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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]

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]

The NHS Long Term Workforce Plan (2023a) has set a trajectory to approximately double the size of the psychological professions workforce in England. If this is achieved, it can deliver a step change in provision of effective psychological healthcare. To deliver on the plan, we will need to embed dedicated professional leadership, and to continue a joined-up approach to expanding and developing the workforce across the psychological professions, designed around the needs of the public. Specific further action will be needed to develop a diverse and representative workforce, support retention, develop a variety of career paths, to diversify how we train, and crucially, to demonstrate the impact of our growth on patient outcomes and experience. [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]

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]

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]

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.

Why you should read this article: • To understand the barriers and facilitators to integrating new non-medical practitioners in general practices • To recognise the challenges associated with integrating new non-medical practitioners in general practices • To acknowledge that sustainable models of transdisciplinary working are needed to ensure that the general practice workforce can deliver safe, effective and responsive patient care General practices in England face workforce challenges because of insufficient numbers of GPs and practice nurses, combined with an increase in demand for services. One solution is to integrate new non-medical practitioners – such as advanced nurse practitioners, paramedics, pharmacists, physician associates and physiotherapists – in the general practice team. The integration of some of these roles is incentivised by the Additional Roles Reimbursement Scheme launched in 2019 for five years. This article reports on and discusses the findings of a scoping review of the recent literature on the barriers and facilitators to the integration of new non-medical practitioners in general practices in England. The review found that the integration of new non-medical practitioners faces many challenges and that sustainable models of transdisciplinary working are needed. [ABSTRACT FROM AUTHOR]

Objectives: Health policy and funding initiatives have addressed increasing workloads in general practice through the deployment of clinicians from different disciplinary backgrounds. This study examines how general practices in England operate with increasingly diverse groups of practitioners. Methods: Five general practices were selected for maximum variation of the duration and diversity of skill-mix in their workforce. Individual interviews were recorded with management and administrative staff and different types of practitioner. Patient surveys and focus groups gathered patients' perspectives of consulting with different practitioners. Researchers collaborated during coding and thematic analysis of transcripts of audio recordings. Results: The introduction of a wide range of practitioners required significant changes in how practices dealt with patients requesting treatment, and these changes were not necessarily straightforward. The matching of patients with practitioners required effective categorization of health care patients' reported problem(s) and an understanding of practitioners' capabilities. We identified individual and organizational responses that could minimize the impact on patients, practitioners and practices of imperfections in the matching process. Conclusions: The processes underpinning the redistribution of tasks from GPs to non-GP practitioners are complex. As practitioner employment under the Primary Care Network contracts continues to increase, it is not clear how the necessarily fine-grained adjustments will be made for practitioners working across multiple practices. [ABSTRACT FROM AUTHOR]

Social work is one of the core professions within mental health services in the UK, though its position as local authority 'outsider' excludes it from health-based workforce planning, leaving the exact national composition of mental health social work shrouded in mystery. In the context of increasing demand and limited resources, this lack of clarity precludes effective use of the mental health workforce. This study aimed to map the provision of mental health social work across England and Wales. A cross-sectional design was used, with brief surveys issued to all local authorities and National Health Service trusts responsible for providing social work or mental health services. These surveys collected the number of mental health social workers in each agency and their employment contexts for subsequent descriptive statistical analysis. Responses were received from 96.6 percent of agencies, employing 6,584 social workers. Findings indicated that mental health social work varies widely across both nations, with little clear rationale for, or consistency in, how social work is structured within mental health services. While these findings establish the first robust framework for understanding the size and scope of mental health social work provision, further research is required to establish temporal and contextual understandings to inform future service planning. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand some of the benefits that the nursing associate role can bring to community and primary care nursing teams • To be aware of the challenges involved in training and embedding nursing associates in community and primary care settings • To recognise the need for clarity on the boundaries and expectations of the nursing associate role in community and primary care settings Nursing associates have been part of the health and social care workforce in England since 2017 and are starting to contribute to managing workforce challenges. However, little is known about the nursing associate role in community and primary care settings. This article provides an overview of what is known about the nursing associate role in community and primary care settings and introduces some emerging findings from recent research. The article identifies some of the benefits that nursing associates can bring to community and primary care nursing teams and some of the challenges involved in training and embedding nursing associates in these sectors of the health and social care workforce. [ABSTRACT FROM AUTHOR]

Background: The diversification of types of staff delivering primary care may affect professional, population, and system outcomes. Aim: To estimate associations between workforce composition and outcomes. Design and setting: Cross-sectional analysis of 6210 GP practices from a range of geographical settings across England in 2019. Method: A multivariable regression analysis was undertaken, relating numbers of staff in four groups — GPs, nurses, healthcare professionals, and health associate professionals — to patient access and satisfaction, quality of clinical care and prescribing, use of hospital services, GP working conditions (subsample of practices), and costs to the NHS. Data were obtained from the GP Patient Survey 2019, Quality and Outcomes Framework, prescribing data, the Hospital Episode Statistics database, the NHS Payments to General Practice 2019/2020, and the Tenth National GP Worklife Survey 2019. Results: Having additional GPs was associated with higher levels of satisfaction for the GPs themselves and for patients, whereas additional staff of other types had opposite associations with these outcomes. Having additional nurses and health associate professionals was associated with lower costs per prescription but more prescribing activity than having additional staff from the other two groups. Having more GPs was associated with higher costs per prescription and lower use of narrow-spectrum antibiotics compared with the other staff groups. Except for health associate professionals, greater staff numbers were associated with more hospital activity. Conclusion: Professional, population, and system outcomes showed a variety of associations with primary care workforce composition. Having additional nurses was associated with lower quality in some aspects, and higher costs and activity. The association between additional healthcare professionals or health associate professionals and higher costs was less than that for additional GPs, but was also linked to lower patient and GP satisfaction. [ABSTRACT FROM AUTHOR]

Background: During the coronavirus disease 2019 (COVID-19) pandemic, support staff working with people with learning disabilities experienced a range of stressors directly related to the effects of the pandemic on themselves and on service users. Supporting staff well-being is crucial given their essential role in the lives of people with learning disabilities. Aim: To investigate the experiences, during the COVID-19 pandemic, of support staff working in residential and supported-living services for people with learning disabilities and understand the stressors staff encountered, the ways in which they managed stress and the support mechanisms they found useful. Method: A qualitative descriptive approach was used and individual semi-structured interviews were conducted with 14 support staff working in residential or supported-living services for people with learning disabilities in the south of England. Findings: The COVID-19 pandemic caused additional stress for staff, including information overload, challenges in providing person-centred, holistic support, and feelings of unfairness or being let down. However, staff derived benefits from timely, practical and non-judgemental support from managers and peers, and from celebrating their own and service users' achievements. Conclusion: A greater focus on non-judgemental listening by managers, celebration of staff's and service users' achievements and awareness of the potential overwhelming effects of email communication could reduce the stress levels support staff are exposed to. [ABSTRACT FROM AUTHOR]

This article reports on a study assessing the incentives and deterrents to long-term care (LTC) supply in two local markets in England. The supply of LTC in many countries is facing the issues of rising demand, (lack of) workforce and the interaction of the public and private sectors. Findings from qualitative interviews of local council and provider stakeholders exploring barriers and enablers faced by LTC providers in two local authorities (LAs) are presented and discussed. The interviews provided insight in three main areas: staffing, demand and stakeholder relationships. Staffing, in particular, is crucial and we found that there are many difficulties for providers in maintaining their workforce. Consistent with previous research, we also found that public spending levels on LTC puts pressure on providers striving to maintain a good quality service, including improved remuneration of staff. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To familiarise yourself with the challenges that have affected the care home sector in recent decades • To understand the effects of the COVID-19 pandemic on care home staff and residents • To consider how care homes may be reformed to achieve integration of health and social care services for older people During the first wave of the coronavirus disease 2019 (COVID-19) pandemic, older people were discharged from hospitals to care homes to release NHS beds. This influx of new residents whose COVID-19 status was largely unknown added to the many challenges already experienced by care homes, with serious consequences including an increased number of deaths among residents. The social care sector has been fragile for several years and the pandemic has brought the challenges experienced by care homes to the forefront, prompting renewed calls for improved funding and reform. This article describes the ongoing challenges and additional challenges caused by the pandemic in the care home sector. The authors argue for urgent reform to enhance the status and education of care home staff, move towards registration of the social care workforce in England, and achieve integration of health and social care services for older people. [ABSTRACT FROM AUTHOR]

Aims: To examine if the introduction of Diabetes Inpatient Specialist Nurses impacted on length of stay and rates of readmission. Design: Knowledge discovery through data mining as part of a larger realist evaluation of the role. Methods: Data from January 2017 to January 2019 was extracted and examined. A subset of performance data from July 2017–November 2018 was analysed. This consisted of 7320 records for Hospital Episode Statistics and 272 incident reports (Datix). The data were analysed via Generalised Linear Model regression routines in R. Analysis of readmission rates utilized binary logistic regression, while for the Length of Stay a count regression method was employed. Results: Four trusts were found to have complete and rich data sets. All Trusts that returned complete data were found to have varying decreased length of stay and reduced readmission rates. In two trusts there were significant decreases in patient readmissions and length of stay after the introduction of the Diabetes Inpatient Specialist Nurses. A marked decrease (approximately half) in patient length of stay was found in one London trust after the introduction of the post. Issues with data quality were noted. Conclusion: Reduced patient length of stay and rate of readmission were found since introduction of Diabetes Specialist Nurses. Patient safety data was incomplete and varied significantly between trusts. Impact: The project sought to understand the impact of employing Diabetes Inpatient Specialist Nurses in hospitals in London. Overall, the specialist nurses helped reduce length of stay and the rate of readmissions. The research will have an impact on the workforce in diabetes and also people with diabetes who need hospital care. [ABSTRACT FROM AUTHOR]