Last reviewed 3 July 2023
Announcing the long-awaited NHS Workforce Plan, Prime Minister Rishi Sunak said: “On the 75th anniversary of our health service, this Government is making the largest single expansion in NHS education and training in its history”, indicating “this is a plan for investment and a plan for reform.”
In the coming years, he said, twice the number of doctors will be trained a year, as will an extra 24,000 nurses, and he pledged: “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.”
Chancellor Jeremy Hunt said it will improve patient care, help to cut waiting lists, end the reliance on expensive agency staff and build an NHS that “can match up to the scale of tomorrow’s challenges”.
Pressed on how long it will take to see the benefits of the changes, Rishi Sunak told the BBC’s Sunday With Laura Kuenssberg show it could take “five, 10, 15 years for these things to come through”.
The plan sets out a modelling of NHS workforce demand and supply over a 15-year period and the resulting shortfall, and shows that without “concerted and immediate action” the NHS will face a workforce gap of more than 260,000 to 360,000 staff by 2036/37. This compares to a current shortfall of 112,000 staff.
The Government’s aim is to train more NHS staff domestically so that, in 15 years, around 9% to 10.5% of the workforce would be recruited from overseas, compared to nearly a quarter now. NHS England said that, coupled with retention measures, this could mean an extra 60,000 doctors, 170,000 more nurses and 71,000 more allied health professionals in place in 15 years. Modelled increases are particularly targeted towards general practice.
There is a strong emphasis on expanding the primary care workforce so that specialist advice can be offered by other clinicians such as mental health practitioners, social prescribers, nurse and physician associates and pharmacists.
With an extra 15,000 patient care staff and 5000 more nurses joining GP teams by 2036/37, NHS England Primary and Community Care Director Dr Amanda Doyle said the plan will ensure many more patients can be seen through this route. Additional education and training places will be backed by a £2.4 billion investment from the Government over five years, in addition to existing funding commitments.
The plans for training would:
double the number of medical school training places, taking the total number up to 15,000 a year by 2031/32; by 2028/29 the number of places will be increased by a third to 10,000 a year
increase the number of GP training places by 50% to 6000 by 2031/32 — the first 500 new places will be available from September 2025
provide 22% of all training for clinical staff through apprenticeship routes by 2031/32, up from the current 7%
introduce medical degree apprenticeships, with pilots running in 2024/25 so that by 2031/32 2000 medical students will train via this route.
The plan says new medical schools could open up in areas of the country where there is the greatest staffing shortfall, with similar plans for postgraduate medical training places.
Also, adult nursing training places will increase by 92%, taking the total number of places to nearly 38,000 by 2031/32; and 20% of registered nurses will qualify through apprenticeship routes compared to just 9% now.
There will also be an expansion of training places for clinical psychology and child and adolescent psychotherapy, and training for around 150 additional advanced paramedics annually, including to support same day emergency care.
Many in the NHS believe that retention is now biggest issue. The plan recognises that keeping experienced staff is “critical” and highlights the importance of having occupational health and wellbeing services for all NHS staff, as well as improving culture and leadership.
However, although there are specific retention plans for consultants, who will be able to offer their services flexibly after retirement, and there are career development plans for nurses, midwives and allied health professionals, there is no specific mention of GPs. NHS England includes general pledges to:
continue to implement actions from the NHS People Plan
support integrated occupational health and wellbeing services for all staff
support NHS staff to use new childcare support for working parents over the next three years.
Reform: work and train differently
The plan aims to “build broader teams with flexible skills”, and reform education and training to deliver more staff in roles and services “where they are needed most”. This includes:
expanding enhanced, advanced and associate roles, with a focus on generalist and core skills needed to care for patients with multimorbidity, frailty or mental health needs
growing the number and proportion of NHS staff working in primary, community and mental health care.
Plans for reform include a commitment from NHS England to support experienced doctors to work in general practice, under the supervision of a fully qualified GP, and ensure all foundation doctors get at least one four-month placement in general practice by 2030/31. GPs in training will be able to spend three full years of their training in primary care settings.
The Government will work with the General Medical Council (GMC) and medical schools to consult on introducing four-year medical degrees and medical internships “allowing students to start work six months earlier”.
Work will also be done to ensure all new roles are appropriately regulated and actually free up the time of other clinicians as much as possible.
The plan recognises that training more GPs and increasing the workforce won’t work if the estates and infrastructure to support these staff are not in place, although it says the specific measures required to expand physical estates are “outside the scope” of the plan. Other measures cover:
embracing technological innovations such as artificial intelligence (AI) and robotic assisted surgery, with an expert group tasked with harnessing advances in AI
investing in technology to free up more time — GP practices could adopt innovations such as speech recognition to deal with administrative workload.
The plan, in the main, has been well received, with representative bodies seeing it as an essential first step to tackle the current workforce crisis. The King’s Fund Chief Executive Richard Murray said it “could prove to be a landmark moment”, and NHS Employers Chief Executive Danny Mortimer welcomed the increase in contribution of different roles and ways of working in primary care, the ambitions around apprenticeships and degree apprenticeships, and an offer that should create “clearer and better career pathways for our existing people as well as future generations of health workers.”
There have been comments from the British Medical Association (BMA) that plans for staff retention, especially for GPs, are disappointingly “light”, with utterances from BMA Workforce Lead Dr Latifa Patel that there is “no point having more students if there are no academics to teach them, no spaces to learn in and no consultants and GPs to supervise them once they graduate”.
Concerns exist around the reduction of GP training time if newly qualified GPs will require more support from experienced doctors, taking them away from patient care; together with the untested nature of accelerated degrees and medical apprenticeships in addressing the current workforce crisis.
An important strategic objective is evident in the plan, that training should support a better balance of generalist and specialist skills so that doctors are equipped to provide the “joined-up care” needed for people with multiple morbidities, according to Dr Amanda Doyle.
The King’s Fund warned that some of the wider ambitions of the plan will need sustained investment and therefore rely on future governments to support the strategy. And now that the plan has been published, it said the Government should complete its work and “create a sister plan for social care, with its own funding and own projections”.
NHS England confirmed that the plan will need to be updated every two years as circumstances change.
NHS Long Term Workforce Plan, June 2023.
The King’s Fund response to the NHS Workforce Plan.
GP Shortfall Projected at 15k by 2036 as Workforce Plan Sets Out Training Overhaul, BMA’s response covered by Pulse magazine.