6. Workforce as a system solution by supporting fragile services and reducing backlogs

An important and evolving area of provider collaboration is the way systems are using their workforce as a shared resource, both to address backlog pressures and to stabilise fragile services.

In the Black Country Provider Collaborative, which is made up of four acute trusts, workforce collaboration has been a key part of the approach to reducing variation and improving service resilience. Through clinical networks and shared working, providers have:

• improved performance through shared clinical networks, reducing long waits from 104 to 52 weeks or less, achieving top-quartile GIRFT performance for Orthopaedic length of stay, increasing FIT-based urgent suspected lower GI cancer referrals to 85 per cent, and enabling over 50 per cent of fast-track dermatology cancer referrals to be managed without a hospital appointment
• enabled clinicians to work across organisational boundaries, reducing workforce fragility and improving resilience through cross-site working and specialist networked services including ENT and ophthalmology services, and establishing urology cancer centres of excellence and shared breast radiology provision 
• delivered specialist services at scale across the Black Country, including development of a single-system breast reconstruction service, hosted at a single trust on behalf of the system, enabling equitable access to specialist care while making best use of scarce workforce and theatre capacity
• reduced variation and improved equity of access through shared clinical standards, specialist service specifications, service repatriation and expansion of local services, helping more patients receive high-quality care closer to home. This included repatriating Mohs surgery services back into the Black Country and developing shared patient tracking lists (PTLs) for key surgical areas.

Across systems more broadly, emerging workforce models are helping to increase flexibility and capacity, including shared recruitment and staff bank models, workforce portability arrangements and collaborative approaches to training and skills development such as clinical networks as development platforms for more ‘on-the-job’ system learning and standardising training approaches across sites and developing consistent service specifications and pathways.

These approaches are particularly important in addressing fragile services, where workforce shortages make it difficult for individual organisations to sustain safe and effective provision. By working at system level, collaboratives can:

• pool scarce expertise
• reduce duplication
• ensure more consistent access for patients.

The most successful approaches combine formal mechanisms such as shared services and agreements with strong relationships and active coordination. 

Key takeaway

Treating workforce as a system asset where appropriate and possible can unlock capacity, improve resilience, and support more sustainable models of care.