The required actions from nurses to enable the delivery of the NHS Long Term Workforce Plan (LTWP), whether in frontline care delivery or education roles, need some consideration. Setting out both ambition and actions, the plan (NHS England, 2023) estimates that the NHS workforce will need to grow to from 1.4 million full-time equivalent (FTE) staff in 2021/22 to between 2.3 million and 2.4 million FTE workers in 2036/37.
The LTWP includes expansion of pre-registration and clinical apprenticeship programmes. The aim is that, by 2031, 22% of training for all programmes will be provided via this route from the current baseline of 7%. This is supported by several reform priorities for the clinical professions, including a 40% rise in nursing associate training places over the next 5 years. By 2036/37, the objective is to have over 64 000 nursing associates working in the NHS, compared with 9300 in 2023.
The plan also states that over 3000 clinicians will start advanced practice programmes in both 2023/24 and 2024/25, with an ambition that, by 2031/32, there will be over 6300 clinicians starting advanced practice pathways each year.
At the Nursing and Midwifery Council (NMC), we are working closely with colleagues across the UK to ensure that our work responds to areas required for future staffing demand. This includes several considerations as part of our undergraduate practice learning review, the delivery plans following the agreement to apply additional regulation to advanced nursing and midwifery practice roles, and the agreement this month to the NMC regulating the role of the Nursing Associate in Wales following a request from the Welsh Government.
However, the National Audit office (NAO) (2024) has just assessed NHS England's modelling for the LTWP. This has highlighted a number of weaknesses, including a complex design, manual adjustments, optimistic future assumptions, with limited public communication of their uncertainty, and modelling outputs that could not be fully replicated. The NAO report suggests that these weaknesses need to be addressed if the modelling is to be a reasonable basis for regular strategic workforce planning.
The NAO found that some of the assumptions may be optimistic, highlighting that the projection regarding increasing domestic education and training – so that between 2022 and 2031 medical undergraduate numbers double and nursing undergraduate numbers nearly double – is at the top end of the maximum expansion considered by NHS England as theoretically possible. However, NHS England's analysis does not include an assessment of the capacity constraints to an expansion of training on this scale or the costs required to overcome any constraints.
The report also recommends that NHS England's modellers should consider whether it is reasonable to expect the same rate of rising productivity from a workforce increasingly composed of newly qualified staff. It suggests that future versions of the modelling would be improved by taking better account of the factors that could limit the expansion of education and training, and of any reductions in service that might result from rapid increases in the amount of on-the-job training. In addition, the report recommends that the modelling should incorporate more realistic assumptions on the minimum level of international recruitment of doctors in future, as the model projects that there will be no international recruitment of doctors at all from the mid-2030s, which the NAO report states is not a reasonable assumption.
The NAO report highlights that, although the decisions taken as part of the LTWP are out of the scope of its review, the government has only committed funding up to 2028/29 and that NHS England plans to make changes in stages, giving it a built-in opportunity to make adjustments to its workforce plans after it has revisited the modelling.
NHS England has committed to regularly refreshing the modelling and publishing the results, recognising that there is potential to improve it. Navina Evans, NHS England's chief workforce officer, said the long-term workforce plan is ‘based on credible and robust modelling’ that has been developed by experts and assessed by think tank The Health Foundation.
Responding to the NAO report, Saffron Cordery, deputy chief executive at NHS Providers, said:
‘Trust leaders want – and need – the NHS long term workforce plan to be a success. It is therefore deeply concerning that “significant weaknesses” in its modelling have been identified.’
Data-driven plans are critical for success, for our profession to understand both the baseline and delivery plans. It is therefore critical that we engage with the professional conversations that are needed now for clarity of the future requirements from the existing workforce.