30 Jun I wouldn’t start from here
There’s an old joke about a tourist who stops a local to ask for directions to a local landmark, only to be told “If I were you, I wouldn’t start from here”.
It’s certainly the case that the best time for an NHS workforce plan would have been two decades ago. But the second-best time is definitely now. And, after years of lobbying, detailed policy reports and public campaigning, a substantive, funded workforce plan has been delivered.
We shouldn’t understate how significant this is. The consensus that such a plan is needed has been unshaken for years now. Several NHS policy documents have promised workforce implementation plans, improvements to workforce planning, or indeed specific targets.
Indeed, the workforce crisis is so evident that there is now serious research being undertaken to understand why successive governments have failed to solve the problem.
The long and winding road
The answer to that question is perhaps fairly obvious.
It takes ten years or more to turn a new medical student into a fully qualified GP or Consultant. A government which commits to such an expansion will almost certainly not be around to see the benefits. Indeed, the incentives of our whole political system runs counter to the sort of long-term planning needed to address the challenge of meeting the healthcare needs of an aging population.
It is arguably all the more remarkable that a government which appears to be nearing the end of its time in office would make such a commitment. Perhaps the calculus was that the newly qualified doctors could start entering the workforce shortly after the current governing party returns from a couple of terms in opposition.
Whatever the case, the measures in this new strategy look to address the key priorities of most of the sector, with a long-term, sustained commitment to increase medical school places, delivered in areas of existing shortages, plus immediate action to improve retention of the doctors already in the system (the same doctors who will be vital to train those who will now be recruited), increased nurse training, support to expand the wider multi-disciplinary practice team, and efforts to improve broader working conditions.
None of this will come cheap, so it’s reassuring to see that government is committing £2.4 billion to support this. Other experts will no doubt be running the numbers as we speak to check they add up, but there are already some question marks over funding and timescales, including on the increase to medical school places, which isn’t expected to double until 2031.
First steps
There will, of course, be areas of debate around the plan.
Some people will no doubt be concerned that the focus on degree apprenticeships (which allow government to expand medical training places while reducing their costs), will create a two-tier system (though it’s unclear whether prospective students with high social capital will game the system to avoid the debt, or whether less advantaged students end up getting left in under-resourced programmes).
Others will argue that expanding Physical Associates and other similar roles undermines training opportunities for junior doctors. For my own part, I am always sceptical of any plan which relies on new technology as part of a solution to deliver efficiencies in the public sector.
Such disagreement is inevitable. But details can get ironed out over time. This plan represents an essential first step in ensuring the NHS can sustain itself for future years.