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The NHS Workforce plan

NHS England has published the long-awaited Workforce plan which recognises the challenges the NHS faces and outlines what they are proposing to do.

William Greenwood
William Greenwood

In three words it focuses on:

  • Train
  • Retain
  • Reform

What does it say?

Train

NHS England want to double the medical places and nursing training places. They propose the introduction of medical apprenticeships. There is also an expressed desire to be less reliant on overseas staff. There appears to be a desire for more GPs (and consultants) to work in parts of the country with the most healthcare need. It does not detail how this might be achieved.

Retain

There is a very brief mention of the changing NHS culture and mention of incentives for those who are approaching retirement. There is no mention of how this will be paid for.

Reform (and recruit)
A multitude of proposals are crammed into this section including:

  • Expanding nurse, physician, and anaesthesia associates
  • Shortening medical school training to four years.
  • Bring physician associates and others under the regulation of the General Medical Council.

Artificial intelligence (AI) receives mention in this section.

Will it work?
That answer is yes for recruitment, though with a caveat. The plan is funded for the first five years but for ten years after that there is an assumption that future governments will find the money to keep up with the required growth in training places. This is not guaranteed and may limit the implementation of the plan.

Expanding the number of clinical staff to the extent which is envisaged in the plan will eventually have a positive impact, but retention will be a bigger ask. The plan’s policies to improve morale and hang on to staff look very vague. Recruitment will not achieve much if there is the current exodus at the same rate as now. This is a very weak point in the plan.

Is it the right approach?
Recruit and retention have long been held up as the required twin-track approach for the NHS. Health think tanks were queueing up to welcome the plan as it adopted the policies called for by many experts.

Some of the royal colleges have noted the plan is ambitious and they want to see more detail. The idea of medical apprenticeships is radical, but the precise workings of this scheme have no detail. There are productivity assumptions included in the plan.

Why is pay not part of the plan?
The plan says, “Everyone in the NHS should be recognised and rewarded fairly to help ensure we attract and retain the staff we need to provide the best possible care.”

But the elephant in the room is the lack of any reference to pay. In my view the plan does not have the right steps in place to make the vision happen. What is more, the much-trumpeted £2.4 billion funding is aimed at new training but does not cover increased salaries, on-costs of employment, or additional needs. Where will the money for this come from?

Most big organisations drawing up a workforce plan would have a section on appropriate remuneration to attract the best staff. That is a significant (and deliberate) omission in the NHS England strategy. NHS pay is in the gift of the politicians who decide. Health unions have long argued that the best way to hold on to staff is to increase wages in line with the cost of living.

Is it going to be any use?
In the short-term probably not.

It takes several years to train clinical professionals and the expansion of new places at medical schools and universities will not begin until the end of 2024. Implementation may be slower if there are not enough experienced doctors and nurses to set aside time to run the training. Retention initiatives aimed at reducing the number of NHS staff leaving might make a small difference, but patients currently finding it difficult to get a GP appointment or who are on a waiting list for an operation will not notice.

Is now not the time for a broader strategy?
Training thousands of health staff right through till beyond 2030 is welcomed. There has been nothing comparable in recent years with only occasional short-lived initiatives, but what will the rest of the NHS look like by then? Will the service have kept up with the increasing levels of sickness of an ageing population? Integrated care teams are the new buzz words. It is essential therefore that workforce planning also ensures a sustainable social care workforce to deliver integrated care.

A second elephant in the room is that there is no long-term plan for investment in buildings or IT to house or facilitate the working of these extra staff. Is the public willing to keep funding the NHS through taxation? Might new payments for some services be introduced during the life of this plan? How much difference will AI, or new treatment technologies make? Will there be new providers entering the system?

William Greenwood, governing body member of PCC and Chief Executive Officer for Cheshire Local Medical Committee.

Last Updated on 4 October 2023