After many years of waiting, the long-term workforce plan for the NHS has finally been published, so what exactly does it promise for the NHS and its staff?

The 151 page document sets out how the NHS is going to train thousands more doctors, nurses, and other healthcare workers to fill the current vacancies in the NHS (currently around 112,000) and to provide staff for the predicted increase in demand over the next 14 years.

The government projections are for the number of people over the age of 85 to grow by 55% by 2037, and this risks a shortfall of NHS staff of between 260,000 and 360,000 by 2036-37.

A plan is badly needed if the NHS is to fill these vacancies with NHS-trained staff and move away from employing agency workers at high rates of pay and raiding other countries’ healthcare systems for staff.

If the plan is successful, the government believes the NHS will have 300,000 extra doctors, nurses and other health professionals by 2037. The key to achieving this is, according to the government plan, training, retention and reform.

Increased training places

Over the next 14 years the plan is for an increase in the traditional training routes for doctors and nurses, but also a big expansion in apprenticeships. The plan mentions that the latter routes should open up opportunities for people from under-represented backgrounds in healthcare.

For doctors, the number of places in medical schools each year will rise from 7,500 now to 10,000 by 2028 and 15,000 by 2031, with a focus on specialties where there are too few doctors. 

There is also a massive shortfall in GPs and training places will increase by 50% to 6,000 by 2031/32, although the first 500 new places won’t be available until September 2025.

For nurses, the plan is for a big expansion in adult nursing training places, taking the total number each year to nearly 28,000 by 2028-29 and nearly 38,000 by 2031-32.  The broader plan is to increase the number of nursing and midwifery training places to about 58,000 by 2031-32.

One of the major changes in how NHS staff will be trained is a large expansion in apprenticeships, with a goal that 22% of all clinical training will be done through this route by 2031/32, up from 7% at present. 

Medical degree apprenticeships will be introduced, with pilot schemes running in 2024/25, with an aim for places to increase to more than 850 by 2028/29.

There are plans to expand dentistry training places by 40% so that there are more than 1,100 annual places by 2031-32, and possibly to introduce a tie-in period requiring dentists to commit to working for several years for the NHS after graduation.

Training more NHS staff domestically is intended to reduce reliance on international recruitment from nearly a quarter of staff at present to about 10% of the workforce.

How will staff retention be improved?

This is a major issue in the NHS. After years of training staff either leave to work in healthcare systems elsewhere, such as Australia, go part-time, join an agency to then work for the NHS, or leave healthcare entirely. The goal is for 130,000 fewer staff to leave the NHS over the next 15 years.

The reasons staff leave include pay, burn-out, lack of flexible working, and the culture in certain sections of the NHS, such as bullying and racism.

The actions in the plan on improving retention lack much detail, but mention improvements in flexible working and access to health and wellbeing services. Plus funding professional development and supporting working parents with extended childcare support.

Recently retired consultants will be targeted for work in the NHS via an NHS Emeritus Doctor Scheme and there are plans to improve flexible opportunities for those about to retire. Modernisation of the NHS pension scheme is also part of the plan.

Most notably, what is not mentioned is any improvements in pay, which is the subject of the ongoing strike action in the NHS.

What reform is planned?

The section of the plan focused on reform, talks of innovative ways of working and new roles within multidisciplinary teams, and changes to training. The way services are delivered is targeted for reform with mention of digital and technological innovations, including the use of AI.

The new roles of nursing associates (NA) and physician associates (PA) will see training places increase.  NAs to 10,500 by 2031/32 and PAs to over 1,500 by 2031/32. The plan is for there to be over 64,000 NAs in the NHS and around 10,000 PAs by 2036/37.

The plan aims for a greater focus by the NHS on preventative and proactive care, moving more care into the community. To enable this, there is an ambitious target of growing the number of staff working in mental health, primary and community care by 73% by 2036/37.

A more controversial change in training will be medical schools being asked to shorten their degree programmes, from the current five or six year degree programmes to four years. There will also be a pilot medical internship programme. The government wants students to move into the workforce earlier in their training to boost staff numbers. There have also been plans for nursing students to begin on the wards six months earlier than at present.

How will it be funded?

The big question, how will this plan be funded? Well, the increase in training places for doctors, nurses, midwives and other health professionals will be funded by an extra £2.4bn over five years. After this there is no amount mentioned for funding of the continued increase in training as it will be the subject of political choices.

Other than the £2.4bn, the government is hoping there will be a labour productivity increase of up to 1.5-2%, brought about by “reducing the administrative burden through technological advancement and better infrastructure” and improving efficiency through reducing hospital admissions and using a broader range of staff.

The idea is also that the plan will generate some savings, for instance by reducing spending on temporary agency staff by £10bn.

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