Amanda Graham takes a look at the NHS workforce plan
The NHS workforce plan centres on the need to train, reform and retain its employees to meet future demand, leading to an increase of up to 360,000 new staff across integrated care systems (ICSs). Increasing the number of formal training places available through more diverse points of entry and improving retention through rewarding career and development are at the heart of what needs to be done to deliver this plan. The introduction of new roles, reforming the way care is delivered and by whom, will be critical to meeting anticipated demand in 2036/37. But these roles will need to be designed, clinically led and committed to driving productivity to create the capacity needed.
Determining which roles will be needed to meet demand
It is important to recognise that more staff will not increase capacity without redesigning clinical pathways to be more efficient and effective. During COVID-19 there was around a 10 per cent increase in headcount within NHS acute trusts. However, at the beginning of 2023/24, providers were at 97 per cent of pre-pandemic productivity levels. Delivery of the NHS workforce plan means broadening the skill mix of multidisciplinary teams, creating new and diverse roles across systems. In designing the new workforce, the roles need to create new capacity to meet demand, either through new services to meet future need or increasing provision in existing services.
Creating a new role requires the redesign of the way the multidisciplinary teams work together. The starting point for this workforce design should be the optimal clinical pathways, rather than what is being done today. That means setting out the clinical red lines (what can only be done by a registered healthcare professional), looking at the skills and roles needed and the most efficient use of capacity. The design of the COVID-19 vaccination workforce demonstrated how new roles could be created to meet increased demand. That led over 145,000 people to join the NHS working as unregistered vaccinators who came from diverse backgrounds including retired medical staff, airline workers, volunteers and students.
Systems will also need to be more focused on the competency of the workforce, training employees in the skills needed to deliver their role safely and efficiently. The aim from the offset should be designing broad and rewarding recruitment, training and career pathways that will attract and retain the right talent. This could include consideration of how these roles can be steppingstones into future training or careers, as well as how apprenticeships could open doors for eligible people to take on these new roles. To meet growing demand in the national breast screening programme in collaboration with the College of Radiographers, roles and clinical career frameworks were redesigned to introduce two unregistered roles, mammography associates and assistant practitioners, with defined scopes of practice and accreditation to undertake mammography. Approximately 30 percent of the workforce is now in these new roles.
Clinical leadership is required
Creating new roles in healthcare is about shifting care or elements of decision making to another trained and competent healthcare professional. This requires a change in approach from the provision of clinically delivered care to a position where healthcare is clinically led but can be provided by a diverse multidisciplinary team. Clinicians should be at the centre of the redesign of the workforce but their input will need to be coupled with that from those with the skills and expertise in increasing capacity.
The NHS has had mixed success in integrating new roles into healthcare teams. The COVID-19 vaccination programme was a nationally designed workforce model which used simulation to provide an evidence base and was clinically led and worked well. Another approach, the Additional Role Reimbursement Scheme (ARRS) was established in 2019 had more variable results. This provided an automatic funding stream to Primary Care Networks to recruit 26,000 alternative roles to expand service provision and reduce patient waits. This was part of the government commitment to improve access to general practice and included roles such as clinical pharmacists and technicians. Not all practices have seen the anticipated benefits of these roles, with the Kings Fund highlighting that the roles were not being implemented or integrated into primary care teams effectively.
It will also be important to manage the expectations of patients away from expecting that they will always see a medical professional. The government and NHS leaders will need to consider how to secure public acceptance of self-management for those with long term conditions, more care being provided in the home and community rather than hospital, and from trained staff who are not medically qualified. There will need to be a visible improvement in access to healthcare services if the public are to support these changes. The NHS are aiming to have 10,000 virtual ward beds in place to support growing demand this winter, a clinically led redesign of the workforce means that care will continue to be overseen by a medical team but the delivery of healthcare will predominantly be through a multidisciplinary team of healthcare support workers and allied healthcare professionals.
New capacity will be needed to meet training needs
The workforce plan contains a commitment to grow the number of training places across all professions. Capacity to provide this training will need to be created from existing workforce and services. This creates a risk that waiting times may increase.
The plan commits to growing the number of medical school training places from 10,000 in 2028/29 to 15,000 by 2031/32. Each of these training place requires support from existing clinicians. The British Medical Association (BMA) recommends additional non-patient facing time to support trainees, of only an hour a week per trainee for consultants. To meet this standard will require over 125 full time consultants/GPs to be released each year from NHS services. By 2036/37, this will mean over 625 full time consultants/GPs will be supporting additional trainees rather than delivering care. That makes it critical that productivity and efficiency are at the heart of service redesign to minimise the impact on waiting times.
This underlines that the plan’s ambitions on training and retaining staff will not be achieved without reform. That will require a careful analysis of the right size and shape of the workforce that will be needed to meet future demand for local populations. Now more than ever, diverse, multidisciplinary, efficient and clinically led approaches will be the key principles that systems should be adopting when driving the reform of their workforce.
