Through the development of a clear baseline the WRaPT team was able to show the variation in the staffing model across the various localities. This formed the “as-is” current picture.

The WRaPT team then worked with the clinical redesign team to develop three models for future provision – these models then combined to show a clear workforce requirement for the future – the “to-be” picture.

The models were as follows:
• Community Teams: Based on the existing teams and activity levels several areas were identified as being under provided in each area, this model quantified the staffing requirement in order to provide for the unmet need as well as ensuring that the provision is sufficient to enable reductions in Secondary Care.
• PIFU: This model examined the impact of moving patients onto patient initiated follow up’s rather than regular appointments as done currently. The cohort was identified through collaboration with the clinical lead and examination of the NICE guidance on follow up’s for each of the 4 conditions.
• “Do Nothing” Model: Throughout the design process population growth was identified as a limiting factor for any savings in Secondary Care, as such this model was produced to show the impact of taking no action to redesign Respiratory services across the three localities. This only included specialist respiratory services and therefore there would be additional costs to doing nothing which are not accounted for (such as A&E attendances).

Following this , the team were then able to set out the changes required to move the workforce from its current to future states.

The redesign of the system is considered to have exceeded its original objectives, further to this key changes and benefits to the workforce are:

• Reduction in agency usage at the acute service
• Increase in specific grades of community staff to account for model changes, activity increases (over time) and activity shifts from the acute site. The WRaPT model provides specific details of how many staff in each role and band are required (to a total of 28.57 new staff across South Cumbria)
• Increase in non-medical staffing, without an increase in medical staffing
• General increase in training and development for triage, use of tele-health and training patients in self-management

Next steps prior to implementation include a competency review and production of development plan, staff training and development and addressing the WRaPT finding of significant time spent travelling to improve the productivity of the staff.