catering and Laundry, Security, Decontamination and Transport services.

Workforce | Caithness

In Caithness the NHS employs around 600* people. They work either in the hospital setting (Caithness General Hospital and Wick, Town & County Hospital) or in Caithness District.

People / Description
599* / Caithness Workforce
356 / Workforce (District)
243* / Workforce (Acute)

*Please note these figures do not include services provided in Caithness but which are hosted outside on the North and West Operational Unit. “Hosted” services include Dental Services and Acute Mental Health.

The figures above also do not include medical services such as Junior Doctors or the rotational Consultants from Raigmore who are included in the figures for Raigmore.

Caithness Acute (Caithness General)

People / Description
97** / Nursing/Midwifery (Registered)
55** / Nursing/Midwifery (Unregistered)
16 / Allied Health Professionals
7 / Health Sciences
6 / Senior Medical
4 / Other Therapeutic

**The figures above include Wick Town & County Community Hospital

At Caithness General the medical services include a surgeon, anaesthetist and four Rural Practitioners. Rural Practitioners (RP) have enhanced skills in emergency care and resuscitation. The first RP was recruited to Caithness General in March 2016. They are supported by a team of eight doctors in training at different levels: three Foundation Year 2 (“FY2”) doctors, one General Practice Speciality Training (GPST), two Clinical Development Fellows (CDF) and two locums

There are a number of other medical staff working routinely at Caithness General Hospital and include Consultant Physicians, Consultant Surgeons, Consultant Obstetricians and Gynaecologist. Thesestaff are “based” at Raigmore but rotate to Caithness on a weekly basis.

Other consultants and specialists visit Caithness General on regular basis to conduct outpatient clinics. For example a care of the elderly consultant provides a visiting service from Raigmore. This consists of clinics in GP practices, care home reviews, home visits and a specialist Parkinson’s disease clinic run in Caithness General Hospital. Other clinics and specialism’s include consultants from Orthopaedics, Ear, Nose & Throat (ENT), Ophthalmology, Paediatrics, Rehabilitation, Renal Services and Respiratory. In addition there are nurse led clinics for amongst other specialism’s Parkinson’s Orthotics, Epilepsy, Audiology, Sexual Health, Lymphodema and Stoma care.

Caithness District

People / Description
168 / Personal & Social Care
55*** / Nursing/Midwifery (Registered)
32 / Support Services
22 / Allied Health Professionals
15*** / Nursing/Midwifery (Unregistered)
19 / Estates
7 / Medical (GP)
4 / Other
2 / Other Therapeutic

***The figures above include Dunbar Community Hospital

Most GPs work as independent businesses with a contract with the Scottish Government, but if they cannot maintain their business then NHS boards take on the responsibility for the GP practice. They are termed as “salaried practices”. In Caithness there are three salaried practices, employing seven people as GPs in either full or part time roles.

They are Lybster, Riverbank (Thurso) and Riverview (Wick). Traditionally practices are GP led but these practices have developed extended primary care teams including Advanced Nurse Practitioners and Advanced Pharmacist Practitioners (see 2 Other Therapeutic).

There are also a number of consultant and nurse led clinics which take place at the Dunbar in Thurso, these include Diabetes, Psychiatry, Gynaecology, Orthopaedic, ENT, Paediatric, Oncology and Care of the Elderly, as described previously.

Age Profiles

Age profiles for Caithness General and Caithness district are shown (Appendix 1). In Caithness General just under a half of all staff (46%) are aged 50 years or older. For Caithness District the figure is slightly higher at 53%.

Vacancies

There is a Human Resources (HR) Team based at Caithness General Hospital, covering the North Area (Caithness and Sutherland). The role of the team is to support staff and managers in line with employment legislation and to ensure that national and local guidelines are followed. In terms of vacancies the HR Team are involved from the initial agreement to advertise a post through to supporting the successful candidate’s commencement in to that post.

Posts are advertised either internally or externally. An internal post would be advertised via local vacancy distribution lists and via the NHS Highland “intranet”. An external post would be advertised via SHOW (Scotland’s Health on the Web) and can be on “caithness.org”, Caithness Chamber of Commerce, and the Job Centre; links are also created to Facebook and Twitter. For posts which are advertised at Band 6 or above they are automatically uploaded to the Remote and Rural NHS Scotland website. Posts can be advertised in local and national press, though this would be following discussion with managers and medical jobs are advertised in the BMJ.

Caithness Posts Advertised; January 2017 to December 2017

Caithness Acute

Last year (2017) NHS Highland advertised 61 new vacancies at Caithness General Hospital, of which 34 were full-time posts(A full-time post in NHS Scotland is 37.5hours per week) and 27 were part-time or flexible. Six out of ten posts were filled on first advert.

No. Full-time Vacancies / No. Part-Time Vacancies / Total / Posts Filled on First Advert / %
Administrative Services / 5 / 5 / 3 / 60%
Allied Health Professionals / 2 / 3 / 5 / 2 / 40%
Health Sciences / 1 / 2 / 3 / 3 / 100%
Medical / 3 / 1 / 4 / 3 / 75%
Nursing/Midwifery (Registered) / 23 / 8 / 31 / 17 / 55%
Nursing/Midwifery (Unregistered) / 4 / 7 / 11 / 8 / 73%
Other Therapeutic / 1 / 1 / 2 / 2 / 100%
Total / 34 / 27 / 61 / 38 / 62%

Caithness District

Last year (2017) NHS Highland advertised 109 new vacancies at Caithness District of which 18 were full-time posts and 91 were part-time or flexible. Seven out of ten posts were filled on first advert. Just over a third of Registered Nursing and Midwifery posts were filled on first advert. Medical staff are the most difficult to recruit to.

No. Ft Vacancies / No. PT Vacancies / Total / Posts Filled on First Advert / %
Administrative Services / 1 / 4 / 5 / 5 / 100%
Allied Health Professionals / 2 / 1 / 3 / 2 / 67%
Medical / 4 / 4 / 1 / 25%
Nursing/Midwifery (Registered) / 10 / 16 / 26 / 9 / 35%
Nursing/Midwifery (Unregistered) / 4 / 4 / 2 / 50%
Other Therapeutic / 2 / 2 / 2 / 100%
Personal and Social Care / 5 / 56 / 61 / 53 / 87%
Support Services / 4 / 4 / 4 / 100%
Total / 109 / 78 / 72%

On some occasions it was not possible to recruit to a post on the first advertisement (see below).

Caithness General

Some of the posts were advertised on more than one occasion (Appendix 2). While some were filled on the second or third time of advertising in the case of one of the radiographer posts and a number of the registered nursing/midwifery posts remain unfilled.

As of 1st March 2018 there were six open vacancies at Caithness General, of which four relate to nursing/midwifery (registered) and two to support services.

Caithness District

Appendix 3 highlights some of the posts in Caithness District which during 2017 were advertised on more than one occasion. For example a full time community mental health nurse post was advertised on six occasions and remains unfilled. The post is to be redesigned as a development post and will be re-advertised.

Innovative Solutions to Recruitment

With changes made to some posts it has been possible to recruit. Below are some examples:

1(c)A Staff Nurse (Band 6) 22.5hr p/w post at the Dunbar was unsuccessfully advertised twice, as was an 18.75hr p/w post which was also a Staff Nurse (Band 6) post. By reviewing these posts it was possible to create a Full Time Staff Nurse (Band 6) post at the Dunbar. Although it had to be advertised on more than one occasion this post was successfully recruited to.

2(a)The Community Mental Health Team advertised a Full Time (Band 6) Community Specialist Practitioner (Drugs & Alcohol) unsuccessfully in August 2017; this was on top of unsuccessfully trying to recruit to another Band 6 post six times. It was therefore decided to change the post on re-advertisement to a Band 5/6 Development Post. The post was advertised in November 2017; the successful candidate took up post in February this year.

3(a)Thor House advertised twice for a Day Centre Care Assistant on flexible hours but were unable to recruit. The post was re-worked to create a 22.5hr per week permanent post and was re-advertised successfully in August 2017.

4Traditionally the medical model, as per other Rural General Hospitals Caithness General Hospital had the following substantive consultant positions: Physicians (3), Surgeons (3), Anaesthetists (3) and Obstetricians (3). They were supported by Junior Doctors. Between January 2014 and June 2015 six advertisements were placed on SHOW and in the BMJ for a range of permanent consultant posts. None of these resulted in an appointment. During this time locum consultants were being used to “back-fill” or cover the vacancies. It was in August 2015 as result of its concerns around the staffing levels at CGH that the NHS Education for Scotland and NHS Highland took the decision to suspend temporarily the training of Junior Doctors at Caithness General Hospital.

A sustainable model was required; a Raigmore consultant led model was developed to provide a four strong team of medical consultants to rotate to Caithness General Hospital providing weekday cover (similar to the model agreed for the surgical consultants). The post of Rural Practitioner was introduced in March 2016. At the time of writing there are four RPs in post (3.3WTE) along with a Clinical Fellow and a GP. The stability created through the introduction of the rotational consultants, RP and Clinical Fellow resulted in the re-introduction of Junior Doctors to Caithness General in April 2017

Workforce | Summary | Turnover

“Stability Factor” is staff remaining in post for 12 months or more. At this stage it has not been possible to break the figure down and provide a figure for Caithness; however it is possible to show a NHS Highland figure and figures for the operational units within.

Generally speaking this shows that NHS Highland has a low turnover rate. When recruitment is successful and an appointment is made generally nine out of every ten staff remain in post for 12 months or more.

April / May / June / July / Aug / Sept / Oct / Nov / Dec
Argyll & Bute / 88.6% / 88.3% / 88.6% / 88.4% / 89.0% / 89.2% / 88.9% / 89.1% / 88.8%
Corporate / 88.5% / 88.6% / 89.8% / 89.9% / 90.8% / 91.2% / 90.9% / 91.6% / 91.0%
North & West / 89.1% / 88.3% / 88.3% / 88.3% / 89.1% / 89.% / 89.2% / 89.6% / 89.8%
South & Mid / 92.0% / 92.2% / 92.1% / 92.1% / 92.3% / 91.8% / 92.2% / 92.3% / 92.3%
Raigmore / 88.3% / 88.2% / 87.9% / 88.1% / 90.2% / 90.6% / 90.1% / 90.8% / 90.4%
NHS Highland / 89.7% / 89.7% / 89.6% / 89.5% / 90.7% / 90.7 / 90.7% / 91.1% / 91.0%

Caithness |Workforce | Summary | Sickness Absence

NHS Highland as a whole has a target rate of 4% for sickness absence.

The table below provides a comparison between NHS Highland and the North and West Operational Unit, which includes Caithness. The figures are a total figure i.e. they include both short and long term sickness.

(April 2017 / Jan 2018)

Apr / May / Jun / Jul / Aug / Sept / Oct / Nov / Dec / Jan
NHS Highland / 4.7% / 4.9% / 4.8% / 4.6% / 4.6% / 4.9% / 4.7% / 5.0% / 5.0% / 5.8%
N&W OU / 5.1% / 5.0% / 4.9% / 4.6% / 4.9% / 5.4% / 5.2% / 5.7% / 5.9% / 6.5%
Caithness Acute Total / 5.5% / 7.4% / 6.3% / 5.9% / 5.7% / 4.7% / 5.0% / 5.6% / 5.1% / 4.9%
Caithness District Total / 4.2% / 2.9% / 4.0% / 3.9% / 2.9% / 3.7% / 6.0% / 7.1% / 7.6% / 7.9%

For the period April to September 2017 Caithness District was reporting lower level of overall sickness when compared to Caithness Acute and NHS Highland as a whole, however November, December and January saw an increase in sickness levels. There were a number of contributing factors associated with this rise.

The monthly figures below show the percentage of sickness absence broken down by Caithness Acuteand Caithness District. They include both short-term (STS) and long-term sickness (LTS) and are for the current financial year.

Sickness Absence | Caithness Acute (April 2017 / Jan 2018)

Apr / May / Jun / Jul / Aug / Sept / Oct / Nov / Dec / Jan
Caithness Acute Total / 5.5% / 7.4% / 6.3% / 5.9% / 5.7% / 4.7% / 5.0% / 5.6% / 5.1% / 4.9%
Caithness Acute LTS Total / 4.5% / 5.8% / 5.0% / 5.2% / 4.9% / 3.4% / 4.1% / 4.3% / 3.2% / 2.9%
Caithness Acute STS Total / 1.0% / 1.6% / 1.3% / 0.7% / 0.8% / 1.2% / 0.9% / 1.2% / 1.9% / 2.1%

Sickness Absence | Caithness District (April 2017 / Jan 2018)

Apr / May / Jun / Jul / Aug / Sept / Oct / Nov / Dec / Jan
Caithness District Total / 4.2% / 2.9% / 4.0% / 3.9% / 2.9% / 3.7% / 6.0% / 7.1% / 7.6% / 7.9%
Caithness District LTS Total / 2.7% / 1.2% / 2.3% / 2.3% / 2.1% / 2.8% / 4.8% / 5.7% / 6.6% / 5.9%
Caithness District STS Total / 1.6 % / 1.6% / 1.7% / 1.6% / 0.8% / 0.9% / 1.2% / 1.4% / 1.1% / 2.0%

Appendix 1 Age profile of workforce

Caithness General

Age Range
20-24 / 25-29 / 30-34 / 35-39 / 40-44 / 45-49 / 50-54 / 55-59 / 60-64 / 65+ / Total
Medical / 1 / 1 / 1 / 1 / 2 / 6
Nursing/Midwifery (Registered) / 8 / 16 / 7 / 9 / 10 / 10 / 18 / 15 / 2 / 2 / 97
Nursing/Midwifery (Unregistered) / 2 / 4 / 4 / 2 / 2 / 7 / 18 / 10 / 6 / 55
Allied Health Professionals / 1 / 3 / 2 / 2 / 3 / 1 / 2 / 2 / 16
Health Sciences / 2 / 1 / 1 / 1 / 1 / 1 / 7
Other Therapeutic / 1 / 3 / 4
Administrative Services / 2 / 6 / 8 / 13 / 9 / 17 / 2 / 1 / 58
Total / 13 / 24 / 16 / 20 / 25 / 33 / 51 / 45 / 13 / 3 / 243

Caithness District

Age Range
20-24 / 25-29 / 30-34 / 35-39 / 40-44 / 45-49 / 50-54 / 55-59 / 60-64 / 65+ / Total
Medical / 1 / 2 / 2 / 1 / 1 / 7
Nursing/Midwifery (Registered) / 4 / 6 / 3 / 10 / 5 / 9 / 8 / 7 / 2 / 1 / 55
Nursing/Midwifery (Unregistered) / 2 / 1 / 2 / 1 / 2 / 3 / 3 / 1 / 15
Allied Health Professionals / 2 / 1 / 1 / 2 / 2 / 3 / 1 / 8 / 2 / 22
Other Therapeutic / 1 / 1 / 2
Personal & Social Care / 7 / 11 / 11 / 11 / 15 / 24 / 31 / 39 / 13 / 6 / 168
Other / 1 / 1 / 1 / 1 / 4
Support Services / 3 / 2 / 2 / 9 / 8 / 5 / 3 / 32
Administrative Services / 3 / 3 / 1 / 3 / 5 / 7 / 7 / 2 / 1 / 32
Estates / 1 / 2 / 2 / 1 / 3 / 4 / 1 / 14
Total / 17 / 23 / 23 / 27 / 30 / 45 / 64 / 80 / 30 / 13 / 352

Appendix 2 Number of times post advertised and whether filled in Caithness General

Permanent /
Fixed Term Contract / Date Post First Advertised / No. of Times Advertised / Post Filled
Administrative Services
Admin Assistant (30hrs p/w) Maternity / Permanent / 24/03/2017 / 2 / Yes
Audio Typist (20hrs p/w) Medical Records / Permanent / 21/09/2017 / 2 / Yes
Allied Health Professionals
Dietician (22.5hrs p/w) (North Area) / Permanent / 12/01/2017 / 2 / Yes
Radiographer (F/T) / Permanent / 21/11/2016 / 3 / Yes
Radiographer (30hrs p/w) / Fixed Term Contract / 09/11/2016 / 4 / No
Medical
Consultant Anaesthetist (F/T) / Permanent / 01/01/2017 / 2 / No
Nursing/Midwifery (Registered)
Staff Midwife (F/T) / Permanent / 30/12/2016 / 1 / No
Staff Midwife (F/T) / Permanent / 13/01/2017 / 1 / No
Staff Midwife (F/T) / Permanent / 22/02/2017 / 1 / No
Staff Midwife (F/T) / Permanent / 11/08/2017 / 1 / No
Midwife Sonographer (F/T) / Permanent / 30/01/2017 / 1 / No
Staff Nurse (F/T) Surgical Suite / Permanent / 18/07/2016 / 4 / Yes
Advanced Practice Lead (F/T) / Fixed Term Contract / 13/03/2017 / 1 / No
Staff Nurse (22.5hrs p/w) Surgical Suite / Permanent / 29/09/2017 / 1 / No
Staff Nurse (17.5hrs p/w) Bignold / Permanent / 31/05/2017 / 1 / No
Staff Nurse (F/T) Bignold / Permanent / 27/07/2017 / 1 / No
Staff Nurse (F/T), Bignold / Fixed Term Contract / 27/07/2017 / 1 / No
Senior Charge Nurse (F/T) Bignold / Permanent / 08/08/2017 / 2 / No
Advanced Practitioner (F/T) / Permanent / 07/11/2017 / 1 / No
Senior Charge Midwife (F/T) / Permanent / 13/12/2017 / 2 / Out to advert
Nursing/Midwifery (Unregistered)
Healthcare Support Worker (29hrs p/w), Surgical Suite / Fixed Term Contract / 05/05/2017 / 1 / No
Healthcare Support Worker (17hrs p/w) Rosebank / Permanent / 25/08/2017 / 1 / No

Reminder: A full time post in NHS Scotland is 37.5hours p/w

Appendix 3 Number of times post advertised and whether filled in Caithness Community

Permanent /
Fixed Term Contract / Date Post First Advertised / No. of Times Advertised / Post Filled
Allied Health Professionals
Occupational Therapist (F/T), Community / Permanent / 29/12/2017 / 2 / Not at present
Medical
Salaried GP (Flexible Hours,) Riverbank & Riverview – A number of posts advertised / Permanent / 01/02/2017 / 2 / 1 post filled, others remain unfilled
Nursing/Midwifery (Registered)
Senior Charge Nurse (F/T) Fixed Term, Dunbar / Permanent / 22/11/2016 / 2 / Yes
Staff Nurse (15hrs p/w) / Permanent / 22/11/2016 / 2 / No
Staff Nurse (F/T), Dunbar / Permanent / 03/02/2017 / 3 / Yes
Staff Nurse (22.5hrs p/w), Dunbar (1a) / Permanent / 03/02/2017 / 2 / No
Staff Nurse (F/T), Dunbar / Permanent / 20/02/2017 / 2 / No
Staff Nurse (30hrs p/w), Dunbar / Permanent / 14/03/2017 / 2 / No
Staff Nurse (18.75hrs p/w), Dunbar (1b) / Permanent / 14/03/2017 / 2 / No
Staff Nurse (F/T) Dunbar (1c) / Permanent / 02/05/2017 / 3 / Yes
Community Mental Health Nurse (F/T), Caithness / Permanent / 23/11/2016 / 6 / No
Community Specialist Practitioner; Alcohol & Drugs (F/T), Caithness (2a) / Permanent / 30/08/2017 / 2 / Yes
Macmillan Palliative Care Support (22.5hrs p/w), Caithness / Permanent / 06/10/2017 / 2 / Out to advert
Community Staff Nurse (F/T) / Fixed Term Contract / 28/12/2017 / 2 / Yes
Advanced Nurse Practitioner (2 posts; F/T & 18.75hrs p/w) / Permanent / 22/11/2017 / 2 / Out to advert
Community Staff Nurse (30hrs p/w) / Permanent / 07/02/2017 / 2 / No
Community Staff Nurse, (18.75hrs p/w) / Permanent / 08/02/2017 / 1 / No
Community Staff Nurses (Bank; Flexible hours) / Permanent / 24/02/2017 / 1 / No
Practice Nurse (20hrs p/w) Riverbank / Permanent / 11/12/2017 / 1 / No
Nursing/Midwifery (Unregistered)
Healthcare Assistant (21hrs p/w), Riverbank / Fixed Term Contract / 05/10/2017 / 2 / Yes
Domestic Assistant (20hrs p/w) Riverbank / Permanent / 14/12/2017 / 1 / No
Personal & Social Care
Care at Home Worker (14hrs p/w) / Permanent / 20/01/2017 / 2 / No
Senior Health & Social Care Worker (14hrs p/w), East Caithness / Permanent / 30/10/2016 / 4 / Yes
Senior Health & Social Care Worker (Flexible hours), East Caithness / Permanent / 07/02/2017 / 1 / No
Day Centre Care Assistant (Bank, (flexible Hours)), Thor House (3a) / Permanent / 18/05/2017 / 2 / Yes
Social Care Assistant (Bank (flexible hours)), Bayview House / Permanent / 21/06/2017 / 4 / Yes
Social Care Worker (Bank (flexible hours)), Bayview House / Permanent / 21/08/2017 / 3 / Yes
Social Care Worker (20hrs p/w), Bayview House / Fixed Term Contract / 03/07/2017 / 4 / Out to advert
Social Care Worker (18.75hrs p/w), Bayview House / Permanent / 09/08/2017 / 1 / No

Reminder: A full time post in NHS Scotland is 37.5hours p/w