The long-awaited NHS long-term workforce plan was published by NHS England (NHSE) to a broad welcome by numerous healthcare organisations. The plan promises "record recruitment" as well as training for "record numbers" of new doctors, nurses, dentists, and other healthcare staff, but some experts questioned if the plan would be enough to fix the staffing crisis facing the NHS.
Amanda Pritchard, NHS chief executive, described it as "a once in a generation opportunity to put staffing on sustainable footing for the years to come". NHSE claimed it focused on "retaining existing talent" alongside "the biggest recruitment drive in health service history".
Staffing vacancies now stand at 112,000, and the plan for the first time sets out long-term workforce projections. "The growing and ageing population, coupled with new treatments and therapies, means that without action, the gap could grow up to 360,000 by 2037," NHSE said. The plan involves recruiting and retaining "hundreds of thousands more staff" over 15 years.
Greater Flexibility and Pension Reform Promised
Retention will be boosted by giving staff greater flexibility and career progression, and improving culture, leadership, and wellbeing. The service will make it easier for those who have left to return in flexible or temporary roles, and the pension scheme will be further reformed so staff can partially retire or return to work seamlessly, and continue building their pension after retirement. Childcare support will be enhanced throughout the NHS.
Working practises will be reformed so that healthcare staff "have the right multidisciplinary skills and can harness new digital and technological innovations", the plan said. NHSE estimated that innovations, such as AI, speech recognition, robotic process automation, and remote monitoring, could mostly or fully automate 44% of all admin work in general practice.
Prime Minister Rishi Sunak said the Government was "proud" to back the plan and would fund the expansion of education and training for the first 5 years in full, with over £2.4 billion of additional investment.
The plan also aims to reduce reliance on "expensive agency spend" and said that this could cut the bill for taxpayers by around £10 billion between 2030/31 and 2036/37. It will also enable cuts to international recruitment, so that in 15 years around 10% of the NHS workforce would be recruited internationally, compared with nearly a quarter today.
Medical School and GP Training Places to Increase
Specific aims promised included:
- Doubling the number of medical school places to 15,000, starting in September 2025, with a move from 5-year to 4-year degree programmes
- Increasing GP training places by 50% to 6000 by 2031, with the first 500 new places available from September 2025
- Increasing nurse and midwife training places by 24,000 more per year by 2031, including training over 5000 more mental and learning disability nurses each year
- Expanding dentistry training places by 40% by 2031
- Expanding enhanced, advanced, and associate positions with nearly 60,000 more nursing associates, 10,000 physician associates, 2000 anaesthesia associates, and 39,000 advanced clinical practitioners by 2036/7.
NHSE said that along with retention measures, the plan could yield "at least an extra 60,000 doctors, 170,000 more nurses and 71,000 more allied health professionals in place by 2036/37".
Health and Social Care Secretary Steve Barclay said that the NHS was the biggest employer in the country and the "unprecedented" workforce plan, backed by significant Government investment, would deliver "the biggest expansion of staff training in NHS history". The plan will be refreshed at least every two years to help meet future requirements.
Plan 'a Long Time Coming to Fruition'
Professor Dame Helen Stokes-Lampard, chair of the Academy of Medical Royal Colleges, acknowledged that things were currently "very tough" for patients and staff in the NHS, and hoped that the plan would give hope of a more positive future. "This plan has been a long time coming to fruition and we are so pleased and relieved that it is finally here," she said.
"It is also important that this plan is seen as the first of many and will be evolving over time, so where people feel it is not providing the detail or nuance they were seeking now, they have the assurance of influencing future versions."
'The Devil Will be in the Detail' – and in the Delivery
Dr Latifa Patel, BMA representative body chair and workforce lead, said: "After persistent failures to do any sort of proper workforce planning over the last decade, the release of this strategy is long, long overdue.
"At a time when healthcare workers are already contending with more than 100,000 vacancies and in turn, record long waiting lists that the Government says it is so keen on tackling, recruiting enough staff – and crucially keeping them – must be the absolute priority."
Retention was key, she said, and on that "today’s announcement feels particularly light".
"It’s all well and good training new doctors, but pointless if they don’t stay in the workforce," said Dr Patel.
She added that, despite the plan's "laudable aims", for it to succeed it needs to take the profession with it. "Without a detailed road map to say how it will improve care for patients and working conditions for staff, it is merely a wish list."
Professor Kamila Hawthorne, chair of the Royal College of GPs, said the proposals, including initiatives to retain GPs and recruit more, were "encouraging". However: "The devil will be in the detail, and also the delivery - we need to see work begin to ensure this plan becomes a reality as a matter of urgency."
Matthew Taylor, chief executive of the NHS Confederation, said: "We see this plan as the crucial first leg in a three-legged stool that the NHS needs to revive and thrive – the other two being an equivalent plan for the social care workforce, alongside extra investment in capital and technology."
Dr Matthew Lee, chief executive of the Medical Defence Union, described the plan as "a first step" towards improving conditions for staff but cautioned that urgent regulatory reform was needed in parallel. "Workforce retention in the NHS is not helped if the regulatory system that healthcare professionals are subjected to is as outdated as the ones currently operated by the GMC [General Medical Council], GDC [General Dental Council], and other regulators."
He pointed out that the additional £2.4 billion funding "would be eclipsed in one year alone by the annual cost of harm reported by NHS Resolution", which he said stood at over £13 billion in 2021/22. "You also cannot harness every penny possible in the NHS towards front line patient care if billions of pounds every year are leaving the system in clinical negligence settlements, because of a legal system that is no longer fit for purpose," he said.
'Betting the Farm' on Training 'Could be a Costly Gamble'
Nuffield Trust Senior Fellow Dr Billy Palmer also sounded a note of caution.
He said: "After years of drift, it is a relief to finally see some real planning for the NHS workforce. The huge increase in trainees promised will mean less risk of shortages in the long term." However, he warned that given the "dismal reality" of working in the NHS, there was a risk that "we will feed more and more people into training only to burn them out ever faster".
The Trust's analysis showed staff sickness had stayed alarmingly high, and there was a big problem with people dropping out from training. "Large increases in the number of GP trainees since 2014 had barely any effect on the number ultimately coming through," he said. "Betting the farm on just training more could be a costly gamble."
The sudden boost in training "carries some risks", he warned. "Nobody wants to see standards drop in selecting doctors and nurses. The time required for so much supervising by more senior clinicians will be an issue and could eat into efforts to clear the backlog – a risk I hope the plan will recognise."