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This article reports a portion of the findings from a 5-year longitudinal study on child and family social work, commissioned by the Department for Education. The study explored issues relating to child and family practice over the five years, utilising a mixed-methods design, including large-scale surveys, quantitative telephone interviews and semi-structured interviews and culminating in an annual report, published by the Department for Education at the end of each wave. This article focusses on wave four, and on the semi-structured interview phase, which explored how practitioners felt their racial or ethnic identity impacted on their experiences of practice. Five themes were developed across the different topics explored in the interviews; structures and organisations; workforce and colleagues; lack of diversity; working with families and intersectionality. This article presents these themes as part of the challenging context of inclusivity and anti-racism in contemporary social work, and makes recommendations regarding workforce diversity, training needs and reducing the additional burden carried by social workers from minoritized ethnicities, by amending the regulatory requirements of practitioners, education providers and continuing professional development recording. [ABSTRACT FROM AUTHOR]

As the Ministry of Justice looks to develop a 'new generation' of programmes to reduce reoffending, we reflect on what can be learnt from the only accredited domestic abuse programme in England and Wales, Building Better Relationships (BBR). Findings from an ethnographic study of BBR are situated within the Probation Inspectorate's recent inspection of domestic abuse work within the newly unified Probation Service which revealed a fractured and overstretched workforce. Our central argument is that if we are to avoid making matters worse, practitioners must be equipped with the time, supervision and skill needed to maintain something akin to a 'therapeutic alliance', that will endure in moments of crisis in their own lives as well as those of their clients. [ABSTRACT FROM AUTHOR]

The introduction of the Initial Education and Training Standards for Pharmacists reforms outlined that trainee pharmacists will be able to qualify as independent prescribers (IPs) on registration from 2026. To enable this transformation, sufficient numbers of designated prescribing practitioners (DPPs) are required to supervise the IP element of their training. A regional survey identified 12 DPPs, which highlights a potential workforce challenge. This study expanded on the findings of the survey, aiming to explore the experiences of DPPs to understand how to increase capacity and inform the next steps towards implementing the reforms. In a descriptive, qualitative study, a series of two focus groups were conducted with DPPs and a chief pharmacist. Training and funding of DPPs was reported as the key enabler to increasing capacity whilst time constraints was the most significant barrier. Cross-sector supervision was considered possible provided there was time and funding. NHS England Workforce, Transformation and Education Directorate (NHSE WT&E) are a national organisation leading on this work stream and should consider targeting some of the immediate enablers (training and funding) and barriers (time) as identified from this study to increase DPP capacity in preparation for 2026. NHSE WT&E should consider developing plans to address other important themes identified such as whether DPPs can provide supervision cross-sector supervision as well as funding showing that the themes identified do not exist in isolation but intricately linked to one another. [ABSTRACT FROM AUTHOR]

Aim(s) Background Design Methods Discussion/Conclusion Implications for the Profession and/or Patient Care Impact Reporting Method Patient or Public Contribution The aim of this study is to understand factors that challenge retention and support nurses to stay in general practice.One in four general practice nurse positions in England expected to be left unfilled within the next 10 years. Cultural and structural issues associated with working in general practice have been linked with nurses leaving general practice, re‐evaluating their professional futures, adjusting work‐life balance and bringing forward retirement. This has implications for the future of the general practice nursing workforce and patient care more broadly.Exploratory qualitative interview study funded by the General Nursing Council Trust for England and Wales. University of York ethics approval (Ref: HSRGC/2023/586/A) was gained in September 2023. The study will be conducted between September 2023 and August 2024.Qualitative interviews will be conducted with a range of nurses working in, or who have worked in, general practice as well as nurse leaders associated with general practice across England and Wales. Recruitment will be via professional and social media networks and snowballing techniques. We aim to purposively recruit 30–40 participants for maximum variation. Cultural and structural influences which may contribute to retention decisions will be explored. Data will be analysed following framework analysis.This study will explore how underpinning cultural and structural issues may impact on retention of this highly skilled professional group and identify factors to support retention.By exploring factors that support or discourage nurses to remain in general practice, retention strategies can be better planned on order to address the general practice nursing workforce crisis.What problem did the study address? This study will address the retention crisis in nursing in general practice by exploring how cultural and structural issues may impact on retention of this highly skilled professional group and identify factors to support retention.Where and on whom will the research have an impact? From the study findings, recommendations will be developed to inform future policy and practice. Key factors to address attrition will be generated to support employers and policy makers in future primary care workforce planning, as well as supporting nurses, at an individual level, in negotiating their roles in practice.Standards for Reporting Qualitative Research (O'Brien et al., 2014).As this is a workforce study protocol, there is no patient or public contribution. [ABSTRACT FROM AUTHOR]

Objectives: Ancillary staff – cleaning, catering, housekeeping and laundry workers – play a crucial role in care homes, by promoting infection control, food preparation and hygiene, and contributing to the care home environment. This study sought to understand the experiences of ancillary staff working in English care homes during the COVID-19 pandemic. The results will inform policy makers, employers, care home managers and others, both in England and overseas, as how to best support the ancillary workforce. Methods: Between March and August 2021, video and telephone interviews were conducted with those working or living in care homes in England. Participants comprised ancillary staff (n = 38), care home managers (n = 8), care home residents' family members and friends (n = 7), human resource managers (n = 5) and care home residents (n = 5). Results: Ancillary staff often had increased responsibilities and contributed to pandemic efforts by changing working practices, routines and job roles with the aim of supporting residents and other staff. Teamwork, underpinned by strong leadership, helped ancillary staff feel supported. Conclusions: Ancillary staff should be better recognised as being central to care home care. They are essential workers helping to keep residents safe and well. [ABSTRACT FROM AUTHOR]

Objectives: As general practice increasingly moves towards large group practices, there is debate about the relative benefits, safety and sustainability of different care delivery models. This study investigates the performance of single-handed practices compared to practices with multiple doctors in England, UK. Methods: Practices in England with more than 1000 patients were included. Workforce data and a quality control process classified practices as single-handed or multiple-handed. Outcomes were (i) GP patient survey scores measuring access, continuity, confidence in health professional and overall satisfaction; (ii) reported diabetes and hypertension outcomes; and (iii) emergency department presentation rates and cancer detection (percentage of cancers diagnosed by a 2-week wait). Generalised linear models, controlling for patient and practice characteristics, compared outcomes in single and multiple-handed practices and assessed the effect of GP age in single-handed practices. Results: Single-handed practices were more commonly found in areas of high deprivation (41% compared to 20% of multiple-handed practices). Single-handed practices had higher patient-reported access, continuity and overall satisfaction but slightly lower diabetes management and cancer detection rates. Emergency department presentations were higher when controlling for patient characteristics in single-handed practices but not when also controlling for practice rurality and size. Increased deprivation was associated with lower performance in seven out of eight outcomes. Conclusions: We found single-handed practices to be associated with high patient satisfaction while performing slightly less well on selected clinical outcomes. Further research is required to better understand the association between practice size, including increasing multidisciplinary working, on patient experience and outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Allied Health Professionals (AHPs) are the third largest professional group in the National Health Service (NHS). This qualitative study aimed to establish the representation of AHPs at NHS Trust board level. Design/methodology/approach: Examination of public Trust board minutes and Care Quality Commission (CQC) reports from a sample of NHS provider Trusts in the West Midlands. One reviewer extracted data concerning all details pertaining to professional staffing groups. Findings: A stark picture of under-representation which is statistically significant emerges. AHP representation to Trust boards via public board meetings was 7% for AHPs, compared to 41% for doctors and 52% for nurses. There were similar results with CQC reports, with the representation of AHPs at 11%, whilst doctors and nurses were significantly higher at 42 and 47%, respectively. Research limitations/implications: The data gathered for this paper was from a small number of NHS provider Trusts in the West Midlands of England, which can be considered a limitation of the study. However, the results of this study are stark and provide a compelling snapshot of the significant under-representation of AHPs to those NHS Trust boards included. Practical implications: AHPs are a significant staff group within the NHS; their representation at board level is of benefit to the Trust boards both in terms of engaging with staff and in terms of managing quality and risk. Recommendations are made that Trust boards ensure they have a board member with responsibility for AHPs who actively engages with, understands and provides challenge, and that the CQC considers the inclusion of examples of AHP activity and staffing levels in their inspection, and that these are confirmed with senior AHPs in the organisation being inspected. Originality/value: This is an original paper and is the first to address the representation of AHPs at Trust board via consideration of board papers and CQC reports, providing a platform for further consideration. [ABSTRACT FROM AUTHOR]

Background: Following government calls for General Practices in England to work at scale, some practices have grown in size from traditionally small, General Practitioner (GP)-led organisations to large multidisciplinary enterprises. We assessed the effect of practice list size and workforce composition on practice performance in clinical outcomes and patient experience. Methods: We linked five practice-level datasets in England to obtain a single dataset of practice workforce, list size, proportion of registered patients ≥ 65 years of age, female-male sex ratio, deprivation, rurality, GP contract type, patient experience of care, and Quality and Outcomes Framework (QOF) and non-QOF clinical processes and outcomes. Latent Profile Analysis (LPA) was used to cluster general practices into groups based on practice list size and workforce composition. Bayesian Information Criterion, Akaike Information Criterion and deliberation within the research team were used to determine the most informative number of groups. One-way ANOVA was used to assess how groups differed on indicator variables and other variables of interest. Linear regression was used to assess the association between practice group and practice performance. Results: A total of 6024 practices were available for class assignment. We determined that a 3-class grouping provided the most meaningful interpretation; 4494 (74.6%) were classified as 'Small GP-reliant practices', 1400 (23.2%) were labelled 'Medium-size GP-led practices with a multidisciplinary team (MDT) input' and 131 (2.2%) practices were named 'Large multidisciplinary practices'. Small GP-reliant practices outperformed larger multidisciplinary practices on all patient-reported indicators except on confidence and trust where medium-size GP-led practices with MDT input appeared to do better. There was no difference in performance between small GP-reliant practices and larger multidisciplinary practices on QOF incentivised indicators except on asthma reviews where medium-size GP-led practices with MDT input performed worse than smaller GP-reliant practices and immunisation coverage where the same group performed better than smaller GP-reliant practices. For non-incentivised indicators, larger multidisciplinary practices had higher cancer detection rates than small GP-reliant practices. Conclusion: Small GP-reliant practices were found to provide better patient reported access, continuity of care, experience and satisfaction with care. Larger multidisciplinary practices appeared to have better cancer detection rates but had no effect on other clinical processes and outcomes. As England moves towards larger multidisciplinary practices efforts should be made to preserve good patient experience. [ABSTRACT FROM AUTHOR]

Online learning has the potential to improve best practice in substance use treatment by facilitating access to high-quality resources. A user-centered design (UCD) approach can identify the needs, motivating factors, and working contexts of learners. Aim: The aim of this study was to identify ways of improving online learning for people working in substance use treatment services in England. Methods: Semi-structured interviews were conducted with 31 substance use professionals in England and 14 other professionals working in the field. Participants were asked about their training needs, working contexts, and current use of online resources. Data were analyzed according to the principles of UCD via Iterative Categorisation. Results: Participants reported "unmet needs" for training in therapeutic relationships and advanced therapeutic techniques. They enjoyed training that demonstrably improved the quality of life for people who use drugs and that provided career and personal development opportunities. Participants completed many mandatory online courses that were short and unpopular. Access to training was limited by time and financial constraints, with online training partially addressing these barriers. Conclusion: If online learning is to be optimized, the needs of substance use professionals must be accommodated; however, online learning that meets the needs of substance use professionals does not always match the best evidence. [ABSTRACT FROM AUTHOR]

In 2023, the UK Government published its long-awaited reform strategy for England's children's social care system. Whilst the strategy set out planned reforms for several aspects of the wider system, an area requiring particular 'priority' was the purported workforce instability seen within child protection social work. However, the strategy has subsequently faced criticism on the basis that the suggested reforms were not satisfactorily informed by the testimonies of practicing social workers. This paper draws from a mixed-method study to report on the lived experiences of a sample of 201 child protection social workers practicing across England, in the context of better understanding the factors which they believed were impacting on workforce stability within England's child protection system. Implications that emerge are the need for an increase in the monetary commitment offered by the UK Government (especially in the context of tackling high caseloads, and improving local authority pay scales to reduce the allure of agency work); a targeted emphasis on challenging local cultures preoccupied with evidencing compliance over time spent with children; and the Government taking a more assertive role in tackling the often-counterproductive commentary perpetuated by politicians and media. [ABSTRACT FROM AUTHOR]

Aim: To explore how nurses working in general practice experienced remote and technology-mediated working during the COVID-19 pandemic. Design: Exploratory qualitative study with nursing team members working in general practices in England and national nurse leaders. Methods: Data were collected between April and August 2022. Forty participants took part in either semi-structured interviews or focus groups. Data were analysed using Framework Analysis informed by the PERCS (Planning and Evaluating Remote Consultation Services) Framework. University of York ethics approval [HSRGC/2021/458/I] and Health Research Authority approval were obtained [IRAS:30353. Protocol number: R23982. Ref 21/HRA/5132. CPMS: 51834]. The study was funded by The General Nursing Council for England and Wales Trust. Results: Participants continued to deliver a significant proportion of patient care inperson. However, remote and technology-mediated care could meet patients' needs and broaden access in some circumstances. When remote and technology-mediated working were used this was often part of a blended model which was expected to continue. This could support some workforce issues, but also increase workload. Participants did not always have access to remote technology and were not involved in decision-making about what was used and how this was implemented. They rarely used video consultations, which were not seen to add value in comparison to telephone consultations. Some participants expressed concern that care had become more transactional than therapeutic and there were potential safety risks. Conclusion: The study explored how nurses working in general practice during the COVID-19 pandemic engaged with remote and technology-mediated working. It identifies specific issues of access to technology, workload, hybrid working, disruption to therapeutic relationships, safety risks and lack of involvement in decision-making. Changes were implemented quickly with little strategic input from nurses. There is now an opportunity to reflect and build on what has been learned in relation to remote and technology-mediated working to ensure the future development of safe and effective nursing care in general practice. Impact: The paper contributes to understanding of remote and technology-mediated working by nurses working in general practice during the COVID-19 pandemic and indicates to employers and policy makers how this can be supported moving forward. Reporting method: Standards for Reporting Qualitative Research (O'Brien et al., 2014). Patient or public contribution: This was a workforce study so there was no patient or public contribution. Implications for the profession and patient care: The paper highlights specific issues which have implications for the development of remote, technology-mediated and blended working for nurses in general practice, care quality and patient safety. These require full attention to ensure the future development of safe and effective nursing care in general practice moving forward. [ABSTRACT FROM AUTHOR]

Background Mental ill health has a high economic impact on society and employers. National and international policy advocates line manager (LM) training in mental health as a key intervention, but little is known about employer training provisions. Aims To explore the prevalence and characteristics of organizations that offer LM training in mental health. Methods Secondary analysis of existing longitudinal anonymised organizational-level survey data derived from computer-assisted telephone interview surveys collected in four waves (2020:1900 firms, 2021:1551, 2022:1904, 2023:1902) in England, before, during and after a global pandemic. Results The proportion of organizations offering LM training in mental health increased pre- to post-pandemic (2020:50%, 2023:59%) but 41% do not currently provide it. Logistic regression confirmed that LM training is more likely to be offered by large-sized enterprises, organizations with a larger proportion of employees who are younger (aged 25–49), female, disabled and from ethnic minority communities. Sector patterns were inconsistent, but in 2023, organizations from the 'Hospitality' and 'Business Services' sectors were more likely to provide LM training than other sectors. Conclusions Continued efforts are needed to increase the proportion of employers offering LM training in mental health, particularly small- to medium-sized enterprises, and organizations with predominantly male, White and/or older workforces. [ABSTRACT FROM AUTHOR]

Background Cervical cancer remains an important global public health concern. Understanding the factors contributing to a decline in screening uptake in high-income countries is fundamental to improving screening rates. We aimed to identify general practice and patient characteristics related to cervical screening coverage in England between 2013 and 2022. Methods We analyzed a panel of 59 271 General Practice (GP)-years from 7881 GP practices. We applied correlated random effects regression to examine the association between cervical screening uptake and a rich set of GP practice workforce, size, quality and patient characteristics. Results Our results show a decline in overall screening rates from 2013/14 to 2021/22 from 77% to 72%. We find GP workforce and list size characteristics are strongly related to screening rates. An increase in 1 FTE Nurse per 1000 patients is related to a 1.94 percentage point increase in cervical screening rates. GP practices located in more deprived areas have lower screening rates. Conclusions GP workforce and patient characteristics need to be considered by decision-makers to increase screening rates. The implementation of self-sampling screening methods could help address some of the current barriers to screening, including lack of healthcare staff and facilities. [ABSTRACT FROM AUTHOR]

Objectives: There is limited literature on the experiences of internationally educated nurses (IENs) who have joined NHS trusts in England in the past 20 years. The objectives of this integrative review included exploring and analysing the experiences of IENs in the NHS in England and identifying the cultural, pastoral and training needs of IENs during their first 2 years working in England and providing research-informed recommendations to better support IENs. Design: An integrative review of primary research studies using quantitative, qualitative, and mixed methods of data collection. Data source: CINAHL, British Nursing Index and Google Scholar. Results: Nine articles met the inclusion criteria for this integrative review. All articles contributed to the findings of three main analytical themes: expectations, challenges and belongingness. Conclusion: Limited research fully met the search criteria. This was concerning since IENs have been working in the NHS for decades, yet so few primary studies have been conducted into their experiences. The findings were in line with previous studies, which found that IENs faced challenges both in the workplace and in settling into an English way of life, and often reported feeling that they were not treated equally to their English counterparts. This integrative review raises issues and increases awareness of how the NHS in England can better support IENs transitioning into their new life and ways of working, to further aid recruitment and retention of the international nursing workforce. [ABSTRACT FROM AUTHOR]

Due to the large number of unpaid carers in England, there is an extensive body of research which examines the determinants of carers' employment. Despite this, little is known about the relationship between the specific tasks that carers perform and their labour supply. Using data from the Survey of Adult Carers in England, we examine the relationship between carer tasks and carer employment outcomes. We find that carers who perform tasks that are time‐bound have a lower probability of working compared to carers who do not perform these tasks. Similarly, carers who perform shiftable tasks have a higher probability of working compared to carers who do not perform these tasks. If future social policy is to be designed to allow carers to also maintain their employment, then targeting services at the carer tasks which have the largest impact on employment needs to be taken into account. [ABSTRACT FROM AUTHOR]

Integrated disease surveillance (IDS) offers the potential for better use of surveillance data to guide responses to public health threats. However, the extent of IDS implementation worldwide is unknown. This study sought to understand how IDS is operationalized, identify implementation challenges and barriers, and identify opportunities for development. Synthesis of qualitative studies undertaken in seven countries. Thirty-four focus group discussions and 48 key informant interviews were undertaken in Pakistan, Mozambique, Malawi, Uganda, Sweden, Canada, and England, with data collection led by the respective national public health institutes. Data were thematically analysed using a conceptual framework that covered governance, system and structure, core functions, finance and resourcing requirements. Emerging themes were then synthesised across countries for comparisons. None of the countries studied had fully integrated surveillance systems. Surveillance was often fragmented, and the conceptualization of integration varied. Barriers and facilitators identified included: 1) the need for clarity of purpose to guide integration activities; 2) challenges arising from unclear or shared ownership; 3) incompatibility of existing IT systems and surveillance infrastructure; 4) workforce and skills requirements; 5) legal environment to facilitate data sharing between agencies; and 6) resourcing to drive integration. In countries dependent on external funding, the focus on single diseases limited integration and created parallel systems. A plurality of surveillance systems exists globally with varying levels of maturity. While development of an international framework and standards are urgently needed to guide integration efforts, these must be tailored to country contexts and guided by their overarching purpose. [ABSTRACT FROM AUTHOR]

Background: This observational study, paired with National Health Service (NHS) workforce population data, examined gender differences in surgical workforce members' experiences with sexual misconduct (sexual harassment, sexual assault, rape) among colleagues in the past 5 years, and their views of the adequacy of accountable organizations in dealing with this issue. Methods: This was a survey of UK surgical workforce members, recruited via surgical organizations. Results: Some 1704 individuals participated, with 1434 (51.5 per cent women) eligible for primary unweighted analyses. Weighted analyses, grounded in NHS England surgical workforce population data, used 756 NHS England participants. Weighted and unweighted analyses showed that, compared with men, women were significantly more likely to report witnessing, and be a target of, sexual misconduct. Among women, 63.3 per cent reported being the target of sexual harassment versus 23.7 per cent of men (89.5 per cent witnessing versus 81.0 per cent of men). Additionally, 29.9 per cent of women had been sexually assaulted versus 6.9 per cent of men (35.9 per cent witnessing versus 17.1 per cent of men), with 10.9 per cent of women experiencing forced physical contact for career opportunities (a form of sexual assault) versus 0.7 per cent of men. Being raped by a colleague was reported by 0.8 per cent of women versus 0.1 per cent of men (1.9 per cent witnessing versus 0.6 per cent of men). Evaluations of organizations' adequacy in handling sexual misconduct were significantly lower among women than men, ranging from a low of 15.1 per cent for the General Medical Council to a high of 31.1 per cent for the Royal Colleges (men's evaluations: 48.6 and 60.2 per cent respectively). Conclusion: Sexual misconduct in the past 5 years has been experienced widely, with women affected disproportionately. Accountable organizations are not regarded as dealing adequately with this issue. [ABSTRACT FROM AUTHOR]

Introduction: Medicines Management Technicians have been shown to be an underused resource in medicines optimisation and medicines waste. In the United Kingdom, there are national recommendations for the clinical pharmacy service in cancer services ambulatory units, despite these recommendations, there was no clinical pharmacy service on the day case unit at a specialist tertiary centre in England. A lot of the patient pathways had been in place for many years and had not progressed with the changes in the clinical pathways. The main objectives of this study were to analyse how a medicines management technician could reduce medicines waste, improve the current pathway, increase medicines optimisation and ultimately improve the patient experience in an oncology day case unit at a specialist tertiary centre in England. Methods: A prospective mixed methods study was carried out at Weston Park Hospital. Descriptive statistical analysis was conducted on the quantitative data collected, and thematic analysis was carried out on the qualitative data collected by questionnaire to staff members and patients. Results: This study has shown that a medicines management technician can complete some of the tasks more traditionally done by the chemotherapy nurses on the day case unit, increasing their capacity for more clinically appropriate tasks. A medicines management technician can work as part of the wider multidisciplinary team on a day case unit contributing to medicines optimisation and cost savings for the oncology directorate. Conclusions: This study has shown that a medicines management technician can act as a valued member of the wider multidisciplinary team, improving communication and patient pathways, improving medicines optimisation and contributing to cost saving initiatives. Further studies are required to assess whether a medicines management technician role can be of the same value on a haematology day case unit. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Nurses work in mental health services around the world, constituting the largest professional group.Nurses have been identified as being potentially able to carry out a much wider range of functions than are typically allowed in practice, when provided with suitable training.There are long‐term concerns regarding shortages of mental health nurses in England and many other countries.Workforce data is rarely subject to analysis in peer‐reviewed journals. What the paper adds to existing knowledge?: This paper provides a case study of the workforce patterns of a national mental health nurse (MHN) workforce overtime allowing comparison with other countries and specialities.MHN numbers reduced from 2011 to 2017, then increased to near the 2011 level by 2021, not meeting ambitious national plans for increasing numbers.The mental health nursing proportion of the total NHS nursing workforce decreased through this period.Advanced practice roles and skills are widely, but unevenly, distributed and are provided by a small proportion of nurses.The proportion of nurses working in community settings has increased to constitute more than half of all nurses for the first time.The ratio of support workers to nurses increased in inpatient settings and will continue to change. What are the implications for practice?: Historical challenges in recruiting MHNs suggest that future plans to expand the profession are overly optimistic.To support the development of advanced practice roles and new skill sets, clearer research evidence of impact is required and clearer national guidance regarding best practice models.Good workforce data are essential to inform good workforce planning. Introduction: Data regarding changes in characteristics of the MHN workforce is commonly cited in governmental publications, but is rarely analysed in peer‐reviewed journals, despite ongoing concerns regarding high vacancy rates within mental health services. Aim: The aim of the study was to characterize changes in the MHN workforce, implementation of new nursing roles/skills and alignment with national policy. Method: Analysis of nationally published workforce data, peer‐reviewed publications and governmental policy/planning documents. Results: Nurse numbers declined from 2011 to 2017, subsequently returning to near 2011 levels, but remaining below national targets. Nurses in community settings increased to constitute more than half of all nurses, whilst inpatient numbers declined, although more slowly than bed numbers. The ratio between nurses and support workers changed due to more support workers in inpatient settings. New advanced skills and roles for nurses have increased, but are unevenly distributed, constituting a small proportion of the total workforce. Implications for Practice: This paper provides a case study against which comparisons may be made with the nursing workforce in other countries and specialities. Even clear policy commitment to nursing growth may not deliver planned changes in numbers and introducing new roles may have uneven impact, especially in the absence of a robust evidence base. [ABSTRACT FROM AUTHOR]

By using the case studies of Denmark, England, and Greece, this desk review focuses on the directions of mediation for sustainability in relation to recruitment and retention of registered nurses (RNs) in order to inform policy and practice. The review focuses on six major thematic areas, i.e., nursing regulation, ageing nursing workforce, job satisfaction/well-being, education and training, migration, and finance to delineate the challenges related to recruitment and retention of the nursing workforce in the three geographical case studies. The review is structured in five sections, which are introduction, methodology, contextual analyses of three different countries, discussion and recommendations. Using a cross-national analysis, strategies that have been followed to enhance retention and recruitment as well as the barriers regarding their implementation are discussed. [ABSTRACT FROM AUTHOR]

Background: There are inequalities in the geographical distribution of the primary care workforce in England. Primary care networks (PCNs), and the associated Additional Roles Reimbursement Scheme (ARRS) funding, have stimulated employment of new healthcare roles. However, it is not clear whether this will impact inequalities. Aim: To examine whether the ARRS impacted inequality in the distribution of the primary care workforce. Design and setting: A retrospective before-and-after study of English PCNs in 2019 and 2022. Method: The study combined workforce, population, and deprivation data at network level for March 2019 and March 2022. The change was estimated between 2019 and 2022 in the slope index of inequality (SII) across deprivation of full-time equivalent (FTE) GPs (total doctors, qualified GPs, and doctors-in-training), nurses, direct patient care, administrative, ARRS and non- ARRS, and total staff per 10 000 patients. Results: A total of 1255 networks were included. Nurses and qualified GPs decreased in number while all other staff roles increased, with ARRS staff having the greatest increase. There was a pro- rich change in the SII for administrative staff (−0.482, 95% confidence interval [CI] = −0.841 to −0.122, P<0.01) and a pro- poor change for doctors-in-training (0.161, 95% CI = 0.049 to 0.274, P<0.01). Changes in distribution of all other staff types were not statistically significant. Conclusion: Between 2019 and 2022 the distribution of administrative staff became less pro-poor, and doctors-in-training became pro-poor. The changes in inequality in all other staff groups were mixed. The introduction of PCNs has not substantially changed the longstanding inequalities in the geographical distribution of the primary care workforce. [ABSTRACT FROM AUTHOR]

Background: The recent publication of data on appointment volumes for all general practices in England has enabled representative analysis of factors affecting appointment activity rates for the first time. Aim: To identify population, workforce, and organisational predictors of practice variations in appointment volume. Design and setting: A multivariable cross-sectional regression analysis of 6284 general practices in England was undertaken using data from August–October 2022. Method: Multivariable regression analyses was conducted. It related population age and deprivation, numbers of GPs, nurses, and other care professionals, and organisation characteristics to numbers of appointments by staff type and to proportions of appointments on the same or next day after booking. Results: Appointment levels were higher at practices serving rural areas. Practices serving more deprived populations had more appointments with other care professionals but not GPs. One additional full-time equivalent (FTE) GP was associated with an extra 175 appointments over 3 months. Additional FTEs of other staff types were associated with larger differences in appointment rates (367 appointments per additional nurse and 218 appointments per additional other care professional over 3 months). There was evidence of substitution between staff types in appointment provision. Levels of staffing were not associated with proportions of same-or next-day appointments. Conclusion: Higher staffing levels are associated with more appointment provision, but not speed of appointment availability. New information on activity levels has shown evidence of substitution between GPs and other care professionals in appointment provision and demonstrated additional workload for practices serving deprived and rural areas. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To learn about the experiences of nursing students who witness physical restraint on practice placements • To understand how to support these students after episodes of physical restraint • To reflect on the provision for supporting nursing students in your own practice area Background: There is a paucity of research on mental health nursing students' experiences of witnessing physical restraint in practice, despite the fact that they spend half of their time in clinical placements. Aim: To understand the experiences of mental health nursing students who witnessed physical restraint during their clinical placements. Method: Qualitative data were collected through semi-structured interviews conducted remotely with three students from three universities in England. Thematic analysis was used to analyse the data. Findings: Participants found witnessing physical restraint distressing but had positive experiences of the support provided to them by clinical teams. They felt that receiving some education on physical restraint before their first placement could have reduced their distress and feeling of unpreparedness. Conclusion: In placement settings, clinical teams need to be mindful of students' support needs after an incident of physical restraint. At university, enhanced education reinforced by simulation and lived experience accounts could better prepare nursing students for witnessing physical restraint in practice. [ABSTRACT FROM AUTHOR]

Introduction: Poor sleep and fatigue are common in acute and emergency healthcare staff. CATNAPS is a multi-site, multi-method study that explores how fatigue can be managed in the NHS ambulance workforce. The overall CATNAPS aim is to develop a comprehensive fatigue risk management system (FRMS) for UK NHS ambulance services, which is acceptable, feasible and likely to improve patient outcomes and staff well-being and experience. This is the first study to develop a comprehensive approach to fatigue management in an NHS workforce. In this particular sub-study, we investigate how frontline staff and patients experience current fatigue actions and explore the potential to improve safety culture and reporting. Methods: We recruited 30 frontline ambulance staff members and three ambulance service users from two trusts for a one-to-one semi-structured interview. Staff participants were asked about their experience of fatigue, including their engagement with and/or opinions about our coproduced list of components for fatigue management. Patients were also asked for their views about the same recommended actions. All participants were also asked how, and whether, the recommended actions could be implemented, addressing any potential facilitators and barriers. Thematic analysis was undertaken on the interview data. All members of the research team, including two members from a patient and public involvement perspective, were involved in the analysis. Results: Seven themes explain staff and patient perspectives on fatigue management, including the proposed implementation of the recommended components of the FRMS: * Fatigue is not spoken about. * There is a lack of consistency from management. * Trusts have implemented limited initiatives to manage fatigue. * Fatigue management is a matter of personal preference. * There is impact of, and on, the personal lives of staff to consider. * Staff and patients have views about potential implementation of proposed fatigue management strategies. * There are concerns that fatigue can impact quality of care. Conclusions: Staff expressed reluctance to report fatigue because of fear of consequences, while both staff and patients supported formalised and evidence-based implementation of fatigue management actions by ambulance trusts. Current actions are predominantly staff led, so they are highly individualised, including caffeine use, role switching and sleep banking. Successful implementation by trusts of preferred fatigue management actions will require buy-in from front-line staff, managerial support, improved resourcing and increased public awareness on the importance of managing fatigue. These insights are informing development of implementation guidance so ambulance services can tailor the FRMS to their staff and their setting. [ABSTRACT FROM AUTHOR]

How to boost numbers in the shrinking learning disability nursing workforce in the UK is an ongoing concern. [ABSTRACT FROM AUTHOR]

The English child protection system continues to be the focus of national commentary in light of several high-profile deaths and the recently published reports from the Review of Children's Social Care, and the Child Safeguarding Practice Review Panel. Whilst narratives of 'failure', 'betrayal', and 'scandalous incompetence' perpetuate, these forgo consideration of the complexity of child protection work, nor do they acknowledge that during the COVID-19 'lockdowns', social workers remained one of the few professional groups visiting vulnerable families at home. Moreover, of the recent accounts of the lived experience of social workers, these have omitted a specific overview of what it means to be a child protection practitioner. Drawing from an original ethnography of a statutory child protection team and supplemented by follow-up interviews, the article seeks to elucidate the long-standing lived experience of a cohort of child protection social workers. It highlights a 'tendency' to be the target of threats and intimidation and identifies other costs in the context of health and personal relationships. The article concludes that these findings could help us better understand child protection workforce instability and the system's reliance on agency staff – both of which continue to be identified as contributory in child death tragedies. [ABSTRACT FROM AUTHOR]

Claire Leader discusses the three-year delivery plan for maternal and neonatal services in England, focusing on the goal to grow the maternity workforce [ABSTRACT FROM AUTHOR]

Background: Worldwide there are concerns about the supply of nurses into health systems. Understanding and balancing the supply of and demand for healthcare professionals is crucial to efficient healthcare delivery, yet there is relatively little research that examines in detail where nursing students come from and where they go after qualification. Objectives: To investigate the demographic characteristics of applicants to nursing and midwifery programmes in England, those that are enrolled, attrition during study, and their career intentions on graduation. Methods: A descriptive case study was conducted in south west England drawing on a complementary set of analyses of routinely collected application and enrolment data from 2017–2020. These were augmented by derivation of student deprivation indices and a follow-up study of nursing and midwifery students qualifying between May 2020 and April 2021. Results: The percentage of males applying for nursing doubled and the mean age of all enrolled students (except midwifery) increased during the study period. The mean level of deprivation of applicants increased from the 51st to the 55th centile indicating widening of participation. Most applying and enrolled students originated from the same region as the nursing school and remained working there on qualification. Successively more males than females were lost from the system at each stage from application to qualification. Qualifying students most common job choice was within acute Trusts, with Medical, District nursing and surgical being the most common choices. The most important factors regarding job choice were location, the characteristics of the Trust, having been there as a student, and family considerations. Conclusions: The data provide useful information on the nursing educational pipeline. The data discussed here raise questions that would benefit from further regional and national empirical research. [ABSTRACT FROM AUTHOR]

The implementation in England of a Social Care Workforce Race Equality Standard (SCWRES), initially confined to social work, started with a first set of eighteen volunteer local authorities (LAs) in 2021. This article discusses a rapid evaluation of the SCWRES during its first year. We used Normalization Process Theory (NPT) to better understand the implementation process of this initiative. Thirty-one interviews were undertaken in 2021. Transcripts were analysed using the constant comparative approach and emerging themes were then mapped onto the NPT framework and its four main constructs. Using these we found some lack of clarity over the aims and data demands of the SCWRES (coherence), but generally substantial personal and employer investment in the intervention (cognitive participation); implementation was assisted by personal support to the LAs from senior managers at national level (collective action); and there was general constructive reflection and positive feedback about the SCWRES (reflexive monitoring). Barriers to implementation of new initiatives might be expected during a global pandemic. However, support for the SCWRES was generally high and participants considered they had learned much in its first six months despite pandemic pressures. This article highlights aspects of implementation to be addressed in any further SCWRES rollout. [ABSTRACT FROM AUTHOR]

Objectives: The objectives are to determine the factors that motivated GP practice managers in England to employ non-medical roles, and to identify an ideal hypothetical GP practice workforce. Methods: Cross-sectional survey of GP practice managers in England (n = 1205). The survey focused on six non-medical roles: advanced nurse practitioner, specialist nurse, health care assistant, physician associate, paramedic and pharmacist. Results: The three most commonly selected motivating factors were: (i) to achieve a better match between what patients need and what the practitioner team can deliver; (ii) to increase overall appointment availability and (iii) to release GP time. Employment of pharmacists and physician associates was most commonly supported by additional funding. Practice managers preferred accessing new non-medical roles through a primary care network or similar, while there was a clear preference for direct employment of additional GPs, advanced nurse practitioners or practice nurses. The ideal practice workforce would comprise over 70% of GPs and nurses, containing, on average, fewer GPs than the current GP practice workforce. Conclusion: This study confirms that more diverse teams of practitioners are playing an increasing role in providing primary care in England. Managers prefer not to employ all new roles directly within the practice. A more detailed investigation of future workforce requirements is necessary to ensure that health policy supports the funding (whether practice or population based), recruitment, training, deployment and workloads associated with the mix of roles needed in an effective primary care workforce. [ABSTRACT FROM AUTHOR]

SUMMARY: Demands on health and social care are growing in quantity and complexity, with resources and staffing not projected to match this. The landmark NHS Long Term Plan calls for services in England to be delivered differently through integrated care systems (ICSs) that will better join commissioners and providers, and health and social care. The scale of these changes is immense, and the detail can feel confusing. However, they are important and will affect all clinicians in the public service. This three-part series provides a primer on integrated care, explaining why it is happening, how services are changing and why clinicians should get involved. In this first article we focus on the changing demographics, and the workforce and financial resources required to address these. [ABSTRACT FROM AUTHOR]

Aim: To explore higher education institution (HEI) perspectives on the development and implementation of trainee nursing associates (NAs) in the primary care workforce in England. Background: Current shortages of primary health care staff have led to innovative skill mix approaches in attempts to maintain safe and effective care. In England, a new level of nursing practice, NAs, was introduced and joined the workforce in 2019. This role was envisaged as a way of bridging the skills gap between health care assistants and registered nurses and as an alternative route into registered nursing. However, there is limited evidence on programme development and implementation of trainee NAs within primary care settings and HEI perspectives on this. Methods: This paper draws from a larger qualitative study of HEI perspectives on the trainee NA programme. Twenty-seven staff involved in training NAs, from five HEIs across England, were interviewed from June to September 2021. The interview schedule specifically included questions relating to primary care. Data relating to primary care were extracted and analysed using a combined framework and thematic analysis approach. Findings: Three themes were developed: 'Understanding the trainee role and requirements', 'Trainee support in primary care' and 'Skills and scope of practice'. It is apparent that a more limited understanding of the NA programme requirements can lead to difficulties in accessing the right support for trainees in primary care. This can create challenges for trainees in gaining the required competencies and uncertainty in understanding what constitutes a safe scope of practice within the role for both employers and trainees. It might be anticipated that as this new programme becomes more embedded in primary care, a greater understanding will develop, support will improve and the nature and scope of this new level of practice will become clearer. [ABSTRACT FROM AUTHOR]

Teachers and school leaders have long claimed that increased workload negatively impacts results and teacher retention. However, scant empirical evidence exists to support these claims until now. Using longitudinal data from England's School Workforce Census, this paper presents the results of a study revealing associations between contact hours, timetable complexity, GCSE performance and teacher attrition. This supports the notion that decreasing departmental average contact hours may lead to higher GCSE value added for that department. The size of this drop is equivalently opposite to recent estimates of GCSE gains arising from additional allocated instruction time for pupils, showing a fiscally neutral way for departments to improve teacher workload without negatively impacting results. Further analysis in this study links improvements in teacher's contact hours, and the complexity of their workload, with teacher retention. Thus schools rethinking their use of time by increasing non-contact time for their teachers are likely to retain those teachers longer and raise their results in the process. [ABSTRACT FROM AUTHOR]

Estimates of how health affects employment vary considerably. We assess how different methods and health measures impact estimates of the impact of health on employment using a unified framework for the United States and England. We find that subjective and objective health measures and subjective measures instrumented by objective measures produce similar estimates when using sufficiently rich objective measures. Moreover, a single health index can capture the relevant health variation for employment. Health deterioration explains up to 15 percent of the decline in employment between ages 50 and 70. Effects are larger for the United States than England and for the low educated. [ABSTRACT FROM AUTHOR]

The article focuses on the challenges faced by the social care workforce in the UK, including high turnover rates and difficulties in recruitment and retention. Topics include the economic impact of social care, the need for a person-centred approach in nursing education to prepare students for social care settings, and proposals to establish social care nursing as a recognized fifth field of practice.

The article discusses the introduction of nursing associates in critical care settings in the United Kingdom, addressing concerns regarding role boundaries, scope of practice, and patient safety implications. Topics include the background leading to the creation of the nursing associate role, differences in responsibilities between registered nurses and nursing associates and efforts to clarify the role of nursing associates in critical care through guidelines and competencies.

Urinary tract infections (UTIs) are a common cause of hospital admissions, particularly in older people. In the past five years, there were more than 800,000 hospital admissions for UTIs in England alone – with almost three fifths occurring in people over 65 years. [ABSTRACT FROM AUTHOR]

National Health Service (NHS) knowledge and library services in England are integrating digital advances into their systems and services. Health Education England (HEE) leads on the development of NHS library services. A key workstream focuses on (1) improving the infrastructure to enable discovery and management of digital knowledge resources; (2) collaborating with local teams to establish regional library management systems that are integrated with the new national discovery service for healthcare staff and learners. This article explores initiatives on resource discovery as well as the need for system‐wide partnership working to ensure that biomedical knowledge in computable form is findable, accessible, interoperable and reusable. Low levels of health and digital literacy pose a significant barrier to using health information and accessing health services. A range of interventions are aimed at enhancing citizens' digital and health literacy skills. The education and life‐long learning needs of the knowledge and library services workforce are considered. Working with CILIP and higher education institutions, HEE delivers a range of educational offers through its Learning Academy. As Artificial Intelligence and automation are implemented in health systems, knowledge and library staff form a crucial bridge between technology and those who use it. [ABSTRACT FROM AUTHOR]