Train, retain, reform – NHS England’s Workforce Plan published

NHS England has published the NHS Long Term Workforce Plan, to outline measures to address the current 112,000 staffing shortfall, and to highlight how it will support staff retention, increase education and training, and capitalise on technology to support reforms.

The plan sets out an ambition that by 2036/37 – with retention measures delivered for current staff – the health service will have at least an additional 60,000 doctors, 170,000 nurses and 71,000 allied health professionals.

There are three overarching priorities for the plan:

  • Train: to significantly increase education and training, 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.
  • Retain: ensuring more staff stay within the health service by better supporting people throughout their careers, supporting flexible working in ways that suit staff and patients, and continuing to improve the culture and leadership across NHS organisations.
  • Reform: improving 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 that frees up clinicians’ time to care, increases flexibility in deployment, and provides the care patients need more effectively and efficiently.

A key theme in the plan is to capitalise on developments in science, research, technology, digital and data. It notes the requirement to “build digital skills and capabilities and change ways of working” and adds “to meet the changing healthcare needs of the population in a cost-effective way, the NHS workforce will need to take full advantage of digital and technological innovations”. It states that “widespread safe, effective and ethical adoption of these innovations will be one of the most important ways of delivering the stretching productivity ambitions in this plan”.

With investment, education and recruitment highlighted as key areas, the plan notes that action is required for “improving culture and retention, training the workforce differently, evolving the skills mix and delivering productivity”. Here, it states this “ambition requires a combination of delivering care closer to home while avoiding costly admissions, achieving operational excellence, reducing administrative burden through better technology and infrastructure, and capturing the benefits appropriately in productivity measurement.”

To achieve this productivity ambition, the plans says it “will require continued and sustained investment in the NHS infrastructure, a significant increase in funding for technology and innovation, and the delivery of the broader proposals in this plan.”

It goes on to highlight the role of different aspects of health tech, including the NHS AI Lab, which is supporting 86 projects at the moment across 99 hospitals, showing promising results. It notes the impact AI could have in the short and longer term, where AI could be used for predictive health analytics, patient triage and preventive healthcare. It also pays reference to the potential of foundational AI models such as “generative AI or large language models, which can understand and produce an image, text and audio”, and “are predicted to transform work across all sectors”.

NHS England notes a number of actions to achieve improvements with AI, including:

  • Reviewing initial evaluations from the AI Award – to be completed by the end of 2024.
  • Supporting the government’s Foundation Model Taskforce, which is set to support the next generation of AI, to support and optimise implementation across the NHS.
  • Ongoing investment in the Fellows in Clinical Artificial Intelligence programme.
  • Building the workforce’s confidence in AI, by establishing governance and robust implementation of AI technologies and driving AI-related education training including fundamentals for the full workforce and advanced training where it is required.
  • Leading workforce development in AI and digital healthcare technologies as informed by the AI and Digital Healthcare Technologies Capability framework.
  • Developing understanding of the implications for the workforce and working with partners, including royal colleges, to plan for these – including considerations for specialist roles and teams as well as the wider workforce – and on system efficiencies, as technology continues to develop.

The next area of focus is administrative functions, and the opportunity for using AI and speech recognition, where it highlights an example in general practice where 44% of administrative work could be automated. Here, the plan also covers the use of robotic process automation to automate back-office tasks in the NHS, and states: “All 42 ICSs now use RPA, including 38% of community or mental health trusts and 61% of acute trusts, but there are opportunities for further uptake”. Here it projects that: “If all trusts implemented processes that have been ‘time validated’, this could save more than 7.2 million hours annually, equivalent to over 965,000 working days released. Over the next 10 years, this could be nearer 22 million hours saved, equivalent to more than 2.9 million working days released”.

The plan goes on to highlight the need for successful adoption of innovations, and “continued, sustained investment in digital technologies and ongoing work to understand the impact of these technologies on staff and workforce planning, transformation and skills development”. Here it adds: “This includes capturing and driving potential changes in workflows, upskilling and training staff to maximise technologies and avoid the risk of de-skilling, the creation of new roles and responsibilities, and further ethical and legal considerations to ensure safety, accountability and fairness.”

The plan covers the rise in the use of robotics, and the need to ensure there is formal robotics training and regulated adoption. It states: “NHS England is collaborating with the Royal College of Surgeons of England, the accrediting surgical bodies, and the robotic industry providers to build a framework for a robotic curriculum. The aim is to create a roadmap for implementing the curriculum, which will identify barriers to training and offer solutions to overcome them. This will lead to provision of a fully trained, accredited RAS surgical workforce with demonstrable patient benefit.”

Virtual care and remote monitoring is a focus in the plan. It states: “Work is underway to expand NHS@Home pathways and this includes developing and testing new approaches for managing major conditions such as cardiac and respiratory disease. Investment in 2023/24 via the Adult Social Care Technology Fund is also supporting testing of remote monitoring solutions.” Here, the plan notes the need for “evolving the skills mix of multidisciplinary teams” and that it “is vital for the continued growth of new models of care such as virtual wards, SDEC, intermediate care and expanded community services”.

The plan also highlights the benefits of flexible staffing pools, to note that there are “23 collaborative banks across NHS trusts, with 10 more planned”. It adds: “We will support the NHS to take measures that allow greater mobility of staff across boundaries and sectors through collaborative banks.”

Another requirement is the need “to upskill the workforce with core skills and increase the number of expert roles across digital, genomics and personalised care. The use of more diverse roles and skills, combined with enabling technology, will lead to more care being delivered remotely, closer to home or in the community, such as in virtual wards, and will enable more teams to work across organisational boundaries”.

Overall, achieving the productivity improvements assumed in the plan is dependent on two key factors, the plan states: “First, it requires a sustained increase in capital investment in the ageing NHS estate, including in primary care, to replace equipment that has passed its recommended lifespan, and expand capacity to accommodate the increased demand for healthcare from an ageing population. Second, it requires investment in digital infrastructure throughout the NHS, including appropriate training and support, to enable NHS staff to make the most of new technologies”.

It’s anticipated the plan will be updated every two years. To read the plan in full, please click here.