The NHS Long Term Workforce Plan was issued by NHS England on Friday 30th June 2023, following much anticipation.
The plan is not supposed to be the total solution which will fully meet all of the workforce needs in the NHS. It is, however, the first step in a process of frequent planning that will change and grow as service needs develop.
I have read some commentary on social media, and whilst many believe the plan will move us in the right direction, others believe it is inadequate and will fail to deliver on the promises set out. However, I would still advise that we take a closer look and try to adopt a balanced view, rather than sit back and throw rotten tomatoes.
The blog covers the following;
The three pillars of the workforce plan
The case for change
What’s missing from the plan
Some questions for consideration on how we can start to improve our workforce planning and the working environment for our team
Do not read this blog if you think the plan is rubbish, as I will only continue to infuriate you. You have been warned!
Let's jump in!
The key pillars of the NHS Long Term Workforce Plan
The plan is the first time the government has asked the NHS to come up with a comprehensive workforce plan. Its strap line, or three core elements, are:
To significantly increase education and training to record levels, as well as increasing apprenticeships and alternative routes into professional roles.
To deliver more doctors and dentists, more nurses, and midwives, and more of other professional groups; including, new roles designed to better meet the changing needs of patients and support the ongoing transformation of care.
To ensure that we keep more of the staff we have within the health service by better supporting people throughout their careers; boosting the flexibilities we offer our staff to work in ways that suit them (and which work for patients) - and continuing to improve the culture and leadership across NHS organisations.
To improve productivity by working and training in different ways; building broader teams with flexible skills, changing education and training to deliver more staff in roles and services where they are needed most, and ensuring staff have the right skills to take advantage of new technology. The idea being that this frees up clinicians’ time to care, increases flexibility in deployment, and provides the care patients need more effectively and efficiently.
The case for change
The plan encourages us to see this as our collective duty, and the case for change is clear and compelling.
Based on current trends, two-thirds of those over 65 will have multiple health conditions, and a third of those people will also have mental health needs
Higher levels of disabled staff experience bullying, harassment or abuse from managers.
Women tend to have worse experiences than men related to harassment and discrimination from a manager.
White applicants are 1.54 times more likely to be shortlisted for a job compared to applicants from ethnic minority backgrounds.
NHS staff who identify as LGBTQI+ are still much more likely to face physical violence, bullying and harassment in their workplace than other staff.
Local services report vacancies totalling over 112,000
Advances in medicine means that there has been an increase in life expectancy by 13 years since 1948.
The number of people aged over 85 is estimated to grow by 55% by 2037, as part of a continuing trend of population growth which outstrips comparable countries.
Inaction in the face of demographic change is forecast to leave us with a shortfall of between 260,000 and 360,000 staff by 2036/37.
The lack of a sufficient workforce, in number and in terms of skill mix, is already impacting patient experience, service capacity and productivity, and constrains our ability to transform the way we look after our patients. An increasing shortfall would mean growing challenges and lost opportunities.
Within the non-registered workforce, healthcare support workers are anticipated to have the largest shortfall between demand and supply. This is driven by limited supply growth and a high rate of leavers for existing staff.
The length of time it takes to train new clinical staff (particularly new consultants and GPs) means that a comprehensive and long-term approach to workforce planning is required.
I do not think many people would argue that there is a clear need for the NHS workforce to continue to grow and evolve.
The ambitions are BIG, and so are not aimed at addressing the short-term issues we face today. This is a 15-year strategy.
What's not in the plan?
From reading the commentary online:
➡️ Amanda Kelly highlights the lack of recognition of social care. Within her article, she says that the plan is very much focused on NHS employees and does not address the critical role of the social care workforce.
➡️ The Institute of General Practice Management (IGPM) welcome the plan but they have highlighted the disparity in pay between primary and secondary care, and the differences in terms and conditions across the system.
➡️ There is no mention of pay reform, and given the ongoing strikes within the healthcare service, this seems surprising.
➡️ Others believe that the plan is not practical enough. They want the 'who, what, why, when and how' to be more clearly defined.
So, what could this mean for Primary Care Networks?
Increased training placements
The analysis presented within the plan clearly demonstrates the need to grow our workforce which will be underpinned by improvements in training, technology, leadership, and both physical and virtual infrastructure.
One significant impact on general practice will be the increased number of placements required to fulfil the ambition of:
Increasing GP training places by 50% to 6,000 by 2031/32.
Increasing adult nursing training places by 92% (taking the total number of places to nearly 38,000 by 2031/32).
Providing 22% of all training for clinical staff through apprenticeship routes by 2031/32, up from 7% today.
Ensuring that all foundation doctors can have at least one, four-month placement in general practice, with full coverage by 2030/31.
Moving forwards, practices and networks will need to think more proactively and strategically about where they can house and support the next generation of workforce and work more closely with training hubs to make this happen.
Continuing professional development
To realise the ambition of continuing professional development for nurses, midwives, and allied health professionals:
Practices need to take advantage of national funding and ensure their staff have clinical supervision and the time to train and feedback on their learning.
Estates and infrastructure
The workforce plan calls for us to reform and work differently. The system is set to receive significant investment in infrastructure and primary care, along with a new hospital programme, community diagnostic centres, and surgical hubs, should start to see some movement in this area.
When it comes to technology, there is so much talk about Artificial Intelligence (AI) and automation and how we can use it, but many practices and hospitals have been using this technology for a while, and people forget that AI is already part of our everyday.
Some studies have shown that over 70% of a clinician’s working time is spent on administrative tasks, and 44% of all administrative work in general practice can be mostly (or fully) automated.
When it comes to remote monitoring, this will enable and empower more patients to manage their conditions at home, whilst providing up-to-date intelligence to support care decisions and relieve pressure on the workforce.
The opportunities are there and have already been adopted. We need to think bigger and be braver to trial and adopt what many others have done before us.
At the other end of the spectrum, we are incentivising practices to switch to cloud-based telephony when the Wi-Fi is still patchy in some areas.
I hope the long-term investment in technology will provide all practices with the fundamental building blocks for operational efficiency, but money is not the only answer; it's a change in mindset and organisational culture which is also required.
Growth in personalised care roles
It is estimated that one in five people who go to their GP do so with concerns that cannot, and do not, need to be addressed with medical treatment.
As part of service and workforce redesign, specific roles are being embedded within multidisciplinary teams to support self-care and to facilitate access to broader local support services.
Primary Care Networks are already familiar with many of these roles, which are funded via the Additional Roles Reimbursement Scheme, and the plan calls for expansion to be targeted at primary care, mental health, and learning disability and autism services, where the need is greatest. The figures in Table 4 below are indicative based on current projections.
Many practices are still trying to get their heads around some of the personalised care roles. There is a lot of variety in how their roles are utilised, so a lot of work needs to be done here, but different approaches need to be tried and tested, along with learning from best practice.
What about the managers?
The plan acknowledges that the task of leading health and care teams is changing, with managers increasingly expected to lead staff to work beyond traditional boundaries between professions and organisations, and to work as part of a network of local systems to transform services.
This acknowledgement is good!
Whilst the plan outlines the desire for more clinical and personalised care roles, we also need to think about managerial and administrative pipelines and the terms, conditions, and treatment of these roles wherever you are in the system.
PCNs do not need to wait to invest in their practice and PCN managers or provide shadowing opportunities and communities of practice to foster their peer support and development.
The clip below is taken from NHS Confed Expo 2023: Amanda Pritchard, NHS Chief Executive keynote and conversation with Victor Adebowale.
All areas of the system need to collaborate more than ever before, and without a doubt, it is challenging.
The maturity of Primary Care Networks is wide-ranging, and many find it extremely challenging to work together. In these moments, we need to remind ourselves of the wider system 'ask' and proactively organise ourselves to work collectively and move forwards.
The role of the ICB and ICS
Communication across so many organisations is another challenging aspect of the work we all do, and this will be a more critical factor in the success of these long-term plans.
Communication that is clear, consistent, and timely is fundamental in planning.
Whilst it is rightly down to us, on the ground, to disseminate communication across our networks, we look to our ICS and ICB colleagues to provide us with
strategic direction and guidance. Unfortunately, this doesn't always happen, with many of us having to check Facebook and WhatsApp groups to find out what is going on.
If we are to introduce more personalised care roles, apprenticeships, training placements - and work in partnership with colleagues across the system - we need longer, more realistic lead times and for managers to be included in the planning process, not just Clinical Directors.
After reading this plan, I believe that this presents a great opportunity for Primary Care Networks to carry out more robust workforce planning, which goes beyond simply picking roles from the ARRS budget and ensuring that the funding is spent.
We need to take a more long-term approach to workforce planning and to consider the following:
❓ What training opportunities are we providing to all staff in our network?
❓ How can we improve our recruitment and onboarding process so people can join our network quickly?
❓ What does an integrated neighbourhood team look like to us?
❓ Who can we proactively start conversations with to support us on this journey?
❓ Are we maximising the technology available to us, and if yes, is there any room to innovate?
❓ Are we doing all we can to provide a great place to work?
We can all start having these conversations now.
These are just my initial thoughts.......
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About the Author
Tara and Team THC provide project and network management and training to Primary Care Networks. Between our training programmes, facilitation, and interim network programmes, we have now supported over 120 PCNs!
Tara has an MBA in Healthcare Leadership and Management, is published in the London Journal of Primary Care, is the author of over 200 blogs and also hosts The Business of Healthcare Podcast.
Find out more about THC Primary Care at www.thcprimarycare.co.uk