The recruitment, retention and development of the integrated urgent care workforce

Grimwood, Tom ORCID logo ORCID: and Snell, Laura ORCID logo ORCID: (2018) The recruitment, retention and development of the integrated urgent care workforce. Health and Social Care Evaluations (HASCE). (Unpublished) Item availability may be restricted.

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Urgent and emergency care services are gradually being restructured to create a more integrated service provision that helps ‘patients get the right care, at the right time, in the right place’ (NHS England, 2014: 21). In order to examine their current working practices and consider how service integration might be enhanced, the North West Ambulance Service (NWAS) commissioned Health and Social Care Evaluations (HASCE) to conduct an evaluation of the recruitment, retention and development of their Integrated Urgent Care (IUC) workforce, specifically those involved with the NHS 111 service and Clinical Hub.

- A literature review was conducted to examine the landscape of integrated urgent care and to identify key developments relating to the recruitment, retention and development of the IUC/NHS 111 workforce.
- An online survey, consisting of 36 quantitative and qualitative questions, was distributed to the NHS 111 and Clinical Hub workforce to investigate their perceptions and experiences of working for NWAS.
- The evaluators planned to conduct further data collection with the NHS 111 workforce, but due to unavoidable delays and institutional changes, along with the challenges associated with coordinating a dispersed and sessional workforce, it was not possible to conduct the interviews within the timeframe of the project.

Key findings:
Patient Care:
- The desire to ‘help’ people is a key motivator for joining NWAS.
- IUC/NHS 111 roles demand a range of personal skills (e.g. listening, communication, negotiation, analytical skills and specialist/clinical knowledge) and characteristics (e.g. empathy, patience, compassion, tolerance, resilience) in order to provide patient care.
Retention of staff:
- The retention of staff was identified as an issue across the IUC/NHS 111 service, both within the literature of existing research and participants in the evaluation.
- Operating an understaffed service can create additional pressures for the existing workforce.
- Reasons for leaving the workforce included: being overworked; low staff morale; unsociable shift patterns; being unable to book annual leave; a lack of support; poor management; and experiences of stress and burnout.
Working practices within IUC/NHS 111:
- There is a lack of consistency in management styles and a reliance on email communication across the service.
- Difficulties with securing annual leave were partly attributed to the service being understaffed.
- Timed targets, constant monitoring and audits are a necessary feature of this type of work, but can result in the workforce experiencing additional pressures and stress.
Staff wellbeing:
- Some members of the workforce can experience stress due to the intensity and volume of the workload, and the time pressures associated with call targets.
- Peer support was evident amongst the IUC/NHS 111 workforce.
- Workforce morale can be negatively affected by low staffing levels, time pressures, stress, limited access to training opportunities and difficulties with securing annual leave.
Personal development:
- Access to CPD and personal development opportunities varies across the service, with most of the training provided through e-learning.
- Progression routes are reportedly clear for paramedics, but less clear for other roles.
- Members of the IUC/NHS 111 workforce often experience a lack of time within working hours to undertake personal and professional development.
- The workforce can experience time pressures/limitations in relation to call handling, shift work, being understaffed, booking annual leave, accessing CPD and training opportunities.
- Time pressures can impact negatively on staff wellbeing, workforce morale and personal development.

- NWAS has recruited many individuals with the necessary skills to provide high quality care; however, the recruitment and retention of the IUC/NHS 111 workforce is an ongoing issue.
- Operating an understaffed IUC/NHS 111 service puts the existing workforce under additional pressure and can impact negatively on working practices, staff wellbeing and workforce morale.
- Call handling work is complex, intense and routinely demands high level communication and analytical skills in order to support the patient.
- Current working practices vary across the service, particularly the management of annual leave, communication, support within the workplace, and management styles.
- The workforce’s access to continuing professional development and training opportunities can vary, with a lack of protected time and unclear progression routes noted as areas of concern.
- Although the monitoring of time is a key feature of the NHS 111 service in order to provide efficient and accurate care for the patient callers, time pressures can be experienced by the IUC/NHS 111 workforce in a variety of ways.

- It is recommended that current working practices for the processing of annual leave requests should be reviewed.
- Mechanisms for sharing examples of positive patient outcomes and good management styles should be explored.
- NWAS’ online recruitment information could adopt the title ‘health advisor’ to more accurately reflect the complex work being undertaken by ‘NHS 111 call handlers’.
- The availability and format of training opportunities for all roles should be reviewed, and career progression routes need to be clearly communicated.
- Shift patterns need to include dedicated and paid time for learning and training opportunities across all IUC/NHS 111 roles.

Item Type: Report
Publisher: Health and Social Care Evaluations (HASCE)
Departments: Health and Society Knowledge Exchange (HASKE)
Additional Information: This evaluation was commissioned by the North West Ambulance Service. The research was conducted by Health and Social Care Evaluations (HASCE), University of Cumbria.
Depositing User: Laura Snell
Date Deposited: 12 Feb 2021 10:53
Last Modified: 12 Jan 2024 20:31
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