Insights Long read

NHS Long Term Workforce Plan: what you need to know

30 June 2023

NHS Confederation analysis of the plan.

Workforce

Key points

Our members – leaders from across the health and care system – tell us that staffing pressures are their biggest concern in terms of giving patients the best possible care. Staffing shortfalls have been a long-standing issue and NHS vacancies now stand at 112,000. We therefore welcome the government’s publication of the first ever long-term workforce plan, which is something we and our members have been calling for years now.
We have welcomed the thoughtful engagement led by Navina Evans, Amanda Pritchard and their teams and the support offered by the Secretary of State and his officials.
Recruitment and retention remain significant barriers to service recovery and improvement. The plan’s modelling estimates that vacancies would rise to 360,000 by 2037 if no action is taken. Over the years we have seen a lack of investment in NHS staffing roles outside of hospitals. We welcome this plan’s ambition to correct this with ambitious growth targets for recruiting more staff into mental health, community care and primary care roles. This reflects the need to catch up from what has been a historically low starting point in these areas, especially in mental health and learning disability nursing.
There will be a renewed focus on retention as this is, if anything, more important than attracting new staff into the NHS. Leaders will hope that the plan provides reassurance to staff that help is on the way to spread the workload, improve working conditions for them and improve care for patients. The mix of measures the plan proposes around flexible working, culture and training time will also support this.
Parity of esteem between mental and physical health is reflected in the workforce plan, as well as the need to deliver more preventative and early intervention services.
Key elements of the plan include:
- Doubling medical and adult nurse training places and increasing GP training places by 50 per cent.
- Increasing apprenticeships, especially in areas where it is harder to recruit. One in 6 of all training for clinical staff will be offered through apprenticeships by 2028 – vital to attracting more staff, including those from diverse backgrounds.
- Targets for more staff in mental health, community and primary care roles.
- Investment in technology.
- Expansion of training places for clinical psychologists and child and adolescent psychotherapy by a quarter.
- Expansion of personalised care roles such as social prescribers and peer support workers.
- Train more NHS staff domestically. In 15 years, expect around 9-10.5 per cent of workforce to be recruited from overseas compared to nearly a quarter now.
We are encouraged by NHS England’s promise to review the plan “at least every two years”. This will be essential to reassess assumptions and take stock of where efforts and resources may need to be refocused. We will work closely with NHS England to support this regular evaluation; the NHS should not have to wait another 20 years for this moment.
However, it is disappointing that the government has not committed to developing a comparative plan for the social care workforce.
The plan is predicated on achieving ambitious productivity increases. NHS leaders share these ambitions, but at 1.5-2 per cent these are very stretching targets and well above the long-term average that has been delivered. ONS data shows that UK healthcare productivity grew by 0.9 per cent on average between 1997-2019. Even to achieve the lower end of the range will require major extra investment in technology, innovation and capital. It is welcome that this is acknowledged in the workforce plan.
In terms of immediate next steps, the government should seek to reach an agreement with medical trade unions over pay as soon as possible to prevent the detrimental impact of ongoing industrial action on productivity and patient care. We also recommend attention turn to developing a comparative plan for the social care workforce, which plays an essential role in people’s care.
We await further detail of the modelling that underpins this plan to be published and clarity around the future funding profile.

Overview

The NHS Long Term Workforce Plan 2023 covers a 15-year assessment of the workforce that will be needed for the future and provides a costed plan of how we develop the current NHS workforce to meet the future challenges.

Commissioned and accepted by the government, it provides a costed plan for how the NHS will develop to meet existing and future demand and challenges and support the health and wellbeing of the population. Over £2.4 billion has been committed to fund additional education and training places over the next five years, on top of existing funding commitments.

The plan sets out the strategic direction for the long term as well as short- to medium-term actions to be undertaken locally, regionally and nationally. Those actions fall into three priority areas:

Train: Substantially growing the number of doctors, nurses, allied health professionals and support staff, which is underpinned by the £2.4 billion funding commitment.
Retain: Renewing the focus and ushering in a major drive on retention, with better opportunities for career development and improved flexible working options. This comes alongside reforms to the pension scheme, with an aim to have 130,000 staff stay working in the NHS for longer.
Reform: Working differently, and delivery training in new ways. Advances in technology and treatments will be explored and implemented to help the NHS modernize and meet future requirements.

The plan also sets out next steps, which set out principles around reviewing the plan and engaging stakeholders over the coming period. While this is a national plan, it allows for priority decisions to be taken at system and local level. There is also a commitment to the plan not being a one off but iterative, with further versions being developed and published on a more regular basis.

1. Train: growing the workforce

The plan sets out a 27 per cent expansion in training places by 2028/29 to prevent a workforce shortfall and reliance on international recruitment. To support this, additional funding of more than £2.4 billion cumulatively will be invested in education and training over the next six years, on top of current education and training budgets.
For each profession, the plan sets out a bespoke approach to optimise domestic supply by detailing expansions to entry routes and increasing training and education to meet demand, with a focus on professions with a heavier reliance on international recruitment.
Some professions, such as paramedics have received recent investment to increase education and training so will need less drastic expansion to reach the projected increase in training places needed (5-18 per cent a year over 15 years).
Full expansion cannot happen immediately, but rather by incremental but significant increase in education and training capacity.
Successful expansion will be contingent on there being an expanded and fully trained supervisory workforce to support evolving learner and workforce need.
The plan assumes that the whole health education pipeline will need to grow at least in line with the demand required to deliver NHS services.

Medical training

Proposed measures would see medical places increase by almost a third, to 10,000, by 2028/29, doubled to 15,000 by 2031, with more places in areas with the greatest shortages.
The scale of expansion set out would require close working with medical schools, higher education institutes and the further education sector, the regulator and other stakeholders.
NHS England is piloting a medical degree apprenticeship from 2024, with the ambition of having 2,000 medical students training via this route by 2031/32. To support this, 200 apprenticeship places are currently funded for pilots running in 2024/25, with an ambition for up to 400 places by 2026/27 and more than 850 places by 2028/29.
The plan’s modelling has taken into account a changing medical workforce; one in which fewer doctors work full time and supporting the necessary shift towards a more generalist workforce and those with generalist skills, including general practice, ensuring doctors are equipped to provide the joined-up care required for people with multiple morbidities.

Nursing and midwifery education and training

The plan’s ambition is to increase training places by 80 per cent to over 53,500 by 2031/32. Proposed measures would see nursing degrees increased by more than a third to 40,000 by 2028/29, the number of adult nurse training places being increased by 41 per cent in 2028/29 and 92 per cent to nearly 38,000 by 2031/32.
Training places for mental health nursing will increase by 38 per cent by 2028/29 and 46 per cent for learning disability nursing to support the ambition of increasing training places for mental health nursing by 93 per cent to more than 11,000 places by 2031/32, and to double training places for learning disability nursing over the same time period (to over 1,000 places).
For health visitors, the plan’s ambition is to expand training places by 74 per cent to over 1,300 by 2031/32. To support working towards this expansion, training places for health visitors will grow by 17 per cent by 2028/29. Alongside this, training places for district nurses will grow by 41 per cent (supporting an ambition to increase places by over 150 per cent to nearly 1,800 by 2031/32) and places for school nurses will grow by 28 per cent (supporting an ambition to nearly double to over 650 by 2031/32).
Currently, only approximately 9 per cent of nurses qualify through apprenticeships. The plan will expand nursing apprenticeships so that by 2028/29, 22 per cent of registered nurses are qualifying through this route, including 33 per cent of learning disability nurses, 20 per cent of adult nurses and 28 per cent of mental health nurses.
The plan sets out a need for broader and longer nursing career pathways, for example growing nurse associate workforce to 10,500 places by 2031/32.

NHS England expects to see solid growth in midwives of 1.8–1.9 per cent per year over the course of the plan due to recent investment in midwifery of 650 training places in 2019 and 1,000 in each of the following three years. Upwards of 4,270 starters on midwifery programmes are likely in 2023/24, a 13 per cent increase compared to 2021/22 levels.
Midwives will receive training through traditional, shortened and degree-level apprenticeship routes, with an ambition for 5 per cent of the annual intake to come through apprenticeship routes (higher in geographies where there is a need).

Primary care training

GP training places increased by a quarter by 2028/29 and doubled to 6,000 by 3031/32. The number of GP speciality training places will also be increased to 5,000 a year by 2027/28, with the first 500 new places being available from September 2025. Dentistry training places will also be expanded by 40 per cent to 1,100 places by 2031/32, beginning with 24 per cent expansion by 2028/29 so there will be 1,000 places that year.
Allied Health Professional (AHP) training places will increase by 25 per cent to 18,800 by 2031/32, increasing by 13 per cent to 17,000 by 2028/29, and an increase of 8 per cent by 2024/25 via both apprenticeship routes and traditional undergraduate courses. The recommendations increase both the scope and reach of AHPs, with them acting as advanced practitioners, independent prescribers and senior decision-makers in appropriate settings.
Pharmacist training places will increase by nearly 50 per cent to around 5,000 places by 2031/32, expanding training places for pharmacists by 29 per cent to around 4,300 by 2028/29, starting with initial growth in 2026/27 when places will increase by 15 per cent.

Public health training

The plan will expand the specialist public health workforce by providing 13 per cent more training places in 2023/24. NHS England will work with national, regional and local system partners, including the Department of Health and Social Care (DHSC) and the UK Health Security Agency, to address the demand and supply challenges of the public health workforce in future years.

Allied professional training

The plan sets out an ambition to increase AHP training places by 25 per cent to over 18,800 by 2031/32. To support this places (both apprenticeship routes and traditional undergraduate courses) will increase by 13 per cent to 17,000 by 2028/29, up 8 per cent by 2024/25.
The plan sets out the following assessment for proportion of entrants joining the AHP workforce via an apprenticeship route by 2031/32, including at least 80 per cent for operating department practitioners, therapeutic radiographers and podiatrists; 25–50 per cent for paramedics, diagnostic radiographers, occupational therapists, dietetics, prosthetists and orthotists and up to 5 per cent for speech and language therapists and physiotherapists.
To enable and enhance the scope and reach of AHP roles to help manage demand most productively, the Plan proposes that paramedics have more rotational training placements across hospital, community and primary care settings. For podiatry, we propose expanding apprenticeships significantly, so they become the main entry route into the profession.

Psychological professions training

The plan aims to increase the number of education and training places for clinical psychologists and child and adolescent psychotherapists by about a quarter, reaching 1,258–1,397 by 2033/34.

Healthcare scientists’ training

The ambition is to increase training places for healthcare scientists by 32 per cent to over 1,000 places by 2031/32. To achieve this, places will be increased by 13 per cent to over 850 by 2028/29. Apprenticeship routes for healthcare scientists are also being made available, with 20 per cent of training places delivered via this route by 2028/29 (supporting an ambition to have 40 per cent starting their training via an apprenticeship by 2031/32).

Implications for international recruitment and temporary staffing

Although the NHS will always retain some level of overseas recruitment to give providers flexibility and as a source of wider and diverse talent, there is an ambition to move away from an over-reliance on international recruitment.
With implementation of the education and training expansion outlined, the plan predicts a decrease in international recruitment across the NHS from the current 24 per cent of all new joiners to 9.0–10.5 per cent a year by 2036/37 (including general practice but excluding dentistry and community pharmacy).
Most notably, a near doubling of nursing education and training places would reduce the proportion of new adult nursing joiners who need to be recruited from overseas from 57 per cent in 2022/23 to approximately 15–17 per cent in 2036/37. The modelling estimates that the maximum level of international recruitment for adult nurses will be 16,200–17,900 a year, but the level of international recruitment depends on the assumed level of demand, productivity levels, speed of training and education expansion.
The plan’s assessed expansion would also support a significant reduction in international recruitment of doctors, from the current position of around 6,000 full-time equivalents (FTEs) a year. NHS England will work with employers, educational stakeholders and the royal colleges, using prospective medical workforce intelligence and modelling, to align the expansion in domestic medical training set out here with future workforce needs.
Investment along these lines would also reduce reliance on temporary staffing over time, with agency engagement becoming the exception rather than the norm. Reliance on temporary staffing in FTE terms would reduce from 9 per cent in 2021/22 to around 5 per cent from 2032/33 onwards, with mostly bank staff fulfilling the requirement for temporary staffing.

Apprenticeship expansion

To implement the plan, NHS England will develop an apprenticeship funding approach that better supports employers with the cost of employing an apprentice and will work with NHS employers, integrated care systems (ICSs), providers and other partners to develop a national policy framework that can be used locally to guide the use of funding.
NHS England will work jointly across government (including with the Department for Education) to ensure that any changes to the apprenticeship funding approach are supported by, and align with, wider government apprenticeship funding policy.
NHS England is committed to supporting ICSs to develop local apprenticeship strategies that maximise benefits from changes to funding approaches and to focus on workforce shortfalls and the deployment of roles that enhance patient outcomes. It will also support ICSs to manage education capacity and to support education plans through provision of annual ICB-level (integrated care board) education and activity funding statements.

Anchor institutions

In line with the ICS people function guidance, and as part of their plans to grow their workforce, all ICSs will be supported to build partnerships to develop a sustainable supply of locally recruited staff, support the health of communities and reduce inequalities.
With this plan’s proposed expansion and development of staff, NHS employers can add social value, benefit communities and reduce inequalities through direct employment practices. For example, by recruiting more people from local communities with a focus on those who may experience health inequalities or proactively facilitating skills development including digital skills, career progression and social mobility programmes.

Recruitment and supply

Recruiting to support worker roles: the plan commits to developing healthcare support workers, giving them opportunities to build specialist knowledge and skills that will enable them to develop in their careers and also support the NHS in addressing specific workforce shortfalls, for example through expansion of apprenticeship opportunities. Over the next two years NHS England will continue a national recruitment programme which has over the past 18 months brought 46,000 healthcare support workers into the NHS and work with systems to improve local recruitment processes. To support local systems to recruit for support worker roles, NHS England will look to run recruitment exercises at scale for entry-level NHS jobs, including healthcare support workers, and work in partnership with Jobcentre Plus where appropriate.
Attracting staff: NHS England will continue national advertising campaigns for NHS jobs and support local NHS systems and organisations to build on the strong reputation and the unique employee value proposition the NHS has to offer by highlighting the flexibility and autonomy that NHS staff enjoy and setting out the opportunities for development across the workforce. The plan proposes an overhaul of national recruitment practices and systems, so they are modern, flexible and provide a good experience for candidates and recruiters and allow local adaptation where this is required. It will ensure it takes no longer than six weeks from the placement of an NHS advert to the completion of a candidate’s pre-employment checks.
Providing flexibility of work through temporary staffing: NHS England aims to reduce agency expenditure in secondary, community and mental health providers as shortfalls reduce, subject to the implementation of the other actions in this plan. NHS England will support the NHS to take measures that allow greater mobility of staff across boundaries and sectors through collaborative banks, for example the primary care flexible pool that all ICSs now have to support staff to work across a locality’s different primary care settings. NHS England proposes to support NHS providers to develop and implement policy that prevents substantive staff from offering their services back to the NHS through an employment agency, and instead do so through their local collaborative bank.
Leveraging the impact of volunteers: NHS England will work with ICSs to achieve a more resilient, interconnected and inclusive volunteering infrastructure, for example through an expansion of the existing NHS and Care Volunteer Responders programme104 into adult social care in summer 2023, to develop a long-term health and social care programme to benefit both sectors.

2. Retain: embedding thr right culture and improving retention

The plan recognises the need to prioritise retention as part of achieving workforce sustainability by reducing the overall leaver rate for NHS-employed staff from 9.1 per cent (2022) to between 7.4 per cent and 8.2 per cent over the next 15 years. This is equivalent to retaining 55,000–128,000 FTEs. The plan recognises leaver rate is likely to go up before it goes down because of postponed leavers due to the COVID-19 pandemic.
Plans to improve retention are rooted in the NHS People Promise and NHS People Plan:

We are compassionate and inclusive: the plan emphasises a compassionate culture built on civility, respect and equal opportunity and refers to the six actions of the recently-published equality, diversity and inclusion improvement plan. NHS organisations are encouraged to undertake a cultural review on a regular basis to understand how to improve working environments so that all staff can thrive.

We are recognised and rewarded: The plan recognises the need for an attractive and competitive reward package, and ICSs will be supported to implement local flexibilities where permissible. The plan notes upcoming (23/24) DHSC reforms to the legacy pension scheme so staff of retirement age can work flexibly if desired, and regular conversations about wellbeing with every staff member. NHS organisations should work with system partners to develop a clear employee value proposition (EVP) including national and local benefits to promote across the workforce, and to determine how to provide a consistent staff experience across organisational boundaries.

We have a voice that counts: Speaking up should be valued as an opportunity to learn and improve. The plan encourages assessment of current methods of staff communication to ensure a listening approach, using national tools and employee engagement metrics.

We are safe and healthy: Recognising staff sickness absence rates that are higher than pre-pandemic, particularly in terms of mental ill-health, the plan encourages integrated and focused support for staff wellbeing including through restorative supervision.

ICSs are asked to work with NHS England to develop and implement plans that invest in occupational health and wellbeing services in line with the national Growing Occupational Health and Wellbeing (OHWB) Together strategy and the ICS design framework to keep staff well, increasing workforce capacity and productivity. OHWB services and interventions should be overseen by the wellbeing guardian (or equivalent leadership role) and reviewed continually by local boards.
NHS organisations are asked to review the NHS Health and Wellbeing Framework and the National Standards for Healthcare Food and Drink to ensure that all staff are working within an environment that supports their health and wellbeing. ICBs and trusts should have joint forward plans for staff who experience domestic abuse and sexual violence.
The plan also notes the government is working on making regulation for healthcare professionals faster, fairer, more flexible and less adversarial over the next two years, starting with anaesthesia associates and physician associates, then doctors, then professionals regulated by the Nurse and Midwifery Council (NMC) and Health and Care Professional Council.

We are always learning: The plan commits to continuing national CPD funding for nurses, midwives and AHPs, and to promoting career pathways frameworks and training opportunities to all staff. NHS organisations and systems, and line managers alike, are asked to identify and address local inequalities in learning and development.

We work flexibly: The plan expresses an ambition that the NHS continues to go beyond statutory requirements in terms of flexible working and encourages consideration of flexible working options for every job including enabling retirees to return; and NHS England will work with partners to develop a national, multi-profession, integrated community and primary care core capability and career framework to support workforce development, and to enable more seamless movement between NHS organisations and between NHS and social care. For primary care, measures to encourage dentists to spend a minimum proportion of their time delivering NHS care will be explored, including tie-in periods post-graduation while, in 2023/24, NHS England will work with partners to develop a national, multi-profession, integrated community and primary care core capability and career framework to support workforce development.

We are a team: The plan encourages organisations to consider how they best support team development, using tools such as the Do OD team toolkit published by NHS Employers. Talent, leadership and management support will incorporate Messenger recommendations.

Other management implications

Findings from Our Leadership Way and the recommendations of the Kark and Messenger reviews will be implemented to deliver a consistently compassionate, inclusive and values-driven culture that delivers better staff experience.
This will run alongside a recently agreed programme of work between DHSC and the NHS Staff Council focused on career development including supporting new staff and ensuring existing NHS staff can pursue development plans without financial penalty. The plan also seeks to embed a culture that helps meet the three core needs of staff – sense of autonomy, belonging and contribution.

3. Reform: working and training differently

Reform will take the form of staff supported to work in different ways so clinicians can spend more time with patients. It will grow the skills and capacity required to move care upstream, delivering care closer to home and supporting people to keep well for longer. To this end, the number and proportion of staff working in mental health, primary and community care will increase, with an ambition to grow the number of roles by 73 per cent by 2036/37, including total nursing staff working outside acute settings is projected to increase from the current 30 per cent to 37 per cent and total community workforce nearly doubling over the modelling period.

Productivity improvement

The plan assumes the NHS will deliver productivity above the long run trend between 1.5–2 per cent, based on activity and workforce available and service changes, and largely focused on acute care; while acknowledging that limited historical investment in estate and technology is negatively impacting labour productivity.
This improvement is planned to come from using lower cost settings, technology to reduce administrative burdens, and changing skills mixes alongside upskilling and retention initiatives.
To support treating more people at home, NHSE propose expanding NHS @home pathways, including new approaches for managing major conditions such as cardiac and respiratory disease.
It sets out investment in the NHS infrastructure and funding for technology and innovation. The plan also proposes working with NHS professionals, government and other partners, to better understand what these obstacles to innovation and how to overcome them.
AI and robotics are expected to be a key driver to free up staff time and improve efficiency. NHS England, with government, will convene an expert group to look at where AI can best be used, and what steps need to be taken so that it supports NHS staff. They also plan to collaborate with the Royal College of Surgeons and the robotic industry providers to build a framework for a robotic curriculum.
All of these measures are expected to be supported by the Federated Data Platform NHSE is procuring this year to better connect parts of the system.

Bringing people into the workforce more efficiently

The plan proposes across various initiatives across disciplines to attract staff, including:

⁠Urging education institutions to offer for newly qualified nurses to join the NMC register on qualification at the end of the third academic year and support the NMC to make further changes to nursing degrees.
Continuing funding for the shortened midwifery course up to 2024/25.
⁠Ensuring funding for MSc two-year paramedic programmes.
Exploring ⁠learning or practical experience gained in one field of practice being accredited to reduce the time it takes to gain another qualification.
⁠Working with the General Medical Council (GMC) and medical schools to explore options for a shortened medical degree programme.
⁠Supporting changes to registration processes for domestic graduates and international recruits for more efficient make entry into NHS employment.
Developing the medical support worker programme as a steppingstone to gain clinical experience while working towards GMC registration.

Educating and training differently

NHSE propose education and training needs to be fundamentally different and address predicted future workforce shortfalls, match differing expectations and meet the needs of those joining the workforce in future. The plan proposes action across a range of areas.
Improving student and learner experience, by:

Looking more closely at why students leave training, reducing attrition as well as supporting trusts to adopt the National Preceptorship Framework.

Introducing a single, equitable policy for funding excess travel and accommodation costs incurred by students undertaking placements.

Continuing development of a national learning hub as a single point of access for learning. The Learning Hub platform.

Widening participation and supporting all to succeed, by:

Supporting ICBs to work with their system partners to maximise how the NHS works as an anchor institution to expand access routes into training in the NHS.

Committing to ensuring all NHS-managed education and training represents best practice in ensuring inclusivity and diversity.

Creating more diverse and integrated clinical placements, by:

Developing more multi-profession, system-based rotational clinical placements, as ICSs are expected to become more involved in education and training planning.

Ensuring all foundation doctors have at least one four-month placement in general practice by 2030/31 and increasing training and supervision capacity in primary care so GPs can spend the full three years of their training in primary care settings.

Supporting ICSs by expanding the existing pilots (trailblazers) to demonstrate the benefits of more generalist approaches to education and training and so there are pilots across all medical specialties and regions by August 2025; and expanding the NHS Enhance Programme to broaden the generalist and core expertise of clinical professionals during early training, expanding across different specialties and more locations.

Adopting new approaches to medical education, by:

Supporting SAS doctors to have a better professional experience, by improving equitable promotion and ensuring options for career diversification.

Reviewing medical career pathways and identify ways to better support postgraduate career progression for locally employed doctors, including routes to progress their careers into high demand specialties such as cancer.

Building on the Out of Programme Pause pilot so that taking out of programme opportunities becomes a more accepted part of the training pathway.

Working with partners so that there is more flexibility and a broader range of career pathways and opportunities available to the medical workforce from early in their careers.

Working with the GMC and NHS employers to support doctors to develop their skills and progress through their careers.

Using established quality assurance training framework to share best practice with ICSs, supporting them to ensure all providers meet the required standards to deliver robust, high-quality training.

Piloting an internship model for newly qualified doctors to trial shortening undergraduate training time, with a view to improving preparedness for practice.

Working to develop four-year undergraduate medical degree programmes so that in future students undertaking shorter medical degrees make up a substantial proportion of the overall number of medical students.

Addressing geographical inequity, by:

Levelling up undergraduate training by focusing new medical schools and additional places in geographical areas with the greatest staff shortfalls and unmet healthcare need.

Supporting a higher proportion of the new 2024/25 cohort to carry out their postgraduate training in parts of the country with the greatest shortages and in services such as primary care, mental health and cancer.

Adapting the structure and delivery of education and training, by:

Leveraging opportunities to fully embed digital technology in training pathways, to support more efficient and effective ways of learning and improved learner experience.
Commissioning an independent evaluation of all the blended learning programmes, to be completed in the next year.
Further expanding the Virtual Hybrid Learning Faculty and Simulation Faculty programmes.
Supporting health information exchanges to adopt the NMC’s new standard allowing up to 600 hours of practice learning to be undertaken via simulation.
Working with regulators, education providers and students to review the structure of undergraduate degree programmes on improving the structure of pre-registration training across professions.
Working with partners to incorporate compassionate leadership and workforce psychological wellbeing within undergraduate curricula.

Enablers supporting education and training expansion and reform

The plan acknowledges that the primary care estate remains a barrier to training staff, although notes that addressing this is outside the scope of this work.
NHS England will work with DHSC to review the NHS education funding policy and deliver the Education Funding Reform Programme.
NHS England will work with stakeholders, informed by the issues they identified through a discovery exercise in 2022/23, to ensure clinical placements are designed into health and care services, and placement providers know the core standards they need to meet.
The plan notes the need to raise the profile of those services concerned with less prevalent diseases by increasing placement opportunities. For example, the NHS will introduce ten clinical fellow posts into sickle cell disease services from 2024/25.

Optimising multidisciplinary teams

The plan sets out an increase in the following roles, important for multidisciplinary teams:

nursing associates	advanced practitioners
physician associates	approved mental health clinicians
anesthesia associates	roles covered by primary care additional roles reimbursement scheme.

Overall, the plan will increase the proportion of these wider team roles from 1 per cent in 2022 to 5 per cent by 2036/37.
Work is underway to develop formal pathways to facilitate the transition for the most experienced and skilled staff from advanced to consultant practice roles.
NHS England will support 3,000 pharmacists who have graduated but not completed an independent prescriber course to gain the required skills, knowledge and qualification to prescribe as independent clinicians.
The following personalised care roles will also be expanded:

care coordinators	social prescribing link workers
health and wellbeing coaches	peer support workers

Upskilling the workforce

NHS England will explore the future genomics training and development model with academia and industry over the next three to five years to support the NHS Genomics Strategy.
NHS England will equip the NHS workforce with the right skills and knowledge to shift care towards prevention and early intervention, including by broadening training for the wider NHS workforce to increase capacity and confidence in these areas.

Next steps

Delivering and embedding the plan into our NHS structures

The plan recommends actions at every level of the NHS across Employers, systems and national organisations will all need to contribute.
NHSE will refresh the plan at least every two years, to ensure the assessment of demand stays up to date – kicking off an ongoing programme of work to embed an integrated approach to planning and delivery.

ICSs will play a critical role

ICSs will be crucial in connecting the NHS to local authorities and wider system partners and building on progress to date. The plan most urgently recommends they prioritise actions that drive recruitment and retention of their ‘one workforce’ across health and care.
The plan supports that systems determine their approach in light of local needs and opportunities, setting out priorities for workforce action in their five-year joint forward plans.
NHSE acknowledge ICS leadership of the work is dependent on having sufficient capacity and technical capability for workforce planning, so they are expanding their support offer, including through a new tool providing system-level workforce intelligence, and facilitating an accredited Strategic Workforce Planning course.

Ongoing refinement of the NHS Long Term Workforce Plan

Planning over a 15-year horizon requires an adaptable approach, so NHSE will keep the plan iterative and the position under assessment - refreshing modelling and reviewing training and education expansion.
This extends most immediately to the assumptions around possible productivity improvement, a review of which may require increased levels of international recruitment in the short term or increase reliance on more expensive temporary staffing, until additional staff could be trained and recruited.

It will also take into account whether required increases in capital investment and digital infrastructure are taking place, alongside the ability of the social care sector to play a role in reducing demand for NHS services.

Analysis

Overall comment

The government should be commended for backing NHS England to produce a thorough, bold and ambitious plan which, as far as possible, is based on the aims and ambitions of the wider NHS. We see this as the crucial first of three pillars that the NHS needs to thrive alongside a plan for the social care workforce and extra capital investment; all equally important to achieve the plan’s laudable aspirations.

While this plan has taken a long time to publish, we know it is the first step towards a longer-term change in how we recruit and retain our staff. We therefore welcome commitments from NHS England to regularly review and update the plan. We would like to see this happen every two to three years at minimum. This will help ensure we are on track or show us where efforts, and resources, should be refocused if necessary.

Productivity and capital

NHS leaders share the desire to increase healthcare productivity; doing so will allow us to meet the demand of an older population with more complex needs. However, the 1.5-2 per cent goal set out in the plan is almost double the historical annual average of 0.9 per cent going back to 1997.

Even to achieve the lower end of the range will require major extra capital investment. It is welcome the plan acknowledges the scale of this. However, the NHS has a long way to go. Capital spending in the NHS declined in real-terms between 2010/11 and 2017/18 and lags behind other OECD countries.

Social care workforce

We are seriously concerned that social care is absent from this plan. The NHS Confederation has written to the Prime Minister to urge his government to now begin work on a social care equivalent. This would help to:

raise the status and value of careers in all social care settings and services
transform staff experience, career development and productivity
invest in pay and conditions to both attract people to work in the sector and reduce turnover
enable better service integration between social care and health.

Training and education

We welcome the planned doubling of medical school places – something NHS leaders have long called for. While this will take years to bear fruit, it is essential to help future proof the NHS.

Apprenticeships will be critical if we are to increase the size of the NHS workforce and attract more people into the service from diverse backgrounds. We believe apprenticeships will provide a particular boost in areas where it is harder to recruit staff and reduce barriers to enable more diverse entrants looking to start a career in medicine.

Over the years we have seen a lack of investment in NHS staffing roles outside of hospitals. This plan aims to correct that with ambitious growth targets for recruiting more staff into mental health, community care and primary care roles. This reflects the need to catch up from what has been a historically low starting point in these areas, especially in mental health nursing.

Plans to increase the number of mental health and learning disability nurses are very welcome. It will, however, take time to increase these roles as we are starting from a very low base due to fewer nurses taking up training in these areas and domestic shortfall is not typically filled by international recruitment.

The increase in training places for clinical psychologists and child and adolescent psychotherapists is positive, but we are concerned that there does not seem to be any plans to increase the number of educational mental health practitioners who work in mental health support teams.

A commitment to increase GP training places and creating opportunities for training placements in general practice will help primary care. Not only will this better reflect activity levels within the NHS (approximately 90 per cent of all activity takes places within primary care) but it is also necessary to meet the ambitions of system-working, moving care upstream and – crucially – addressing workforce shortages that have left general practice seeing 12 per cent more patients than pre-pandemic with fewer full-time GPs.

Further, the plan sets out a commitment to using the full primary care workforce to its best ability, laying the foundations for a greater role for community pharmacy as laid out in the delivery plan for the recovery of primary care access. The expansion of training places for roles that form part of the Additional Roles Reimbursement Scheme (ARRS) is also a step in the right direction, especially given that, by the latest estimates, 29,000 professionals have been recruited via the Scheme, exceeding the goal of 26,000 by 2024.

The drop in life expectancy, combined with widening of health inequalities, shows an imminent need to focus disease prevention and health creation as well as treating illness. The commitment to increasing placements for the specialist public health workforce by 13 per cent over the next year should help.

We also welcome the commitment to training more healthcare scientists and hope this will support the adoption and embedding of health research into the NHS.

Training more healthcare workers involves a large amount of funding for both commissioned medical staff, but also for the placements necessary for non-commissioned roles like nurses. Therefore, it is good to see the government has committed new money to increase training budgets in the plan, rather than insisting that new training is paid for out of existing budgets. Increased capital investment will also help free staff time to train students on placement.

Retention

We are also pleased that there will be a renewed focus on retention. NHS leaders will hope that the plan provides reassurance to staff that NHS England is committed to improving working conditions for them and improve care for patients. The mix of measures the plan proposes around flexible working, culture and training time will support this.

However, international competition for a profession suffering a worldwide shortage means the UK must compete on pay with peer nations. Despite recent pay increases – still below inflation – healthcare workers have seen a decline in pay both in real terms and relative to other professions over the past decade. This reduces the relative attractiveness of healthcare and drives medical staff overseas.

At the same time, the Prime Minister recently said he would ignore the outcomes of various public pay bodies to control inflation. This is directly at odds with the need to retain skilled staff. Similarly, the recent Agenda for Change (AfC) pay settlement did not account for those not employed by statutory NHS bodies but that are on AfC pay rates, such as those throughout primary care and in Community Interest Companies. Despite this, the plan doesn’t address pay at all.

The government should seek to reach an agreement with trade unions over pay as soon as possible to prevent the detrimental impact of ongoing industrial action on productivity and patient care. While international recruitment will always have an important role to play, the measures outlined in the plan should, over time, help to reduce the NHS’s reliance on overseas staff and on the use of agency staff. We absolutely need to ensure our international colleagues are retained to develop and achieve their potential, but longer term the development of the domestic staff pipeline will help ensure that we are not depriving other countries of staff for the sake of our own health service.

The data, digital and technology workforce

Clearly better use of technology to innovate and deliver value for money and high-quality care is important. But greater use of technology should not be seen as an alternative to adequate, safe levels of staffing – levels which must keep pace with demand and grow as our population ages.

Further we urge NHS England to consider the number of digital, data and technology staff to meet their levels of ambition given the service’s ongoing struggle in some areas to recruit and retain this workforce. While it is disappointing that this crucial specialisation has not been included in the long-term workforce plan we know that NHS England are preparing a separate digital data and technology workforce plan and look forward to it being published soon.

Moving forward

We look forward to reviewing the detailed modelling that underpins this plan to be published alongside implementation and funding plans; and look forward to working with the Secretary of State and NHS England to ensure that the capacity and infrastructure is in place to deliver the ambitions the government has set out.
NHS England have correctly identified ICSs as having a central role to play in the delivery of the plan, uniquely positioned to be able to support the proposed reforms and tailor them to their local populations. They will be able to embed the proposed integrated approach, bringing together workforce planning with service and clinical strategies and financial planning.
Our members will work hard to implement the plan and to support future more regular iterations of its findings.

Support for members

We will support members with the implementation of this plan through our networks and forums, at every level across the system.
NHS Employers, part of the NHS Confederation, has developed a bespoke guide on key actions alongside practical resources to help implement the plan.