The government-commissioned plan sets out how the NHS in England will address existing vacancies, which currently stand at 112,000, and meet the challenges of a growing and ageing population by recruiting and retaining hundreds of thousands more staff over 15 years and working in new ways, including the harnessing of digital technology. It’s been predicted that with a growing and ageing population, coupled with new treatments and therapies, a failure to act now could see the shortfall in staff grow up to 360,000 by 2037.

Among its key targets, the strategy pledges to double medical school training places to 15,000 by 2031; increase the number of GP training places by 50 per cent to 6000 by 2031; and almost double the number of adult nurse training places by 2031, with 24,000 more nurse and midwife training places a year. The plan also aims to reduce reliance on expensive agency spend, which could cut taxpayers’ bills by around £10 billion between 2030–31 and 2036–37. More than £2.4 billion has been earmarked to help fund additional education and training places over five years, on top of existing funding commitments.

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.

Advances in technology and treatments will result in staff numbers and roles changing over time, so the NHS will refresh the Long Term Workforce Plan at least every two years to help meet future requirements. Over the next five years alone, medical places will rise by almost a third, nursing degrees will increase by more than a third, and GP training places will jump by a quarter. More training places will also be offered through degree apprenticeships so staff can “earn while they learn” – with 16 per cent of all training for clinical staff offered through apprenticeships by 2028.

The growing number of nursing degrees will be accompanied by a 40-per-cent rise in nursing associate training places over five years, with increases, too, in other associate roles to help support and free up other clinical colleagues.

Retention, efficiency and sickness

Retention of staff is another key element of the plan, with better opportunities for career development and improved flexible working options included, while the Government claims that pension reforms will see up to 130,000 staff stay working in NHS settings for longer. Investment in new technology will be vital in freeing up staff so they can dedicate more time to helping patients. Harnessing advances in AI will be an important part of the mix, with an expert group being set up to identify advanced technology that can be best used across the country.

Reducing the burden and workload on an exhausted workforce will also be crucial, as the service still grapples with the aftershock of the pandemic. Published yesterday (29 June), an analysis by the Nuffield Trust shows that staff sickness in the NHS in England has reached record levels. Sickness absence impacts costs and causes disruption to patient care, and it’s also associated with a higher likelihood of staff leaving the NHS.

Figures reveal that monthly sickness absence rates over the last calendar year never once fell below even the peak in the pre-pandemic year and, on average, the reported rate for NHS staff across 2022 was 29 per cent higher than in 2019 (5.6 per cent v 4.3 per cent).

The reported level of sickness absence – some 27 million days across 2022 – equates, on average, to around 74,500 full-time equivalent staff, including 20,400 nurses and 2900 doctors. This, say authors of the analysis Billy Palmer and Lucina Rolewicz, is likely to be a significant underestimate owing to various causes of under-recording of the sickness absence rate. Over the course of 2022, some 6 million days were recorded for staff being sick on account of mental health and wellbeing related reasons. And the number of reported days of absences related to anxiety, stress, depression, and other psychiatric illnesses increased by 26 per cent between 2019 and 2022.

“Sustainable footing”

NHS chief executive Amanda Pritchard described the launch of the plan as “a truly historic day for the NHS in England” – with its publication giving the health service “a once-in-a-generation opportunity to put staffing on a sustainable footing for the years to come”.

Prime Minister Rishi Sunak said: “In the coming years, we will train twice the number of doctors and an extra 24,000 more nurses a year, helping to cut waiting lists and improve patient care. And we will do more to retain our brilliant NHS staff and reform the way the health system works to ensure it is fit for the future.

“This is something no other government has done and will be one of the most significant commitments I will make as prime minister – acting as the cornerstone for our vision for a better, more modern healthcare system, and putting the NHS on a sure footing for the long term.”

Health and Social Care Secretary Steve Barclay added: “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.”

Among several other measures to boost the NHS workforce, the plan sets out ambitions to work with the General Medical Council (GMC) and medical schools to consult on the introduction of four-year medical degrees and medical internships, allowing students to start work and get onto wards six months earlier than is currently the case.

More student nurses will be able to take up jobs as soon as they graduate in May, rather than waiting until September, while it’s hoped that new medical schools could open in areas of the country where there is the greatest staffing shortfall. A further ambition is to train around 150 additional advanced paramedics annually, including to support the delivery of same-day emergency care. And there are plans to expand training places for clinical psychology and child and adolescent psychotherapy, with numbers anticipated to increase by more than a quarter to over 1300 by 2031.

Commenting on the plan, England’s chief medical officer, Professor Sir Chris Whitty, said ensuring the future NHS workforce and public health system can respond to the future shape of health needs is essential. He explained: “The proposed reform of NHS training and staff retention will help train and retain NHS staff, assist clinicians to retain their generalist skills, and create opportunities for more people to study and train in parts of the country that have historically struggled to recruit.”

“Devil in the detail and delivery”

Professor Dame Helen Stokes-Lampard, chair of the Academy of Medical Royal Colleges, expressed relief that the long-awaited plan had finally been published. She warned that the strategy must be the first of many and evolve over time, “so, where people feel it is not providing the detail or nuance they were seeking now, they have the assurance of influencing future versions”.

Professor Kamila Hawthorne, chair of the Royal College of GPs, agreed that on recruiting and retaining GPs and teams in primary care, “the devil will be in the detail, and also the delivery”.

Representing the view of patients, Rachel Power, chief executive of the Patients Association, said: “We will assess the workforce strategy on two points: will it result in the expansion of safe, effective and compassionate care, and will it allow more patients to become partners in their own care and in the design and delivery of the services they use. Patient involvement in how the workforce strategy is implemented will be key to making it a success.”

Sir Julian Hartley, chief executive of NHS Providers, said the plan has the potential to be “a real step-change moment”, but he cautioned that to ensure its success, it would be vital to see “an emphasis on positive cultures and quality improvement in NHS trusts alongside a laser-like focus on implementation and funding”.

Matthew Taylor, chief executive of the NHS Confederation, noted: “We see this plan as the crucial first leg in a three-legged stool that the NHS needs to revive and thrive – the other two being an equivalent plan for the social care workforce, alongside 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.”

Professor Neil Mortensen, president of the Royal College of Surgeons of England, singled out the proposals to expand medical school and training places across all areas as an especially welcome measure. “It signals a renewed commitment from the Government to investing in healthcare professionals,” he said. “Embedding a culture that truly values staff and their wellbeing, making them want to stay working in the NHS, will also be vital. If we can get this right, I’m in no doubt the plan will pave the way for a brighter and more resilient health service.”

And NHS Employers’ chief executive, Danny Mortimer, gave a ringing endorsement. “A long-term assessment of what we need and how we get there in terms of staffing has long been needed,” he said, “and to see this finally delivered, along with crucial government investment, is a significant step forward for the NHS and its people.

“It reinforces the plans for the longer-term development of services in our communities and responds to the opportunities of new technologies and ways of working. When implemented, it will boost domestic recruitment and supply, and reduce use of expensive agency staff. It will also provide clearer and better career pathways for our existing people, as well as future generations of health workers.”