The NHS 15 Year Workforce Plan: NHS Professionals’ View

Overview

On Friday 30 June, NHS England published its long-awaited workforce plan which sets out the ambitions for growing and developing the NHS workforce over the next 15 years. Its ‘Train, Retain, Reform’ focus establishes a clear direction of travel which, at its heart, commits to:

• Train the next generation of doctors, nurses and allied health professionals (AHPs) in sufficient numbers to close the current workforce gap and meet future demand.This will be underpinned by a £2.4 billion funding commitment from government and will involve ambitious plans for growing the number and proportion of workers that enter and develop in the profession through apprenticeship pathways.Not only will this secure increased numbers, but it will also open access to new workers who have previously struggled to access the healthcare profession
• Retain the workforce we already have through a combination of wellbeing initiatives, career opportunities, flexible working and reform to the pension scheme.The ambition is to encourage 130,000 people to stay working in the NHS for longer
• Reform how work is performed and training is delivered, embracing new technologies and working more efficiently across systems

Critically, for NHS Professionals, the report also clarifies the role flexible workers will be expected to play in the new workforce landscape, plus ambitions for international recruitment and access pathways into healthcare such as the recruitment, training and deployment of healthcare support workers.

The flexible workforce

Staff banks

We were encouraged to see the bank workforce included in workforce supply modelling alongside the substantive workforce, providing an additional resource to meet short-term demand for things like sickness absence and fluctuations in demand.

We wholeheartedly agree with the contention that the bank should offer the most attractive option for flexible workers; those staff that elect a ‘bank only’ option at some stage in their career due to the control and flexibility this way of working offers. We also agree the bank should be available to those substantive workers seeking - but not feeling pressured or obliged - to undertake additional shifts.

 

Agencies

We see the suggestion that substantive workers should be prevented from offering their services back to the NHS via an agency as a positive step in supporting the right messaging around ‘bank is best’. We are already working with a number of NHS trusts to transition agency workers to bank and know that it can be a time-consuming and challenging process for small in-house teams, and unsettling for the workers themselves.  Through a managed process we are able to secure positive flexible worker retention without deflecting those running the bank from ensuring continuity of bank delivery. This is being achieved through the creation of our ‘top up’ NHS Professionals National Bank service which adds these resources to existing bank supply.

 

Collaborative banks

We agree that collaborative banks have the potential to be game-changing.  Not only does collaboration help to eliminate local competition for flexible staff (which inflates pay), it also provides opportunities to move these staff around the system, promoting productivity and supporting work and career opportunities across the wider system which, in turn, support the ‘one workforce’ philosophy.       

We are fully aware of the ‘compete’ vs ‘collaborate’ tension in the move towards collaborative banks.  Trusts that have worked hard to attract flexible workers are fearful that access to this talent will be diluted and that individuals will be tempted to work for others in the system. It is partly for this reason that we have developed our National Bank service – which acts as a supplementary bank that systems can build collaboratively to add new resource without impacting current bank supply.

 

ICS role

The suggestion that ICSs should control bank pay rates at a regional level is welcome. Our NHS trust clients find it challenging that there is pay-led competition for flexible workers and experience the impact this has on the rate at which they need to advertise shifts.  Establishing regional control over rates and, importantly, managing the regional supply chain, is central in our workforce conversations with ICSs. Supply chain management and monitoring has a range of benefits including:

• it supports framework compliance
• it ensures suppliers whose partner companies bridge bank and agency are not shuffling available talent to maximise profit
• It provides oversight, which prevents those working via agencies ‘playing the system’ and waiting for shifts to cascade to higher paying agencies (even off-framework)

 

International

As a large recruiter of international staff to the NHS, we fully support a more targeted approach to international recruitment to fill specific and persistent workforce gaps and encourage the cross-fertilisation of new knowledge and thinking from healthcare sectors around the world. Working in the NHS should be aspirational and rewarding and we agree that upholding these principles, and recognising the challenges being faced by other health systems, should always determine the approach. In addition to working directly with providers, we are already in conversation with system workforce leads around their integrated and targeted strategies for international workforce recruitment.

 

Training

Healthcare Support Workers

We are excited by the commitment to increase the volume of net new workers entering the healthcare profession in lower grade roles. NHS Professionals already supplies a significant number of healthcare support workers (HCSWs) to NHS trusts using our ‘recruit, train, deploy’ model, which achieves above average retention and completion rates. With the workforce plan suggesting that 204,000 new support workers will be needed across the NHS over the next 15 years, we will look to scale our supply accordingly. This includes supply into specialist roles such as maternity, AHP and cancer support.

In line with the career pathway ambitions set out in the plan, we will continue to promote our HCSW roles as a first step into a career in healthcare.  In recent years, we have seen a number of our HCSWs progress on to complete registered nursing apprenticeships. We are already working with our client trusts to make sure these pathways are more defined and articulated so that those interested in pursuing further career development have clearer career routes to follow. 

 

Other entry-level opportunities

We are also uniquely placed to support the expansion of the supervisory workforce and we are already working with our client trusts to utilise the bank to support legacy nurse mentor schemes for those close to, or returning from, retirement. Offering managed service solutions – within which new trainees can be supplied with their own professional mentor and pastoral care support - means we can add capacity in a way that creates minimal disruption for frontline workers. In addition, we are actively widening our early career offering through a pilot scheme with NHS cadets and engagement with the Prince’s Trust, the Department of Work and Pensions and further education colleges.   We have also developed highly targeted programmes to enable specific groups of staff to access the NHS; for example, our Doctors Gateway programme provides a supported pathway into NHS employment for the considerable number of UK citizens that elect to study medicine in Europe. 

Our work with HCSWs and other staff groups means we have already made great strides in engaging, attracting and onboarding new workers to the NHS. Our work through the pandemic – particularly on the National Vaccination Programme – also demonstrates we have the ability to recruit from diverse markets at scale and attract people from all walks of life into the NHS. We will build on these skills and market knowledge as we work with ICSs to create better recruitment solutions that attract people from non-traditional segments of the population. 

 

Retention

Career development

We fully support the link the workforce plan draws between career development and retention. Our own research carried out with NHS Professionals bank members shows they are strongly motivated by training and development to stay on the bank and not gravitate to agency, where the same opportunities may not be available. Developing and upskilling our bank workforce is, therefore, a key facet of bank retention. 

We are excited to see the launch of the Emeritus Doctors Scheme in the workforce plan. The model paves the way for exploring ways in which retirees from professional groups can be brought back into the workforce to offer their services in a flexible way – particularly to support virtual care solutions. Our experience of attracting, recruiting, training and deploying returners through Test and Trace during the pandemic means we are already part way to developing a solution which offers a different type of employment experience to those who are still keen to work but no longer   on the frontline. Our bank-led legacy nurse mentoring scheme (described above) is very much part of this thinking.

 

Reform

Our new NHS Professionals Academy has been set up to support how we upskill both the flexible workforce and substantive workers, where demand dictates. It will be instrumental in our ability to develop our capacity to train workers accessing healthcare employment for the first time, through existing roles and new system roles. It will also upskill existing workers in areas like multidisciplinary team working and system leadership and the ability to deal with major present-day and future demands such as  treating co-morbidities, frailty and mental health. Building on the success of our OSCE training centres, we will continue to build out our skills-based training portfolio in a way that aligns to the ambitions of the plan. 

 

Conclusion

In summary, we believe the workforce plan validates our strategy and supports our ambitions for a targeted, highly skilled flexible bank workforce that gives the health and care sector access to additional capacity and skills and helps providers and systems to plan and manage their workforce with agility. As well as fine-tuning our strategy so it is aligned to the plan, we will proactively engage with Ministers, the Department of Health and Social Care and NHS England to ensure we continue to deliver maximum value and positive impact on patient care.