change in the nhs

It's a while since I've posted anything. So much change is occurring in the NHS it is occupying a lot of my time. I manage a physiotherapy department of about 75 people, providing respiratory, neurological, orthopaedic and musculoskeletal expertise to a large acute hospital.

The new pay structure for the NHS, called Agenda for Change (AfC), is being introduced. This may not seem like much but think about the size of the organisation. The three biggest employers in the world are the Chinese Army, the Indian Railways and the NHS. So it's a massive job.

The government stated than AfC would be funded but this has proved not to be the case. It is likely they could not predict the outcome of this process once it was released into the wild. In one of the effects of the law of unintended consequences, the jobs in the NHS have been valued by the NHS insiders as higher than expected. No surprise there then.

Even though the NHS funding has increased substantially over the last few years, the unleashed demand has taken up much of it, with salaries the main consumers. Massive strides have been made in NHS efficiency with the new funding, so it's not been wasted, but much may be taken up with rewarding serving staff with higher pay.

This is where the tricky stuff comes in. If we reward our staff with higher pay bands and the budget is not infinitely elastic, something has got to give. Even if the higher paid staff take on very different roles to their present ones as justification for their higher banding, the budget still has to be balanced somehow.

This is where the changes come in, and I think they are going to be very far-reaching. We are finding that much of the work we have been doing all these years no longer needs to be done by qualified professionals such as ourselves. On examination, 25 to 75 percent of the work could be done by unregistered practitioners, ie not physiotherapists as such.

Oops. That's going to change the structure of our department over the next few years. If some of our staff are going to be more expensive then there will need to be fewer of them. Since a lesser or greater proportion of our work does not require a qualified physiotherapist, we will have more and more unregistered practitioners.

Nothing bad about all this necessarily, as we move towards having the work done by an appropriate person rather than someone who has always done it. As with everything, there are consequences...