NHS Long Term Workforce Plan launched 

The full document can be read here.

Londonwide LMCs’ line on the NHS Workforce Plan

Dr Michelle Drage’s comment on the Workforce Plan is below. It was quoted in this Pulse piece on the general reaction from the profession, this one specifically on the projected GP workforce shortfall and this GPOnline piece focussing on the increased workload for GP trainers.

“A considered, consulted, costed, plan to tackle the escalating NHS workforce crisis would be welcomed by London’s hard-pressed general practice teams and their patients. Sadly, today’s politically motivated, unilaterally developed, largely unfunded announcement will do little to relieve the pressure on GPs or the frustration of patients.

“How it looks to GPs in London is neither the plan, nor the policymakers, understand the role that GPs play at their core in terms of continuity and management of multiple conditions and complexity. Because they do not see the value of this to the NHS and patients they continue to configure the service as if it’s a roll-on roll-off conveyor belt of single, unconnected conditions to batch and dispatch as cheaply as possible. This fundamental misunderstanding worsens all the current problems relating to access and attrition, with the Workforce Plan’s lack of funding for core general practice doing nothing to reverse the decline.

“Demand for GP appointments is rising month-on-month and despite greater appointment numbers than ever before, without new funding practices cannot recruit the workforce to meet the rising patient need. But we cannot just recruit our way out of the current workforce crisis, we have to also focus on retention. Our most experienced staff are our most valuable staff and they are struggling to maintain safe care against a headwind of increased patient need and long-standing underfunding, 12-plus hour working days, increasing supervisory demands and scape-goating from the Government for waiting lists elsewhere in the system.

“Training more GPs and other supporting roles does not recognise that retention is the biggest issued right now. Reducing GP training time is a false economy, as newly qualified GPs will need more support from experience colleagues, drawing them away from patient care. And the expectation that GPs have the time to supervise growing numbers of pharmacists, physiotherapists and other roles which have been worked into the general practice team over recent years is unrealistic.”

Workforce Plan key points

The plan is designed to be delivered over 15 years with an additional £2.4bn of funding attached to the Plan to be made available by 2028/29, without specifics on how much will be added in each year between now and then. Most of the deliverables set to fall within the parliament are reiterations of existing health policy, with the new targets set almost entirely to fall after latest possible deadline for the next general election.

In this summary anything in quote marks is a direct quote from the document, anything without is summarised.

More non-GP qualified doctors will be working in general practice:

• “Support experienced doctors to work in general practice under the supervision of a fully qualified GP. We will also ensure that all foundation doctors can have at least one four-month placement in general practice, with full coverage by 2030/31.”
• “This is reflective of a growing progressive professional consensus over the past decade that training should change, supporting a better balance of generalist and specialist skills so that doctors are equipped to provide the joined-up care required for people with multiple morbidities. “
• All foundation doctors will have at least one four month rotation in general practice by 2030/31.
• ARRS roles to hit 15,000 within in general practice by 2036/37 and nurses 5,000 by the same year.
• Medical students to have the option of working on wards after four years, de facto taking a year off training.

Automation is expected to release a lot of workforce capacity:

• “Administrative automation: significant workforce benefit can be gained from the automation of administrative processes, including through AI applications such as speech recognition. Some studies have shown that over 70% of a clinician’s working time is spent on administrative tasks181 and 44% of all administrative work in general practice can be mostly or fully automated.”
• The aims around retention include big figures on how many people will be deterred from leaving, but has few specifics on how:
• “By improving culture, leadership and wellbeing, we will ensure up to 130,000 fewer staff leave the NHS over the next 15 years.”
• The retention section is heavily focused on encouraging cultural change plans and organisations to be more supportive of the diversity of their workforce. The struggles created by high workload or lack of resources receive little attention.

The document mostly focusses on training, with commitments to:

• “Double the number of medical school places, taking the total number of places to 15,000 by 2031/32. We will work towards this expansion by increasing medical school places by a third, to 10,000 by 2028/29. We will also ensure there is adequate growth in foundation placement capacity, as those taking up these new places begin to graduate, and a commensurate increase in specialty training places that meets the demands of the NHS in the future. We will work with stakeholders to ensure this growth is sustainable and focused in the service areas where need is greatest.
• Increase the number of GP specialty training places by 50% to 6,000 by 2031/32. To support this ambition, GP specialty training places will initially grow by 500 places by 2025/26, increasing to 1,000 additional places (5,000 overall) by 2027/28.
• Increase adult nursing training places by 92%, taking the total number of places to nearly 38,000 by 2031/32. We will work towards this ambition by increasing adult nursing training places over the next six years so that, in 2028/29, at least 8,000more adult nurses will start training compared to current levels. Over this same time period, to 2028/29, training places will increase by 38% for mental health nursing and 46% for learning disability nursing. By 2028/29, there will be a total of 40,000 nursing places funded. This will put us on the path to increase nursing training places by 80%to over 53,500 by 2031/32.
• Increase training places for nursing associates (NAs) to 10,500 by 2031/32. In support of this, over the coming six years, we will increase training places by 40% to 7,000 by 2028/29.
• Increase AHP training places to 17,000 by 2028/29, putting us on the path to increasing places overall by a quarter to more than 18,800 by 2031/32.
• Increase training places by 26% for both clinical psychology and psychotherapy by 2031, taking the combined number of training places to over 1,300. Training places will be more than 1,000 each year up to 2028.
• Expand training places for pharmacists by 29% to around 4,300 by 2028/29. This will put us on the path to increasing training places by around half overall to almost 5,000 by 2031/32. The number of pharmacy technicians will also grow in future years.
• Increase training places for dental therapists and hygiene professionals to more than500 by 2031/32, and increase training places for dentists by 40% to more than 1,100 by this same year. In support of this, we will increase training places for dental therapy and hygiene professionals by 28% by 2028/29 with an increase of 24% for dentists to 1,000 places over the same period.
• Increase training places for healthcare scientists by 13% to more than 850 places by 2028/29, putting us on the path to increase training places by more than 30% to over 1,000 places by 2031/32.
• Expand advanced practice training by 46%, so that 5,000 clinicians are starting advanced practice pathways each year. This puts us on the path to increasing training places so that more than 6,300 clinicians start advanced practice pathways each year by 2031/32.
• Provide 16% of clinical training places as apprenticeships by 2028/29 compared to 7% now. This will offer greater access to training opportunities for local communities and put us on the path to offering 22% of clinical training places through apprenticeship routes by 2031/32.”