On 30 June 2023, NHS England published its Long Term Workforce Plan which sets out how the NHS will address existing and future workforce challenges by recruiting and retaining healthcare staff. Currently the NHS has 110,000 vacancies in the workforce with 1 out of 10 posts unfilled putting huge pressure on existing staff and impacting on patient care.
The Plan has been commissioned and accepted by Government in order to improve access to healthcare, reduce waiting times and ensure that the NHS has the workforce it needs for the future. The Plan covers a 15-year period for which the UK Government has confirmed funding of £2.4 billion in addition to its existing funding commitments.
NHS England describes the Plan as:
“ambitious and it is bold, while being rooted in the reality experienced by patients and staff now, and it is rigorously aligned to the improvements in care that we aspire to make for patients. Even more crucially, it doesn’t just herald the start of the biggest recruitment drive in health service history, but also of an ongoing programme of strategic workforce planning.”
Areas of focus
NHS England have identified three key areas of focus:
- Train - to significantly increase education and training to record levels, increase apprenticeships and provide alternative routes into professional roles. Medical school training places are to double with up to 15,000 spaces available a year by 2031/32. Nursing training places are to increase by 92% overall; approximately 28,000 places by 2028/2029 and 38,000 places by 2031/32.
- Retain - ensure that NHS retain staff by better supporting people throughout their career, boosting flexibility for staff so that they can work in ways that suit them and improve culture and leadership across NHS organisations.
- Reform - changes to the way NHS work and train, building broader teams with flexible skills, and ensuring staff have the right skills. This will include expanding, enhanced, advanced and associate roles to offer modernised careers, with a stronger emphasis on the generalist and core skills needed to care for patients with multimorbidity, frailty or mental health needs. This will be achieved by providing more advanced practice pathways for clinicians (6,300 by 2031/32), increased training places for nursing associates (10,500 by 2031/32) and physician associates (1500 places by 2031/32). The plans proposes to increase NHS staff working in mental health, primary and community care by 73% by 2036/37.
What does this mean for obstetrics and maternity care?
- A 13% planned increase in the number of midwives in training by 2024/25, compared to 2021/22;
- Growing midwifery education and training in line with the conclusions of the Ockenden Review;
- Trusts will meet establishment levels set by midwifery staffing tools and achieve fill rates by 2027/28;
- continuing national CPD funding for midwives and new preceptorship for newly qualified midwives;
- Funding will continue for the shortened midwifery course in 2023/24 and 2024/25 and 5% of annual uptake for midwifery training to come through apprenticeship routes.
- Maternity Support Workers and Registered Nurses employed to compliment midwives.
- Planned increase in medical specialty training places by September 2024 to more than 2,000 over three years, as well as 1,000 additional specialty training places focusing on areas with the greatest shortages. Maternity services is identified as an area which such shortages.
Whilst the Royal College of Obstetricians and Gynaecologists and Nursing and Midwifery Council have welcomed the publication of the Plan as a means of tackling the significant pressure on delivery services and the impact of staff shortages both have some reservations.
The Chief Executive of Nursing and Midwifery Council, Andrea Sutcliffe commented that whilst "nursing and midwifery are rightly at the heart of this plan" the social care system will still present a problem and a similar plan is required for social care.
Similarly, Dr Ranee Thakar, Royal College of Obstetricians and Gynaecologists President stated that:
“Today’s publication is an important milestone, and we welcome it, with some caution. The ambitions set out will only be achieved with sufficient resource and investment for the full 15 years of the plan, and a huge commitment across the NHS to its delivery”