Professor James Buchan, senior fellow at the Health Foundation, explores what the NHS Long Term Workforce Plan means for the nursing profession and the actions needed to make its ambitions a reality.
After a long wait and a few false starts, the NHS England Long Term Workforce Plan was published in June. It sets out an ambitious approach to addressing huge NHS staffing challenges over the period up to 2036/7 ‘to ensure the NHS has the workforce it needs to sustainably meet the needs of patients’.[i]
Many readers of Nursing in Practice who work as nurses in other health and social care sectors, or in the other UK countries, may have asked what the plan means for them. But, while its focus is on the NHS workforce in England, it does stress the links to social care and other health sectors.
No matter what sector a nurse specialises in, if she or he was trained in the UK, they usually start their career in the NHS, so the implications of the plan stretch well beyond the NHS. The plan notes, ‘Health and care services are interdependent, and if efforts in this plan to tackle the current challenges in the NHS are to yield success, then capacity needs to increase across both.’
To begin with, it is worth looking at the scale of the workforce challenge identified by the plan, which are replicated to some degree in the three other UK countries. Then examining some of the key action points which, if funded and implemented, will have an impact across the whole health care labour market in England, and beyond.
The plan’s headline analysis of the scale of the NHS workforce challenge are worrying. Without action the plan forecasts a shortfall of between 260,000 and 360,000 NHS staff by 2036/37 (Full Time Equivalent – FTE). This includes an FTE shortfall in community nurses of at least 37,000, a mental health nursing and learning disability nursing shortfall of more than 17,000 FTE, and a shortfall in qualified GPs of 15,000 FTEs by 2036/37.
These findings echoed earlier analysis published by the Health Foundation in 2022, which highlighted that under current policy, the NHS faced a shortfall of close to one in four GP and general practice nurse posts by 2030/31 and that there was a need for sustained and concerted policy action to boost GP retention and integrate newer roles within multidisciplinary practice teams.[ii]
The key point here is ‘without action’, because the plan does set out a range of actions aimed at facing up to the workforce challenge. It does so in three main areas:
- Train: to significantly increase education and training to record levels, including increased use of apprenticeships and alternative routes into professional roles.
- Retain: to keep more of the staff currently working in the NHS by better support for their careers, boosting work flexibilities and continuing to improve the culture.
- Reform: to ‘work smarter’ to improve productivity by working and training in different ways, building broader teams with flexible skills, including advanced practice and new roles, and harnessing the potential of research and technology.
The train action points are set out in most detail in the plan, and deserve immediate consideration, because the output from training represents the ‘new’ nursing workforce recruits for all sectors, covering Nursing in Practice readership, not just the NHS. For example, the plan’s aim is to expand health visitor training places by 74% to over 1,300 by 2031/32. Across the same timeframe the aim is for training places for district nurses to grow to nearly 1,800 and training places for school nurses to more than double by 2031/32.
There is also a stated ambition to have over 6,300 clinicians starting advanced practice pathways each year by 2031/32. Areas of demand identified for advanced practice include primary and community care, mental health, learning disability and autism services and specialist services like those for breast cancer [par 4.81].
In addition, the plan highlights that it aims to extend the Additional Roles Reimbursement Scheme (ARRS) in general practice, by increasing the number of non-GP direct patient care staff by a further 15,000, and primary care nurses by more than 5,000 by 2036/37.
These are big numbers, and historically high ambitions for training place growth. There is a clear need for detailed follow-through about where the necessary funding will come from, and how the necessary training capacity will be put in place (including clinical placement availability) if the system is to deliver at this unprecedented scale. It should also be noted that the thorny issue of NHS nurse pay is not directly covered by the plan. In addition, the plan is focused on reducing the projected overall workforce shortfall nationally. Within that there are significant geographical variations and challenges, and implementation will need to place very close attention to the distribution as well as the overall number of staff required.
The plan states ambitions to work together with local authorities and others to provide integrated care that meets population health needs. In particular, it stresses the need for integrated workforce planning across sectors through opportunities for joint teams, joint training and rotation between NHS and social care settings.
So far, the plan is just a report setting out aspirations and intent. It will require full funding, capacity building and detailed implementation to translate from plan to fulfilment. And part of that process will be connecting with the agencies and organisations where many readers of Nursing in Practice are now working.