The first ever NHS Long Term Workforce Plan was commissioned by the government to set out a series of interventions train, retain and reform the workforce, and put the NHS on a sustainable footing into the future.
Backed by more than £2.4 billion in government investment ahead of the health service’s 75th anniversary, it sets out how the NHS will address existing vacancies and meet the challenges of a growing and aging population by recruiting and retaining hundreds of thousands more staff over the next 15 years and reforming the way we work.
NHS England's press release can be found here and this fact sheet sets out more detail on the measures contained in the plan.
Health and Social Care Secretary Steve Barclay said:
“The NHS is the biggest employer in the country and holds the affection of the British people because of the staff who work around the clock to care for us. The NHS Long Term Workforce Plan, backed by significant government investment, shows our determination to support and grow the workforce.
“It sets out how we will deliver the biggest expansion of staff training in NHS history, retain more talented people and harness cutting-edge technology.
“As we celebrate the NHS’s 75th birthday, we are marking the occasion with an unprecedented plan that will further boost our drive to cut waiting lists and ensure the service can continue caring for us for generations to come.”
What are the aims of the plan?
The NHS will:
- Train significantly more staff so we have the right number of doctors, nurses and midwives, GPs, dentists, allied health professionals - such as physiotherapists, pharmacy staff and other staff.
- Retain our dedicated NHS workforce by allowing greater flexibility and career progression and improving culture, leadership and wellbeing, while continuing to focus on equality and inclusion.
- Reform the way we work so healthcare staff have the right multidisciplinary skills and can harness new digital and technological innovations, allowing them to focus on patient care.
Is the government funding the plan?
- The government is backing the plan with over £2.4 billion over the next five years to fund additional education and training places. This is on top of existing increases to education and training investment, reaching a record £6.1 billion over the next two years.
- This represents a significant, long-term investment from the government to transform the future of the NHS.
- Decisions about spending review periods beyond this will need to be taken closer to the time, but this announcement demonstrates our commitment to delivering the whole plan.
How will you improve the way you train the workforce?
- By significantly expanding domestic education, training and recruitment, we will have more doctors, nurses and healthcare professionals working in the NHS. The NHS and government will:
- Double the number of medical school places by 2031 from 7,500 today to 15,000, with more medical school places in areas with the greatest shortages to level up training and help address geographic inequity. A higher proportion of the new medical students will carry out their postgraduate training in services such as primary care, mental health and cancer. The first new medical school places will be available from September 2025.
- Increase the number of GP training places by 50% (2,000 more) to 6,000 by 2031, to ensure more newly trained doctors enter primary care. The first 500 new places will be available from September 2025.
- Almost double the number of adult nurse training places by 2031, with around 24,000 more nurse and midwife training places a year by 2031. Within this we will train over 5,000 more mental and learning disability nurses a year.
- Expand dentistry places by 40%, reaching 300 more training places for dentists and dental care practitioners by 2031.
- As a result of these domestic training expansions, this will reduce reliance on agency staff and international recruitment. In 15 years’ time, we expect around 10% of our workforce to be recruited internationally, compared to nearly a quarter today.
How will you improve the retention of the workforce?
- By improving culture, leadership, and wellbeing, we will aim to ensure up to 130,000 fewer staff leave the NHS over the next 15 years. The NHS and government will:
- Improve flexible opportunities for prospective retirees to keep them in the NHS workforce for longer; and make it easier for those who have already left to come back in flexible, contracted roles or as a temp.
- Reform the pension scheme so staff can partially retire or return to work seamlessly and continue building their pension after retirement. This is in addition to the substantial pension tax reforms in the Spring Budget which mean doctors are not disincentivised from continuing their NHS work or taking on extra hours or responsibilities.
- Commit to ongoing national funding for continuing professional development for nurses, midwives and allied health professionals, so NHS staff are supported to meet their full potential.
- Improve childcare support to help enable NHS staff to stay in work, through changes made in the Spring Budget for working parents over the next three years.
How will you reform the way staff work and are trained to improve efficiency?
- Working differently means staff can spend more time with patients. We can harness digital and technological innovations to enable new and innovative ways of working, alongside reforming training to expand the number of staff. We will:
- Take advantage of digital and technological innovations, such as AI, speech recognition, robotic process automation and remote monitoring to support the NHS workforce, with estimates suggesting 44% of all admin work in general practice can be mostly or fully automated.
- Focus on expanding enhanced, advanced and associate positions, such as nursing associates, physician associates, anaesthesia associates and advanced clinical practitioners.
- Explore measures such as tie-ins to encourage dentists to spend a greater proportion of their time delivering NHS care.
- Take advantage of EU Exit freedoms to explore reducing nurse clinical placement hours and support education institutions to allow trainees to join the nursing register up to four months earlier.
- Support medical schools to move from five- to four-year degree programmes and pilot a medical internship programme which will shorten undergraduate training time, following approval by the regulator the General Medical Council
How many more doctors and nurses will there be?
- Taken with retention measures, the NHS Plan could mean the health service has at least an extra 60,000 doctors, 170,000 more nurses and 71,000 more allied health professionals in place by 2036/37.
How many more enhanced, advanced and associate roles will there be?
- We will train more nursing associates (NAs) so there will be 64,000 NAs working in the NHS by 2036/37, compared to about 4,600 now.
- Increasing the number of physician associates (PAs) will establish a workforce of 10,000 PAs by 2036/37.
- We will increase the number of anaesthesia associates (AAs) to 2,000 by 2036/37.
- Increasing the number of advanced practitioners will mean we have 39,000 by 2036/27.
What is the difference between these roles and nurses and doctors?
- These professions support clinicians in providing medical care and anaesthetic services to patients and can help reduce pressure on doctors and nurses, freeing up their time to focus on tasks only they are qualified to do.
How often will the plan be reviewed?
- The NHS will refresh the Long Term Workforce Plan at least every two years to ensure it is keeping pace with the requirements of NHS staff and patients.
Why does the plan include ranges for numbers of staff that will be delivered?
- Different assumptions have been used in the modelling to reflect uncertainty in key factors.
- These factors include productivity (which impacts demand), retention, training and the estimated levels of education and international recruitment required to reduce staff shortfalls, and the broader recruitment required to meet demand.
How will AI help improve the efficiency of the NHS?
- AI has the potential to free up clinical time and improve accuracy and efficiency of diagnostics in services such as ophthalmology, imaging, pathology and dermatology through interpreting images and automating some clinical decisions, where it is safe to do so. One example is AI can help the delivery of radiotherapy in cancer by reducing the time radiotherapy teams spend isolating tumours for treatment.
- To ensure we take advantage of the opportunities that AI can offer, the government and NHS England will convene an expert group. This group will build on the previous work of Health Education England to work through what skills and training NHS staff may need to make best use of AI, as well as what the anticipated impact of AI may be on NHS staff groups.
How are we guaranteeing patient safety when training students and apprentices?
- As part of the plan, we will work closely with medical schools and the GMC to move from five- to four- year undergraduate degree programmes and will pilot a medical internship programme for newly qualified doctors. This will shorten undergraduate training time and bring newly qualified doctors into the NHS workforce better prepared to deliver patient care.
- We will work with the professions and regulators to reform training, so students have a better experience of learning that prepares them for work in a modern NHS.
- All undergraduate degrees must prepare doctors or nurses to meet the outcomes for graduates set by the relevant professional regulator.
- The introduction of the Medical Licensing Assessment will ensure medical students meet a common threshold for safe medical practice in the UK, providing assurance to patients and the public.
- We will also work with the Nursing and Midwifery Council (NMC) to consider how nurses could join its register with reduced practice hours. The NMC will ensure that current standards are maintained.
What are you doing to grow the workforce in the shorter term?
- We know that if we are to build a stronger, healthier NHS for the long-term with patients at its centre, it is vital to have the workforce to support it. That’s exactly why we’re publishing this plan today.
- We are already growing the workforce and there are almost 59,000 more staff compared to a year ago, including over 5,800 more doctors and almost 14,900 more nurses.
- We’re on track to deliver 50,000 more nurses by next year, with over 44,000 more nurses in April 2023 compared with September 2019, and we have recently expanded the number of medical school places by 25%.
- We are also hiring 29,000 additional primary care staff to boost appointments in general practice – meeting our manifesto commitment a year early.
- In addition, we are training 5,000 nurse associates and 1,250 physician associates this year, training 3,000 more advanced practitioners in 2023-24 and training 3,000 pharmacists to be able to prescribe, easing pressure on clinical staff and freeing up their time.
- We want to build on this progress and that’s why this workforce is focused on recruiting and retaining more staff so we can make the NHS the best place to work.
What are you doing to boost the social care workforce?
- We know social care has pressing workforce needs too, and that’s why at the Autumn Statement we made available up to £7.5 billion this year and next to boost capacity in social care.
- Social care is different to the NHS - it is comprised of many independent businesses and it is right the government doesn’t do workforce planning for them.
- We expect increasing the training of nurses, AHPs and nursing associates will go some way to alleviate the pressures in the adult social care sector as some of the people who train in these professions will choose to work in social care when they are qualified.