Breaking Down The NHS Long Term Workforce Plan

The workforce plan has landed, is substantial and does contain a lot of numbers! Here is our “at a glance” summary of some of the key points so far, as well as links to analysis from various sources for further reading: 

Purpose

• To put staffing the NHS “on a sustainable footing” (Amanda Pritchard)
• The plan addresses three priorities:
  • Train: increasing education and training to record levels
  • Retain: to keep more of the staff we have in the health service
  • Reform: to improve productivity

Training

• Domestic education and training to expand by between 50% and 65% by 2031/32
• Additional funding of over £2.4 billion (12% of the current education and training budget) to be invested in education and training over the next six years
• Individual professions to have their own plans expanding entry routes and increasing provision
• Some professions (e.g. mental health nursing, learning disability nursing and podiatry) will have medium-term shortfalls with future national programmes to be developed
• Aims for medical training include:
  • Medical school places to increase from 7,500 to 10,000 by 2028, and 15,000 by 2031/32
  • GP training places to rise by 50% to around 6,000 by 2031/32
  • NHS England to pilot a degree apprenticeship programme for medical training in 2024/25, with the aim that 2,000 medical students will train via this route by 2031/32
• Aims for nurse education and training include:
  • Increase training places by 34% to 40,000 by 2028/29 and by 80% to over 53,500 by 2031/32 with training places increasing
  • Increase training places for mental health nursing by 93% to more than 11,000 places by 2031/32 (13% by 2025/6 and 38% by 2028/9)
  • Double training places for learning disability nursing over the same time period (to over 1,000 places) and health visitor training places are intended to grow by 74% to over 1,300
  • By 2031/32 have 28% of registered nurses training through degree level apprenticeships including 42% of learning disability nurses and 30% of adult nurses and mental health nurses
  • Expand training in midwifery; public health and allied professions
• In other fields, aims include:
  • To have over 1,000 training places in clinical psychology and child and adolescent psychotherapy
  • Increase training places for pharmacy services by almost 50% to around 5,000 places in 2031/32 while ensuring that all newly qualified pharmacists will be independent prescribers
  • Increase training places in dental therapy and hygiene and dentistry by 40% by 2031/32

Retention

• The Plan identifies areas for action including:
  • Embedding a “compassionate culture built on civility and respect and equal opportunity” as well as tackling wider health inequalities
  • A total reward package, going beyond headline pay, that is “attractive and competitive to respond both to changes in people’s career aspirations and the labour market”
  • Modernising the NHS Pension scheme and reforming the legacy pension scheme
  • The ability of ICSs to agree flexibility within national terms and conditions where permitted
  • Ensuring vehicles exist for staff feedback and building on Freedom to Speak Up approach
  • Addressing inequalities in learning and development
  • Increase the scope to work flexibly
• The Plan notes that single approach models for increasing retention have limited effect, but predicts the collective impact of its proposals will help reduce overall NHS staff leaver rates from 9.1% in 2022 to between 7.4% and 8.2% (retaining 55,000–128,000 FTEs)

Reform

• Recognising that simply growing the workforce will not be enough to meet the changing needs of patients, the plan:
  • Identifies that an increasing proportion of NHS staff will work in non-acute settings
  • Embraces technology, from AI in diagnostics to automation and robotics in administration
• Proposals to maximise recognition of prior learning and experiential learning, including for medical trainees
• More broadly, the plan aims to:
  • Widen participation in training
  • Diversify placements
  • Develop new approaches to medical education
• The Plan looks to increase the breadth of multi-disciplinary teams through the expansion of roles for:
  • Nursing associates
  • Advanced practitioners
  • Physician and anaesthesia associates
  • Approved clinicians (mental health)
  • Expansion of primary care roles
• Similar goals in personalised care roles identify potential expansion in:
  • Care co-ordinators
  • Social prescribing link workers
  • Health and wellbeing coaches
  • Peer support workers in mental health and autism services
• In addition, the Plan provides a focus on current and future means of “upskilling the workforce” across the NHS

Independent Sector

• Despite the increased and successful partnerships between NHS commissioners and providers during the Covid pandemic, there is little indication of how the capacity of the independent sector might be brought to bear in supporting the NHS

Integrated Care Boards and Systems

• ICSs to be important in creating five-year workforce plans, prioritise system recruitment and retention, volunteering infrastructure; to deliver against the 10 outcomes-based functions for ‘one workforce’
• The plan notes that NHS England is expanding its support offer for systems in order to ensure system-level delivery has sufficient capacity and capability

Where to look for further reading – some good sources so far:

• The Plan itself - NHS Long Term Workforce Plan (england.nhs.uk)
• NHS Confederation - NHS England » Record recruitment and reform to boost patient care under first NHS Long Term Workforce Plan
• NHS Employers - NHS Workforce Plan ‘a significant step forward for the NHS and its people' | NHS Employers
• Kings Fund - The King's Fund responds to NHS England's workforce plan | The King's Fund (kingsfund.org.uk)
• HSJ - ‘Once in a generation’ workforce plan promises 300,000 more NHS clinicians by 2036 | News | Health Service Journal (hsj.co.uk) and ICSs handed leading role in delivering long-term workforce plan | News | Health Service Journal (hsj.co.uk) (paywall)
• The Cavendish Coalition - NHS Workforce Plan ‘a significant step forward for the NHS and its people' | NHS Employers