Scottish Government

ISBN 0 7559 1220 9 (Web only publication)
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Contents

1. Introduction
2. Consultants, Staff and Associate Specialists, Doctors in training
3. General Practitioners
4. Dental Workforce
5. Nurses and Midwives
6. Healthcare Scientists
7. Allied Health Professionals
8. Clinical Psychologists
9. Pharmacists
10. Agenda for Change
11. Waiting Times Implications
12. Information Sources
13. Definitions

1. Introduction

This Background and Methodology Annex accompanies the National Workforce Planning Framework 2005. The full report of the Framework can be found at www.workinginhealth.com and also at www.scotland.gov.uk/Publications. A short report is also available at the same web addresses.

This Annex is aimed at those who are responsible in NHS Boards for the technical aspects of workforce planning. Assumptions have therefore been made on the basis of readers' understanding of standard technical terms and analytical methodologies.

This Annex gives more technical detail to underpin the National Workforce Planning Framework 2005 such as the background information, methodology and approach, data sources and assumptions. Through the Annex we aim to provide transparency of the analyses performed and begin to develop a common technical approach to workforce planning across NHSScotland. The guidance to be produced by SEHD for NHS Boards and Regions by October 2005 will all assist in achieving this objective by presenting principle concepts for developing demand and supply estimates along with a workforce planning template.

Detail on the analyses is supplied in this Annex for each of the staff groups presented in the full report and for specific analyses such as Agenda for Change. The Framework explores demand and supply; likewise this Background and Methodology Annex follows the same approach and is cross-referenced to the appropriate paragraphs in Chapter 3 of the full report of the Framework.

2. Consultants, Staff and Associate Specialists, Doctors in training

Demand Factors:

a. Waiting time targets and standards (Paragraph 3.2.1)

There are two workforce demands arising from waiting times targets: one is the initial push to bring current times down to the target level and the other is the on-going activity to maintain them at that level.

To determine the number of additional consultants required to achieve the desired outcome, the level of outpatient and inpatient/day case activity is calculated.

By applying activity per consultant ratios to the additional activity figures, an estimate of the extra number of consultants required to deal with this extra annual activity can be obtained.

Further details on the methodology used can be found in Section 11 of this Annex on 'Waiting Times Implications'.

b. Working Time Regulations (Paragraph 3.2.2)

Estimates of the implications on the junior doctor workforce of reducing to 48 hours per week in 2009 relies on the following data :

• total number of WTEs as at 30 September 2004 for each grade for all specialties (specialist registrar, senior house officer and pre-registration house officer). ( http://www.isdscotland.org/wf_medical Table B1 All HCHS medical and dental staff by time (whole time equivalent))
• monitored average actual hours per week for the period August 2004 to January 2005 by training grade for all specialties. The data supporting this analysis was provided by ISD and is based on the information collected to monitor Doctors in Training - Compliance with the New Deal.

These two data sources are used to calculate the following:

• Total Weekly Hours (2004) is calculated as the product of the WTE₂₀₀₄ X Average Weekly Hours
• Estimated Total Weekly Hours (2009) is calculated as the product of the WTE₂₀₀₄ X 48 hours per week Working Time Regulations Target
• Difference in Total Weekly Hours is calculated as Total Weekly Hours by Grade in 2004 less the Estimated Total Weekly Hours in 2009
• Difference in WTE is based on the Difference in Total Weekly Hours divided by the 48 hours per WTE
• Percentage change is based on the Difference in Total Weekly Hours divided by the Total Weekly Hours in 2004

Note that these estimates do not take into consideration annual leave, study leave and public holiday entitlements. A refinement to reflect these factors may be necessary if considering filling any gaps with staff groups or new roles which attract different entitlements.

c. Mental Health Act (Paragraph 3.2.4)

A review of the Mental Health (Care & Treatment)(Scotland) Act 2003 through the National Mental Health Workforce Group identified three key new or extended activities for psychiatrists: Assessment, Attendance of Tribunals and Membership of Tribunals. An estimate of the commitment for each activity was agreed. In the case of Assessments, extended effort was identified given that psychiatrists already conducted patients assessment.

The volume of assessments was based on the volume of expected short term detentions under the Act. This was estimated based on assumptions stated in the Royal College of Psychiatrists, Scottish Division paper (2002) updated for the Mental Welfare Commission Statistics for 2003/4.

The number of tribunals was estimated at 4000 per year and is based on estimates of the number of short term detentions, long term detentions and Compulsory Treatment Orders that are likely to result in tribunals.

Based on the assumptions, two scenarios of demand are provided below. The main differences in assumptions between the scenarios are:

• the additional effort per assessment (Low 50% v. High 75%) and
• the percentage attendance by psychiatrists at tribunals (50% v. 98%).

The resulting estimate of additional effort is between 16 and 40 WTE. Taking an average between the two scenarios, the additional demand is estimated at 28 WTE.

LOW

HIGH

d. Pay Modernisation (Paragraph 3.2.5)

The following information on the uptake of the new consultant contract across NHSScotland is available:

• Consultants signed off Whole Time Equivalent by specialty and NHS Board ( http://www.isdscotland.org/wf_medical, Table 18)
• Consultants signed off Total Programmed Activities and Out Of Hours by specialty and NHS Board ( http://www.isdscotland.org/wf_medical, Table 19)
• Consultants signed off Average Programmed Activities and Out Of Hours by specialty and NHS Board ( http://www.isdscotland.org/wf_medical, Table 20)

e. Modernising Medical Careers (Paragraph 3.2.6)

Work is ongoing to assess the capacity implications of MMC, both in the short and longer term. A Solutions Group has been established and NHS Boards are quantifying the impact of the changes that MMC will bring. The Solutions Group website is available at: http://www.mmc.scot.nhs.uk/events/solutions_group.asp.

Modelling is being carried out at a national level to determine the number of places in each of the training programmes.

Supply Factors:

f. Allocation of extra SpR places and resulting expected increase in average annual SpRs gaining a CCST (page 36):

Estimates of the number of SpRs produced in the period 2005 to 2014 is based on the number of SpRs due to gain a CCST for a specific year and expected to remain in Scotland. In addition to this SpR supply is the number of CCST holders who gained a CCST in the previous two years, but had not obtained a permanent consultant post and are still in Scotland.

The attrition rate used is the specialty specific average over the last five years. The retention of SpRs gaining a CCST is the average over a three year period.

Estimates also reflect the 'spread' of gaining a CCST: some SpRs gain a CCST in the minimum time, while most extend the minimum period for up to three years. For those SpRs currently in post, the date expected to gain a CCST is based on information collected by NHS Education for Scotland. For those SpR posts that are vacated in the future and the subset of the 375 additional SpRs yet to take up post, the estimated CCST date is based on:

• the Royal College specialty specified minimum years to gain a CCST, and
• the historical pattern of those qualifying during 2002 - 2003.

3. General Practitioners

Demand Factors:

a. GP Patient Contacts (Figure 18)

Current rates of patient contacts broken down by age and sex were provided by Practice Team Information System at ISD Scotland for 2003-04 and applied to the population projections provided by the Government Actuarial Department. This allows estimation of total patient contacts with GPs based on how the characteristics of the population are expected to change as shown in the chart below.

* Source: Practice team Information, ISD. Data for year ending 31 ^st March 2004. Based on a sample of practices representing around 6% of the population.

b. Destination of GP Registrars (Figure 19)

Annual GP census data from the GMP database ( ISD Scotland) was used to create a series of separate GP files which could be linked to identify leavers and joiners to and from each staff group in successive years, including GP registrars. The 2003 Supplementary Medical List ( SML) was used to approximate the numbers of GP sessionals working in Scotland. The SML contains all non-principal doctors and this list was matched to the available census data in order to remove the known assistants, associates, and retainers. This left us with an approximate list of GP sessionals but would also contain some other qualified GPs who are not currently practising. The 2002 census data was linked to the 2003 SML in order to identify those GP registrars becoming GP sessionals in that particular year.

c. Age Profile (Figure 20)

Annual GP census data from the GMP database ( ISD Scotland) broken down by age group.

d. Gender Profile (Figure 21)

Annual GP census data from the GMP database ( ISD Scotland) broken down by gender, staff group, and contract type.

4. Dental Workforce

a. Joiners and Leavers (Figure 22)

The joiners and leavers analysis is based on the number of dentists working in General Dental Services in Scotland, including salaried and non-salaried principals, assistants and vocational trainees. Inflow and outflow from the GDP pool are described as Joiners from VT, Returners and Other Joiners, and an output of Leavers.

5. Nurses and Midwives

a. Waiting Times (Paragraph 3.5.1)

There are two workforce demands arising from waiting times targets: one is the initial push to bring current times down to the target level and the other is the on-going activity to maintain them at that level.

Additional demand was factored into the Adult category to take account of the number of nurses needed to undertake extra non-recurrent and recurrent activity to meet and maintain the 18 week (16 week for cardiology) waiting time targets.

Non-recurrent annual WTE demand due to the waiting time targets were added in 2005/06 and 2006/07. A pro-rata mix of both non recurrent and recurrent was used for the year 2007/08.

Further details on the methodology used on 'Waiting Times Implications' can be found in Section 10 of this Annex.

b. Agenda for Change (Paragraph 3.5.6)

Agenda for Change will affect annual leave/public holiday, weekly contracted hours and overtime entitlements and therefore WTE demand. Given that the SNIP¹ projections provided by NHS Boards included the implications associated with Agenda for Change, no adjustment for this policy was applied for the period 2003/04 to 2007/08.

Section 10 of this Annex outlines in detail calculation of the pre and post Agenda for Change WTE implications for each staff group. For registered nurses and midwives, there is a reduction in WTE. Therefore, demand was increased to cover this reduction.

c. Anticipated required hours for Out of Hours Services (Figure 27)

The Workforce Numbers Group identified the importance of understanding the workforce implications for Primary Care Services. The new Out of Hours arrangements presented an opportunity to understand one aspect of the new GMS contract and to explore new ways of working, such as moving away from traditional staff group definitions to describing skills in terms of practitioner levels. Data was collected during the period November 2004 - January 2005.

Ten out of sixteen NHS Boards responded, representing between 45% and 57% of the Scottish population. Based on the sample collected, a very early and evolving Scottish picture is suggested. Despite difficulties in assessing future needs most NHS Boards plan to move towards a multi-professional service with a reduction in the number of GPs working OoHs and an increase in the other staff groups, particularly nurses.

The Scottish figures were drawn from the NHS Boards' replies and the 2001 Scottish population census published by the General Register Office for Scotland. A pro-rata approach using the population size was taken to complete the Scottish picture. One exception was the return provided by NHS24. Given that NHS24 covers the whole of Scotland no adjustment based on population was required.

As an example, those NHS Boards providing projections of nurse WTE covered 57.2% of the Scottish population. A pro rata adjustment of this WTE figure is based upon the following calculation:

Total WTE for nurses: (( WTE excluding NHS24 X 100)/57.2) + NHS24 WTE.

The WTE figures is converted into hours based on the expected hours for Nurses, Paramedics and AHPs are 1 WTE = 37.5 hours.

d. Leavers and Joiners (Paragraph 3.5.14)

SNIP uses a bottom-up demand approach using data gathered from Boards and others. Supply parameters such as leaving and joining rates for current staff in post and attrition and non-practice rates of students are also considered during the process.

Definition of Joiners

Newly Qualified

These are individuals who have completed a pre-registration training course and have registered with the Nursing & Midwifery Council. This training can be a degree, diploma or short course.

The objective is to establish the number of expected newly qualified practicingNHS nurses and midwives.

NHS Education for Scotland collects information describing expected number of student completions by age, course and completion year. From this data, three year average specialty specific attrition rates by course are determined.

Through annual surveys, the Higher Education Institutions provide information on students' first destination after qualification. From this information, three year speciality specific average non practice rates are determined.

There are three types of non practice: leaving Scotland, choosing not to pursue a nursing career and remaining in non nursing / midwifery further education. Of these three types, the assumptions on 'leaving Scotland' are varied. The other two non practice categories (remaining in further education and not pursuing a nursing career) are not modified.

The high non practice rate assumes that all of those leaving Scotland in fact leave. The low non practice rate assumes that only 50% of those leaving Scotland leave. It is assumed that over the five year SNIP projection period, the low non practice rate is achieved. Applying these year on year rates provides total number of expected practicing newly qualified nurses in Scotland by category year on year. For midwives, the SNIP project team decided that the resulting non practice was not realistic and determined 5% reduction over the five year period.

To determine those nurses and midwives working in the NHS, further data from the Higher Education Institutions is used to establish the proportion of total newly qualified practicing nurses working in the NHS. This proportion is applied to the total and the result is the number of expected newly qualified nurses and midwives practicing in the NHS year by year by age.

Rejoiners

These are individuals who come back to nursing or midwifery after a career break.

All of the analysis described below is conducted by age. The number of NHS total joiners (rejoiners, newly qualified and new joiners), are identified through comparison of the two most recent years of ISD Nursing & Midwifery censuses. A further comparison with censuses from 1979 to 2004 establishes if these joiners have worked previously in Scotland and can be identified as rejoiners. Depending on the specialty, three or four year average rejoiner rates relative to staff in post are established by age.

New Joiners

These are individuals who are not Newly Qualified and come from outside Scotland. Having excluded rejoiners from the same total joiner list, the number of newly qualified joiners is also subtracted. This provides the number of NHS New Joiners by age. New joiner rate relative to staff in post is established for the current year. Depending on the specialty three or four year average new joiner rates are determined by age and applied year on year.

Identifying Leavers

The two most recent censuses are compared to identify those who have left NHSScotland. Current leaving rates relative to total staff in post are established by specialty and age. Depending on the specialty, three or four year average leaving rates are determined by age and applied year on year.

e. Nursing and Midwifery workforce targets (Paragraph 3.5.17)

The movement of nurses and midwives over their career can be analysed by comparing successive censuses. This is made possible through a unique staff identifier - in this case, national insurance number. From the linked census files, the number of joiners between censuses is identified.

6. Health Care Scientists

a. Pay Modernisation (Paragraph 3.6.6)

Section 10 of this Annex outlines in detail the calculation of pre and post Agenda for Change WTE implications for each staff group. For both Medical Technical Officers and Biomedical Scientists, there is a reduction in capacity (0.9% and 0.6% respectively), whereas for the Clinical Scientists there is an increase in capacity of 5.5%.

7. Allied Health Professionals ( AHPs)

Demand Factors

a. Pay Modernisation (Paragraph 3.7.5)

Section 10 of this Annex outlines in detail the calculation of pre and post Agenda for Change WTE implications for each staff group. The overall AHP group sees an increase in capacity of 2.4%.

Supply Factors

b. Projected skill mix changes to the AHP workforce (Figure 59)

These two scenarios for changing skill mix in the AHP workforce rely on the following data:

• Staff in Post ( WTE) as at 30 September for 1994-2004 for registered and non-registered staff. ( http://www.isdscotland.org/wf_spt Table F1)

Two options were chosen as potential skill mixes for the end of the period; 70% qualified and 30% assistants and 60% qualified and 40% assistants.

The data was used to calculate these 2 skill mix options as follows:

• The average annual change in the size of the total workforce was calculated for the period 1994-2004. This was then applied year on year beginning with 2004 to determine the size of the workforce in 2015.
• As the skill mixes at the end of the period had been determined, the change each year to achieve this was calculated. This is equal to: (proportion of the workforce that is registered in 2004 - proportion of workforce that is registered in 2015) / number of years in the period. The proportion of the workforce that is non registered was determined in the same way.
• The total calculated workforce in each year was multiplied by each of the proportions to give the number of registered and non-registered staff for each year in WTE.

8. Clinical Psychologists

a. Data Sources

The data used in the National Workforce Planning Framework 2005 is sourced from the data collection developed by NHS Education for Scotland and Information Services ( ISD Scotland). The report on the most recent collection can be found at: http://www.isdscotland.org/wf_psychology

9. Pharmacists

a. Data Sources

The descriptive data used in the National Workforce Planning Framework 2005 is sourced from the ISD workforce data.

10. Agenda for Change

a. Focus

This work focuses on the following principle changes in the terms and conditions affecting NHS staff following the introduction of Agenda for Change (AfC):

• Annual leave and public holiday entitlement
• Contracted hours
• Overtime entitlement.

b. Purpose and Outputs

Agenda for Change came into effect on 1st October 2004 with implementation beginning on 1 December 2004.

The purpose of this analysis was to look at the impact of implementing AfC without any protection. New terms and conditions were applied to each member of staff before aggregating at Scotland level for the staff groups below:

• Nursing and Midwifery
• Allied Health Professionals
• Scientific, Professional and Technical
• Works
• Administrative and Clerical (including Senior Management)
• Ambulance Services.

The following table provides the results.

Notes:
1. Chief Executives and Medical Directors are excluded as they have different agreements. Other Directors cannot be identified and thus are all included in the Senior Management category. Senior managers posts with a job weight over 720 points are entitled to the same arrangements as Chief Executives and Medical Directors. Nonetheless they have been included in this table, as they cannot be identified separately from other senior managers.
2. Other non-registered AHPs could follow the same annual leave as Helpers or same annual leave as Technical instructors etc, so included with the latest.
3. Overtime is available under the AfC for bands 1 to 7 only.

c. Data Source

Data from the Scottish Standard Payroll System ( SSPS) have been used at 30th September 2004.

d. Assumptions

1) With respect to contracted hours, after a 3-year protection period part-time staff have two options:

• Increase their hours to stay at the same proportion of hours compared to full time staff (for example: increase from 20h for 37h full time to 20.3h for 37.5h full time); or
• Remain at the same number of hours as prior to AfC.

Therefore the same contracted hours have been used in the calculation of working hours for part-time staff under the AfC.

2) The seniority (length of service with NHS) is derived from the superannuation date, and when missing, from the date of commencement (this applies to 14.8% of records).

e. Limitations

1) Senior Management

Non Medical Directors and those senior managers who are under the same agreements as Chief Executives and Medical Directors could not be separately identified and thus have not been removed from the analysis.

2) Definitions of bands for overtime

Only bands 1-7 are entitled to overtime under AfC. However, as there is no direct match of current job descriptions to the AfC bands, a simple approach was taken, whereby all staff are band 1-7 except:

• Nursing and Midwifery: consultant nurses / midwives
• Administrative & Clerical: Senior Managers and A&C grade 9+
• AHPs: consultant AHPs
• Scientific, Professional &Technical:
• MLSO 4 and Patient Focused Care grade 8
• Pharmacists grade E, F and G
• Optometrists/Clinical Scientists grade C and grade B pay spine point (psp) 17+
• Clinical Psychologists/Child Psychotherapists grade B and grade A psp 35+
• Works: Estate Officers grade 4, 5 and 6
• Ambulance: none

f. Example: Effective Date of AfC 1 October 2004

The WTE lost or gained with the implementation of AfC is calculated for each person as follows:

'Pre' calculates the capacity (hours available for work, training etc) before AfC and 'post' the capacity after the implementation of AfC at 30th September 2004:

Pre = (Contracted hours X 52 weeks) - (Contracted hours/week X annual leave & public holidays in weeks)

Post = (37.5 X 52 weeks)-(37.5 X AfC annual leave & public holidays in weeks)

Overtime is then added and the new WTE is calculated as follows:

Bands 1 to 7: (post + ot -(pre + ot)) / 37.5

Band 8 and above: (post -( pre + ot)) / 37.5.

This gives the number of WTE required to cover for the loss of hours or shows the extra WTE available to each staff group under AfC.

Additional factors taken into account in the analysis:

• The seniority in post: the calculation of post and pre WTE varies according to the number of years in post: annual leave and public holiday entitlement changes depending on whether staff have been in post for less than 5 years, between 5 and 10 years or more than 10 years.
• The grade or pay spine point of the person is combined with the seniority to determine the leave entitlement, e.g. registered nurses with 5 years of service will see their entitlement increase from 7 weeks to 7.4 weeks whereas those with more than 10 years of service will see their entitlement increase from 7 weeks to 8.2 weeks.
• Overtime is taken into account in the same way in both types of analysis.

11. Waiting Time Implications

a. Focus

This section explains how the application of waiting time guarantees is assumed to affect workforce demand.

b. Approach

In order to manage waiting times it is necessary to estimate the level of outpatient and inpatient/day case activity required to achieve the desired outcome.

In managing waiting times considerable importance is attached to clinical priority within each waiting list. It is possible to calculate the maximum stable waiting list size using software from the "Checklist Partnership." Analysis is done to establish for a given level of additions to a waiting list, the proportion needing to be seen 'urgently' within x weeks, 'soon' within y weeks or 'routinely' within the maximum waiting time. Then given the current waiting list size one can calculate the additional activity required to get down to that list size over a stated period. Additionally if a particular waiting list is growing because additions exceed the current level of activity there will be a requirement for additional activity on a recurring basis to manage that growth.

These levels of additional activity can then be used to assess the increased demand for workforce to meet the waiting times targets. At the simplest level for each NHS Board area and specialty the additional activity needed divided by current levels of activity per head give an estimate of the extra workforce needed. For example, this approach can be used to calculate the extra consultants required in each specialty.

"Activity ratios" are calculated from historical activity data divided by the whole time equivalent ( WTE) number of consultants. These can be calculated at NHS Board area or national level.

"Activity ratios" are calculated separately for inpatients/day cases (based on elective cases) and outpatients (based on first attendances). By applying activity per consultant ratios to the additional activity figures, an estimate of the extra number of consultants required to deal with this extra annual activity can be obtained.

Ratios were applied in 3 ways:

1) using specific operating division and specialty activity ratios

2) using national ratios at specialty level

3) using a combination of each of these methods.

A summary of the results for the extra number of consultants required at Scotland level by specialty is shown below. This assumes the nature of services will stand still with no change in the design of services, working patterns or productivity which of course is unlikely to be the case.

Allowance should be made for the fact that consultants generally work both on outpatients and on inpatients/day cases so it is not appropriate simply to add the results from calculations for the 2 streams. Taking this consideration into account, the stream providing the higher result for that specialty defines the 'high' scenario, while the stream providing the lower result for that specialty defines the 'low' scenario. The following outlines these results.

Non-recurring and recurring consultant demand to meet waiting times targets

A similar approach was adopted for nursing staff and the table below shows the results.

Non-recurring and recurring nursing demand to meet waiting times targets

12. Information Sources

The following table provides the data sources for each of the Figures presented in the National Workforce Planning Framework 2005 Full Report. Although the national plan looked at all Scotland, ISD data is also available by region and NHS Board and can therefore support similar analyses be undertaken at these organisational levels.

The above list is sourced via various systems including:

• ISD workforce information which is in turn sourced from the Scottish Standard Payroll System, Medman and other workforce systems ( e.g. clinical psychology)
• ISDGP practitioner data sourced via Practitioner Services Division
• Management Information and Dental Accounting System ( MIDAS) - The source of NHS General Dental Services ( GDS) data including dental workforce statistics
• NES - information to support training of doctors and information on student nurse course data
• Care Home information on nursing staff in registered homes.

In the future, information sources will include the SWISS system and its national data repository, information from NES, and Care Home data.

The SWISS Project Board consisting of key stakeholders is overseeing this significant development for workforce information. The project has been split into two parts which are progressing in parallel. More information on SWISS can be found through the following web link: http://www.show.scot.nhs.uk/swiss/board.htm.

Short Term

The first element is to create in the short term (3 years) a national workforce information database to hold information about the NHS Scotland workforce in a consistent format. This will be established in 4 phases.

• Phases 1 & 2 providing personal information was completed in August 2005
• Phase 3 to hold knowledge, skills, training and qualification information is integrated with the implementation of e KSF and will follow the timescales as agreed nationally for this.
• Phase 4 to hold organisational structure and post information will commence in September 2005.

Once established the national workforce database will be easy to update locally via the web. Access to the information held will be strictly controlled with security arrangements in place allowing local, regional and national access. Completion of these Short Term objectives does not deliver a fully functional HR system, the long term activities address this important requirement.

Long Term

The second element is to procure a functional HR system for NHS Scotland. A specification for the system is being finalised. Three different options for development are being considered:

• Option 1 - the adoption of the English/Welsh Employee Staff Record
• Option 2 - the purchase of a bespoke integrated HR/Payroll system
• Option 3 - the upgrading of the current SSPS system and purchase of a HR system which will interface with the SSPS system

This element of the project is planned over the next 3 - 5 years.

Other Important Workforce Information Developments

ISD is developing a performers data warehouse which may be designed to bring together data from MIDAS, GP performer data and other contractors such as pharmacists in community pharmacies. The development of the performers data warehouse coupled with the SWISS initiative will provide an important foundation of workforce information in NHSScotland.

13. Definitions

Agenda for Change is a major Change Programme in the NHS across 4 countries which will modernise pay structures, assist service delivery of patient care, aid recruitment and retention and allow for personal development of staff. Work of Equal Value as assessed under a customised Job Evaluation Scheme will be recognised and paid accordingly. The new pay system will apply to all directly employed NHS staff, except doctors and dentists and the most senior managers at or just below board level. ²

All medical specialties - All medical specialties includes hospital, community and public health medical specialties, but excludes dental hospital, community and public health specialties.

Associate Specialist - A medical practitioner appointed to the Associate Specialist grade will have worked a minimum of four years as registrar, staff grade, clinical medical officer or senior clinical officer. Two of those years are in the relevant specialty. In total the Associate Specialist will have 10 years of medical experience since graduating from medical school.

Average WTE -The ratio between whole time equivalent and headcount which indicates the average WTE per individual. An average WTE less than 1 suggests that there are individuals working less than full time. This measure is used when considering flexible working and part-time working patterns.

Certificate of Completion of Specialist Training ( CCST) - This award is given to medical trainees who have completed a higher specialist training. Under MMC, this will be replaced with a Certificate of Completion of Training ( CCT).

Establishment - Number of funded posts irrespective of whether the posts are filled or not. Establishment is calculated adding the number of staff in post and the number of vacancies at a point in time. It can be measured in WTE or headcount.

Full timer - A full time employee works the full weekly conditioned hours for the grade. This will be 37.5 hours per week under Agenda for Change. Under the New Consultant Contract, the 12 Programmed Activities or 48 hours is the conditioned hours for medical staff.

GMC registration number - A unique professional number allocated to each doctor (usually as a House Officer) once the doctor is professionally registered with the General Medical Council. The number comprises a string of characters that uniquely identify a member of the NHSScotland medical workforce ( GDC for dental workforce). All doctors and dentists (training or trained) will have a GMC / GDC number.

Headcount - refers to the count of individuals, allowing for some to hold more than one post in different organisations. When converting WTE to headcount using average WTE, decimals are rounded up to reflect that contribution will be delivered by one individual. For example 1.2 converted headcount would be rounded to 2 individuals. Total headcount for NHSScotland will not be equal to the sum of the headcount working in the various NHS organisations. This reflects that some individuals work in more than one organisation.

Joiners - The number of employees that join a substantive post, from another staff group, another NHS Board or who are new to NHSScotland. The measure is taken between two census points although individuals can join at any point in time within those two censuses.

Leavers - The number of employees who leave a substantive post to move to another staff group, another NHS Board or leave NHSScotland. The measure is taken between two census points although individuals can leave at any point in time within those two censuses.

National insurance number- A unique 9-character number issued by the Contributions Agency to each member of the working population in the UK. The number remains the same throughout the person's career and can be used to identify leavers and joiners (for non medical and dental staff).

Out of Hours- The out-of-hours period is 18.30-08.00 on weekdays, all weekend and bank and public holidays.

Part timer - A part time employee works less that the full weekly conditioned hours for the grade.

Rejoiners - The number of employees who worked in NHSScotland, had a minimum break of one year and then came back into NHSScotland. This analysis is done by comparing at least three census points.

SNIP - Scottish Nurse Intake Planning models demand from units and supply data collected nationally in order to inform various workforce planning initiatives such as nurse training places to achieve the desired future supply of nurses and midwives in NHSScotland.

Specialist Registrar - The Specialist Registrar is a training grade. Individuals in this grade are allocated a National Training Number for the duration of their training programme. The programme culminates in the award of a Certificate of Completion of Training or CCST; the SpR can then enter the GMC Specialist Register and apply for Consultant posts.

Stability index 1 - the percentage of staff who were in substantive posts at the 30 September that year and who were still in substantive posts in that organisation a year later.

Stability index 2 - the percentage of staff who were in substantive posts at the 30 September that year and who were still in substantive posts in that organisation two years later.

Staff Grade - The Staff Grade doctor will have at least three years full time hospital service in the SHO or a higher grade including experience in a particular specialty.

Staff group-

• Clinical Staff group: This group includes Hospital doctors and dentists, GPs, GDPs, nursing and midwifery staff, allied health professionals, ambulance staff, scientific and professional and technical staff.
• Non-clinical Staff group: This group includes staff in the Administrative & Clerical, Ancillary, Senior Management, Trades and Works groups.

Stock - the headcount of individuals in a particular year.

SWISS - Scottish Workforce Information Standard System

Temporary national insurance number - A Temporary National Insurance number will generally begin with the letters TN, followed by the employees' date of Birth and ending with the employees gender. Staff with temporary national insurance numbers are excluded from the leavers and joiners analysis.

Training Grades - As a general rule trainees are not included in any analysis done on qualified staff groups with the exception of qualified radiographers undertaking further education to become sonographers.

Turnover Rate- The number of 'leavers' during a defined period, e.g. 2003 and 2004 divided by the average number of staff in post over the period concerned. For the 2003/04 time period, the denominator is calculated as: (staff in post at 30 Sept 2003 + staff in post at 30 Sept 2004)/2.

Vacancies- Any unfilled post for which funding is agreed and a decision has been made to fill it; action to fill the post may or may not include advertising the vacancy. Vacancies can be measured in terms of WTE or headcount.

Waiting Times - Outpatient waiting time is the difference in days from the date the hospital receives the request for an appointment to the actual date of the outpatient appointment. Inpatient waiting time is the difference in days from the date the decision is made to admit a patient to the admission date. Waiting times applies to elective inpatient activity, in addition, those patients with an Availability Status Code are excluded.

For example, a patient sees the GP on the 1st October and the GP writes a referral letter to the local hospital dated the 1st October for a consultant orthopaedic appointment. The letter is received by the hospital on the 2 ^nd October and the patient is seen at the orthopaedic surgery clinic on the 1 ^st November. On the 1 ^st November, the consultant decides the patient requires an inpatient visit for a total hip replacement. The patient is ultimately admitted for the total hip replacement on the 1 ^st December and is subsequently discharged after successful completion of the operation and recovery. The waiting time for the outpatient appointment is calculated from 2 ^nd October to the 1 ^st of November. The waiting time for the inpatient stay is from 1 ^st November to the 1 ^st December and the waiting time for the full patient journey is 2 ^nd October to 1 ^st December.

This example is an over simplified illustration as many patients' journeys may include multiple outpatient appointments, diagnostic visits, and alternative treatments. New Ways of Defining and Measuring Waiting Times will be introduced from 1 ^st January 2008 which will facilitate understanding 'effective waiting time' which will reflect these additional stages in the patient journey.

WTE -Calculated as contracted hours/conditioned hours. A widely accepted method of counting staff based on contracted hours taking into account part time working. If evaluating the overall contribution of a team of individuals who have different terms and conditions, it is necessary to measure contribution in term of contracted hours. This approach was required for the Out of Hours case study given that GPs and the other staff involved (nurses, paramedics, and allied health practitioners) had different conditioned hours.

Footnotes

1 The Student Nurse Intake Planning ( SNIP) exercise is a process used to determine the number of pre-registration nursing and midwifery students that need to be trained to meet future demand.

2 http://www.show.scot.nhs.uk/sehd/paymodernisation/AfC/about.htm