SHuRePlan

How big is the impact of each potential supply/demand gap likely to be on service delivery?

Once the supply and demand assessments have been put together it is likely that a number of gaps will be identified.  In developing the action plan, we need to prioritise our actions on those gaps which present the highest risk.  One way in which to think about it is in terms of hot spots and cold spots:

Hot spots

Potential gaps which are hot spots are those which are likely to have a major impact on service delivery.  Factors which are likely to lead to hot spots are:

• Areas where a high level of specialist skill is required
• Areas where regulation restricts who can provide the service
• Areas which require long and/or expensive training
• Areas where specialist skills are already used intensively
• Areas where there is a already a national (or international) shortage
• Areas which form a critical bottleneck on the patient pathway
• Areas where recruitment and retention can be unstable due to labour market competition
• Areas where there is little flexibility to cover shortfalls through overtime or agencies etc.

Clearly these factors are more likely to come together in specialist medical roles but other examples include Therapeutic Radiographers, where it was recognised a few years back that shortages were likely to threaten the investment within the Cancer Plan.  Current policies for Chronic Disease Management and shifting activity into primary care could be threatened by shortages of practitioners with the specialist skills required.

Cold Spots

On the opposite side of the assessment there is under utilisation of skills or scope for flexibility.

• Areas where generalist skills are required and tasks could be carried out by a range of different individuals
• Areas where individuals are only fully using their specialist skills for part of the time
• Areas where there are several different ways in which the patients' needs can be met
• Areas where recruitment is relatively easy

Even in medical roles there are cold spots.  Research has show that a significant proportion of the activities carried out by GPs could be carried out by Nurse Practitioners and others.  Another interesting case is that of Junior Doctors on call.  The Hospital at Night Project has shown that only a small proportion of the time that junior doctors spend on call requires medical skills and that by radically rethinking working practices it is possible provide cover with fewer doctors and considerably increase the job satisfaction of those who are working out of hours.

It is also possible to turn hot spots into cold spots.  For example, if a critical clinical skill is only possessed by a single professional group, it may be possible to train a wider group of people to safely carry out the activity.