NHS Long Term Workforce Plan (England) - briefing

Published on Friday 30 June 2023, this set out NHS England’s plans to address existing and future workforce challenges over a 15-year period. RCPCH responds.
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The NHS Long Term Workforce Plan was commissioned and accepted by the government, and provides a costed approach for how to train, retain and reform the workforce, with over £2.4 billion committed to fund additional education and training places over the next five years.

The College published an initial statement of response on the day the workforce plan was published, in which we welcomed the publication of the plan but highlighted our concerns around a current lack of focus on what it means for the child health workforce. This further briefing is aimed at RCPCH members, and outlines the key commitments within the plan, the College’s response and next steps.   


The central aim of the workforce plan is to start the process of putting NHS ‘staffing on a sustainable footing and improve[ing] patient care.’ It outlines a significant increase in training numbers and recruitment, as well as a focus on retaining staff and making the best use of existing talent.

The plan covers the breadth of the NHS workforce but does not go into detail on supply and demand projection for individual medical specialties, with the exception of general practice. NHS England have been clear this plan will be followed by more detail in future iterations and have committed to updating it at least every two years to ensure it is fit for purpose over the coming years. The College is absolutely committed to further engaging with NHS England as they develop the next iterations.

In the workforce plan, NHS England set out the strategic direction to be taken locally, regionally, and nationally to address workforce challenges over the next 15 years. These actions fall into three areas: train, retain and reform.

Train: Growing the workforce 

The first section outlines measures to significantly increase education and training places as well as increasing apprenticeships and alternative routes into professional roles. This includes commitments to: 

  • Double the number of undergraduate medical school training places to 15,000 by 2031/32  
  • Increase the number of GP training places by 50 per cent to 6,000 by 2031/32 
  • Increase the number of adult nurse training places by 92% by 2031, with 24,000 more nurse and midwife training places a year by 2031/3 
  • Increase the number of advanced practitioners, physicians associates and allied health professionals (AHPs) acting as senior decision-makers in appropriate settings 
  • Launch a new medical degree apprenticeship 
  • Train more NHS staff domestically, reducing the reliance on international recruitment.   
  • Expanding training places for clinical psychology and child and adolescent psychotherapy, on a path to increasing by more than a quarter to over 1,300 by 2031 
  • Expand training numbers of health visitors by up to 74% and nearly double school nursing places by 2031/2032. 

The workforce plan acknowledges the need to ensure adequate growth in foundation year placements and expansion of specialty training in future years, commensurate with the growth in undergraduate medical training. NHS England have committed to working with partners to understand the best way to do this including identifying priority areas for investment.

Retain: embedding the right culture and improving retention 

The second section sets out plans to improve staff retention so 13,000 fewer staff leave the NHS over the next 15 years by: 

  • Implementing actions from the NHS People Plan  
  • Supporting the health and wellbeing of the NHS workforce including ensuring integrated occupational health and wellbeing services are in place for all staff 
  • Developing a clear employee value proposition (EVP) which sets out national and local benefits, including pensions, salary sacrifice schemes and local financial wellbeing support initiatives, and flexible working 
  • Implementing plans to improve flexible opportunities for prospective retirees. This includes delivering the actions needed to modernise the NHS Pension Scheme and the introduction from Autumn 2023 of the NHS Emeritus Doctor Scheme, where recently retired consultant doctors will have an option to offer their availability to trusts across England to support delivery of outpatient care 
  • Ensuring staff are treated fairly within a compassionate and inclusive culture 
  • Supporting individuals, managers, and teams to work together to explore the flexible working options available.

Reform: working and training differently 

The third section looks at working and training differently to improve productivity, including by embracing innovation and data. Commitments include: 

  • Working with professions to embrace technological innovations, such as artificial intelligence and robotic assisted surgery  
  • Ensuring that at core stages of their training, doctors have access to development that broadens their generalist and core skills 
  • Supporting medical schools to move from five or six-year degree programmes to four-year degree programmes 
  • Piloting a medical internship programme which will shorten undergraduate training time 
  • Supporting SAS doctors to have a better professional experience, by improving equitable promotion and ensuring options for career diversification 
  • Delivery of the same care in settings closer to home.

RCPCH response  

The College has been calling for a multi-year, evidence based and costed workforce plan for some time, and we therefore welcome the publication of this plan and the increased investment in training as an important first step towards putting the NHS workforce on a more sustainable footing.

However, we were disappointed by a current lack of focus on children’s health and recognition of the pressures faced by child health professionals, including paediatricians. 

While we note NHS England’s reasons that specific projections for each medical specialty are not covered in the plan, we want to highlight that paediatricians care for a whole population group which makes up nearly 25% of the population and who have distinct needs from much of the adult system. We would therefore welcome greater clarity on what the workforce plan means for the child health workforce, and for children, young people, and their families. There is a concern that without specific focus on how these commitments apply to child health, the paediatric workforce will be left behind in both local and national decision-making. 

Building the child health workforce  

We were pleased to see the commitments to significantly increase medical school training places and look forward to seeing more detail on how this applies to the paediatric workforce. We also welcome the expansion of training places for health visitors, school nurses and members of the child mental health workforce.  

However, we were surprised and disappointed by the disparity between a 92% increase in places for adult nursing, with a 0% increase in numbers of child nursing places.  The plan notes ‘there is currently a sufficient number of training places to meet demand for children’s nursing’, however the experience of our members is that current shortages of child nurses are having a real impact on care for children, including on paediatric surgical cancellations, PIC capacity, and neonatal care. Having enough children’s nurses will play a crucial role in helping to meet the ambitions in this plan, including moving care closer to home and addressing the elective care backlog. 

Concerns around modelling  

RCPCH have significant concerns about the modelling which underpins the workforce projections which is based primarily on demographic population growth, as well as analysis of growing complexity of need and historical trends, and service plans which include the ambition to move care out of hospitals.   

Our view is that the modelling approach focuses predominantly on the needs of an ageing population and does not seem to have sufficiently accounted for the recent rise in birth rate across England, increased complexity in the health needs of children and young people, and rising demand for health services, all of which has created significant pressure on the workforce. Demand for children’s health services has been rising at a faster rate than demand adult health services – with the elective waiting list growing at double the rate and community service waiting lists growing at three times the rate. We strongly believe the increase in demand and complexity needs a well-resourced workforce, and are calling on future workforce modelling to consider these factors in their projections.  

Supporting staff though out their career 

Investment in building the workforce will not achieve the ambitions of this plan if staff are not retained and their wellbeing protected, so we welcome the promise to action the NHS People Plan, ensuring that staff can work flexibly, are treated fairly in an inclusive and compassionate environment, and have access to health and wellbeing support.  

We are aware how crucial it is for the paediatric workforce that doctors are enabled to continue working up until and after retirement and so are pleased to see plans to improve flexible opportunities for those reaching that point in their career and commitment to delivering the reforms to the NHS pensions scheme. 

The College has advocated for increased flexibility and a lifelong careers approach to workforce development for some time, and we welcome this approach across the whole career journey.  

Importance of the community child health workforce 

RCPCH has long championed many of the actions put forward in the plan including innovative ways of working, parity of esteem between physical and mental health and moving care closer to home where appropriate. However, for this to be achieved there needs to be an increased focus on the paediatric and wider child health workforce, particularly in community settings where there continues to be rising demand and lengthening waiting lists.

Reducing demand through prevention 

The success of the workforce plan relies on ambitious assumptions of increased performance and mitigated demand including investing more in prevention and early intervention. Investing in the child health workforce to tackle ill health and reduce risk factors early in life is the most effective way to ensure a healthier future population and reduced demand on services.

The work of the College 

In August 2023, the College will be implementing Progress+ , a sector-leading approach to broad and person-centred training. Progress+ aligns well with the ethos of the workforce plan in its commitments to generalism, a core part of the plan, and to training the paediatrician of the future and expanding opportunities to work outside of the hospital environment during training.

We will continue to speak with NHS England about how the proposed changes to medical training will impact the paediatric workforce, recognising that addressing trainer capacity and burnout is a priority for the current child health workforce.

In the last 12 months, we have secured a commitment from all four nations to retain the number of training posts when Progress+ moves us from an 8-year to a 7-year programme. This will see an increase in the overall number of paediatric trainees reaching CCT (Certificate of Completion of Training) in the coming years and is an important achievement secured through detailed discussions and negotiations.

Work has also started on Thrive Paediatrics, a two-year project that focusses on the main barriers to fulfilling lifelong careers.

The College is developing a new approach to its work around lifelong careers and workforce planning. Please look out for updates in future member communications, and if you have any questions about Progress+ or Thrive Paediatrics, please contact progress-plus@rcpch.ac.uk or thrive@rcpch.ac.uk respectively.  

Next steps

NHS England has made it clear that this plan is the beginning of an ongoing process to address workforce challenges across the NHS.  

We will continue to work constructively with NHS England to ensure the investment outlined in the plan applies equally to the child health workforce, and that any modelling and ongoing planning does justice to the needs of children and young people as 25% of the population. 

We hope you find this briefing useful. If you have any questions about the briefing, please contact us at health.policy@rcpch.ac.uk.