Health leaders welcome NHS workforce plan but say details need clarification

The government will double medical school training places and increase the number of GP training places by 50%, according to figures published in the long-awaited NHS workforce plan.

Under the plans, the number of adult nurse training places will also be doubled by 2031. This means over the next five years alone, medical places will increase by almost a third, nursing degrees will increase by more than a third and GP training places will jump by a quarter.

To incentivise hopeful medical professionals, the government is offering one in six clinical staff the chance to ‘earn while they learn’ and take on medical apprenticeships.

There is also a renewed focus on retention, with better opportunities for career development, improved flexible working options, and government reforms to the pension scheme.

These plans are back by more than £2.4 billion worth of funding, most of which will go towards increasing the number educational and training places.

Greater focus needed on improving working conditions for staff

The plan, which was commissioned and approved by the government, comes following huge pressure from health leaders to address the NHS staffing crisis.

Currently there are roughly 112,000 vacancies across the NHS, but experts fear this number could rise to 360,000 by 2037 unless drastic action is taken.

While the plan has been generally well received, Dr Latifa Patel, BMA representative body chair and workforce lead, says it is “long, long overdue.”

“Finally, we have recognition not just of the vast workforce shortages we have now – but what happens if nothing changes: 360,000 vacancies – the population of a small city missing from the NHS workforce by 2037.

“As ever, the devil will be in the detail – especially when it comes to funding – and we await the full publication to make a proper assessment. The BMA has been campaigning for a national workforce strategy based on credible modelling for years,” she said.

Dr Patel warns that the government will also need to build to infrastructure to support this new swathe of doctors and other healthcare professionals. She also warns that retaining these new doctors may be difficult unless the government pays them fairly.

“Investing in medical school places while refusing to reverse years of pay erosion for doctors and fixing the broken pay review system, is completely illogical and uneconomical. Doctors will leave for better paid jobs abroad and we won’t see the benefits of increased recruitment,” she said.

For this reason, Dr Patel says while the plan has “laudable aims”, details on how the government plans to improve care for patients and working conditions for staff are lacking. Without these details, Patel says the plan is “merely a wish list”.

No plans to increase the social care workforce

Another rather significant omission to the NHS workforce plan is a plan to recruit and retain social care staff.

Health and social care an inextricably linked, and one system cannot succeed without the other. As we have seen all too recently, if there aren’t enough social care places available (due to staff shortages), patients become stuck in hospital and are unable to be discharged into the community.

In 2021-22, adult social care saw its worst ever year for recruitment, with 165,000 vacancies. Recruiting and retaining social care staff is therefore just an important to fixing the NHS staffing crisis.

Matthew Taylor, chief executive of the NHS Confederation, says this workforce plan is therefore just one leg in a “three-legged stool that the NHS needs to revive and thrive.”

The other two legs being “an equivalent plan for the social care workforce” and “extra investment in capital and technology”.

“Both will be required to achieve the plan’s laudable ambitions, particularly when it comes to the level of productivity increases that are envisaged. We now look forward to seeing the full details to understand the full implications,” he said.

However, despite the lack of focus on social care, Mr Taylor says there is “much to welcome in the plan”, including the focus on expanding training places, community care and retaining staff.

Mr Taylor says the government should now ensure the plan is reviewed every two to three years to ensure that the plan stays on track.

“Based on everything we have seen and heard about the plan so far we think it will go a long way to addressing the workforce challenges we are facing. But we look forward to seeing the more detailed modelling, planning assumptions and productivity increases envisaged in it to understand the full implications,” he said.

Boosting training places “carries risks”

Some health leaders have been more critical of the plan, and Nuffield Trust Senior Fellow Dr Billy Palmer says a focus on increasing training places will not solve the underling issues facing the NHS.

“Given the dismal reality of what many staff are experiencing working in the NHS, there is a risk that we will feed more and more people into training only to burn them out ever faster.

“Dropping out from training has been such a big problem that large increases in the number of GP trainees since 2014 had barely any effect on the number ultimately coming through. Betting the farm on just training more could be a costly gamble,” he said.

He also warns that bosting training places “carries some risks”, and could cause a drop in the standard of care provided by nurses and doctors.

For this reason, Dr Palmer says the plan “will fail” unless it is followed up by “efficient, effective ways we can fix the holes in the workforce by making the NHS a place where people really want to work.”

“This is poorly understood and needs more research: put simply, there isn’t a credible solution on the table yet. This must include taking a look at our broken pay review system, which has aggravated dissatisfaction.”

He added that government’s decision to exclude social care from the workforce plan is “missed opportunity”.

“In future, we should align the two to make sure services which keep people well and help them return from hospital have committed, available staff as well,” he said.