The long awaited NHS Long Term Workforce Plan was published in full on Friday, 30 June 2023.
The Plan sets out the Government's strategy for ensuring that the NHS is able to meet the healthcare needs of the UK's growing and aging population, with increasingly complex healthcare needs.
The Plan heralds the start of "the biggest recruitment drive in health service history" as well as a wider programme of strategic workforce planning. There are three broad themes:
(1) growing the workforce through expanded education and training;
(2) improving retention by "embedding the right culture"; and
(3) reforming service delivery.
Education and Training
The Government's modelling shows that, without concerted and immediate action, the NHS will face a workforce gap of more than 260,000–360,000 staff by 2036/37.
The Plan sets out ambitious targets to address this shortfall, principally through the creation of an additional 60,000 training places over the next six years. This includes doubling the number of medical school and nursing places and substantially increasing training places across the medical professions.
The Government has pledged to invest more than £2.4 billion to fund this training expansion, which will be targeted in regions which currently have the greatest staff shortfalls and unmet healthcare needs.
The Plan envisages that this investment in domestic education and training will reduce reliance on international recruitment, as well as the use of agency staff (both of which appear to be particular strategic aims).
One of the most anticipated aspects of the Plan is the proposal to expand apprenticeship routes across the medical professions. The Plan highlights the contribution that apprentices can make to patient care while training, as well as evidence which shows that apprentices are more likely to be retained in the longer term in comparison with those in traditional undergraduate degrees.
The aim is that 22% of all training for all clinical staff will be provided through apprenticeships by 2032 (in comparison with just 7% today). A medical degree apprenticeship will be piloted from 2024.
The Plan commits to backing the focus on apprenticeships with a funding approach that "better supports employers with the cost of employing an apprentice" (although the Plan does not contain any details of what this means in practice).
Retention
The Plan recognises that delivering a better staff experience will improve retention rates (as well as improvements in productivity, patient outcomes and safety). According to the Plan, this will be achieved in part through delivering on the commitments in the NHS People Promise.
The Plan acknowledges the importance of an attractive and competitive reward package for NHS staff. However, the Plan appears to side step the issue of pay, simply stating that the reward package "goes beyond headline pay" before going on to highlight proposed changes to the NHS Pension Scheme which will give staff more flexibility around retirement.
Reforming service delivery
Unsurprisingly, part of the planned reform of service delivery is centred around the increased use of technology - including remote monitoring, AI and robotics – and upskilling the workforce to take advantage of those innovations.
This aspect of the Plan also covers bringing people into the NHS "more efficiently", for example, through shortened two-year courses for midwifery and paramedics. A pilot internship model for newly qualified doctors, whereby medical students will graduate six months earlier and enter a six-month internship programme is planned for 2024. There is also a proposal to work with the GMC to develop a four-year undergraduate medical degree programme in the longer term.
What this means for employers:
While the emphasis on recruitment and training was expected and will no doubt be welcome, many employers will be concerned about the lack of detail on immediate and direct interventions to support retention of existing staff, many of who continue to experience signs of exhaustion and burnout; in the wake of the COVID-19 pandemic.
In addition, retention of experienced staff, particular consultants, will be needed to fully train new trainees so they can progress into specialisms. The Plan is vague about how this will be addressed.
However, it is hoped that the acceleration of new staff into the NHS workforce will have an almost immediate impact on relieving the pressure to which existing staff are currently subject, through the sudden increase in capacity allowing for a 'spreading of the load'.
The expansion of the apprenticeship route should also have positive benefits. The use of apprenticeships has been on the rise since the introduction of the Apprenticeship Levy in 2017 and employers in many sectors are increasingly realising the wide variety of benefits they bring. In the legal sector, our own experience of apprenticeships has been very positive and we can envisage transferable benefits in the NHS, for example:
- Staff can 'earn while they learn'
- Earlier practical experience as apprentices learn 'on the job'
- Earlier access to patients supporting a reduction in waiting times and patient back logs, freeing up other clinical colleagues to deal with more complex cases, and improving the patient experience/journey.
- Apprenticeships (and the other forms of improved access to training) will benefit Equality, Diversity & Inclusion for NHS employers by improving social mobility (i.e. increased access for those who would not otherwise be able to access NHS careers so easily or at all.)
NHS Employers who are introducing apprenticeships will need to consider carefully how these are structured and documented to ensure apprentices get the right learning and support. In our experience, this often involves putting in place bespoke arrangements for managing apprentices, whose needs will be different from other staff who are in training.
