Neonatology - Workforce

Neonatal units should adhere to national staffing standards for nursing and medical staff including additional protected time for medical and nursing quality-enhancing roles. a Review staffing requirement against BAPM medical and nursing standards (utilising 2020 Neonatal Nursing Workforce Calculator). Where staffing standards are not met, a risk assessment should be undertaken detailing mitigation strategies and a timely action plan to meet the set standard agreed by the provider trust. This should be shared with the ODN and reviewed biannually. The action plan should align with network requirements for the service as part of network capacity review (see also recommendation 4c and 4d in GIRFT’s Neonatology National Specialty report regarding changes to gestational thresholds for in-utero transfer where medical standards are not met). b Develop national guidance, endorsed by national bodies, to support providers in benchmarking the appropriate protected time for nurse specialised quality-enhancing roles c Review nursing quality roles against GIRFT benchmarking information and medical and AHP non-clinical/quality roles against current national standards. Gaps in provision should have an action plan signed off at trust board level and agreed by the ODN.

Embed allied health professionals, pharmacy and psychology services into neonatal units and networks, in line with professional standards to improve outcomes for babies. a Match AHP, pharmacy and psychology workforce action plans against professional staffing standards, using GIRFT data where appropriate. Identify gaps and develop business cases to improve resourcing. b Write specific staffing recommendations for psychology services for NICUs, LNUs and SCUs, to enable calculations for staffing based on activity and levels of care. c Develop a network business case for senior network pharmacy lead to support the drug safety agenda (see also drug safety recommendation 12, GIRFT Neonatology National Specialty Report). d Ensure neurodevelopmental follow up clinics have appropriate AHP staffing and resourcing as recommended in the NICE guideline NG72. e Increase AHP, psychology and pharmacy representation at network boards to support planning and service delivery. A minimum of one Board member representative should stand for the AHP / pharmacy / psychology specialities and have strong network links with their lead colleagues through national and network professional groups. f Establish AHP, pharmacy and psychology network groups in each ODN to enable peer support, research and development, standardise care pathways and support or lead on QI projects.

Develop transformational workforce plans that reduce reliance on doctors in training and develop the nursing, allied health professional and wider multidisciplinary team. a Develop an overall regional workforce strategy. This should be developed by neonatal networks in conjunction with relevant regional ICS boards and Local Maternity Systems. b Develop strategies to reduce the reliance on doctors in training, taking account of any changes which may be required to workforce plans as a result of Progress+ (RCPCH Paediatric Training Programme). Consider expanding and developing newer roles e.g. MTI trainees, ANNPs, ENNPs, physician associates and prescribing pharmacists. To ensure appropriate development, transferability and governance, the skills and competencies for these new roles should be agreed at ODN level. c Develop strategies to support new roles within the nursing and AHP workforce, linked to a robust competency-based education programme supported by network workforce/education leads and AHP leads.

Develop sustainable, improved experiences and education for doctors in training, trained medical staff nurses, allied health professionals and newer roles (see also recommendation 6, GIRFT Neonatology National Specialty Report). a Identify and prioritise workforce development monies as well as CPD funding to support access to sustainable QIS funding as a role essential qualification. A similar approach to funding ANNP and ENNP training should also be explored. b Review, in conjunction with overall workforce review, HEE commissioned (Deanery) medical training placements, including those completing subspecialty training in neonatal medicine, to ensure they are appropriately placed to maximise experience, training and educational opportunities. c Review, in conjunction with overall workforce review, junior doctor activities to ensure workload is appropriately distributed across the multidisciplinary team. This should include: a) working with midwifery colleagues to ensure NIPE examinations for well term infants are not a routine part of the tier 1 medical rota; b) agreeing guidelines for which deliveries require neonatal attendance and regularly auditing practice to prevent unnecessary attendance; and c) review medical administrative workload and availability of administrative & clerical support, particularly at weekends to ensure optimal cost-effective cover to reduce the administrative burden for medical staff. d Investigate the feasibility of apprenticeship models to support elements of neonatal career development. e Create a national group bringing together network education/workforce leads that link to key stakeholders such at HEE, NNA and BAPM to achieve a sustainable education and training offer for neonatal nurses. to include: - Quality Assured Neonatal Preceptorship programme - Focus on development into senior nursing roles - Access to wider training such as Leadership - Appropriately protected CPD as discussed and agreed within local PDR/Appraisal with innovative solutions to support development of whole teams of neonatal nurses with focus on educating the educators. f Support production of and utilise a nationally agreed education and training framework to support standardisation of competence and educational offers across the neonatal nursing workforce. g Utilise the BAPM ANNP Framework to support future development in this role. h Embed the nationally agreed AHP training and education standards (expected publication April 2022), including accredited post-graduate training to expand knowledge and skills base as they progress in their chosen field of neonatology.

Neonatal nursing career structures should be recognised nationally and promoted. a Establish a nationally recognised career structure for the specialism of neonatal nursing to improve recruitment and retention and provide sustainable career development. This structure will be supported by HEE through a nationally agreed education and training framework as described in recommendation 4f.