Implementation of the NHS Long Term Workforce Plan

This blog has been contributed by Dr Katie Petty-Saphon, CEO, Medical Schools Council

It has now been over two years since The Medical Schools Council (MSC) recommended that UK medical student numbers be increased by 5000. The Council therefore welcomed the NHS Long Term Workforce Plan when it was published in June and was pleased that the Government had recognised the need for this urgent expansion. However, it was pointed out that success would require collaboration from across the education and training and service delivery landscapes. Through a meeting of 60 senior stakeholders, chaired jointly by Professor Martin McKee and by me, medical student expansion in England was looked at through the lens of the entire system. There was no doubt amongst attendees that the system is extremely complex and that there is a need to address the multiplicity of issues raised. For London in particular, there are specific challenges related to size, the large number of trusts, the squeeze on clinical placement spaces etc.

It must therefore be recognised, that although the plan was devised by NHS England, it cannot impose its will on autonomous organisations. Regulators including the General Medical Council, Ofsted and the Office for Students will need to approve the proposals for change, and Vice Chancellors will need to decide whether the funding accompanying the expansion meets their universities’ requirements to deliver high quality medical degrees that align with their individual university’s mission.

The Plan sets an ambitious timescale to complete a whole series of changes, including:

  • Doubling medical student numbers in England to 15,000 a year
  • Expanding existing schools
  • Creating new medical schools
  • Developing apprenticeships as an alternative route for students from backgrounds which might not have even considered medicine as a career possibility
  • Shortening the standard 5 year medical degree programme from 5 to 4 years.

Current service pressures and their impact on plans for education delivery must be recognized. There is an imperative rapidly to increase medical educators and expand post-graduate training posts. More must also be done to incentivise clinical academic careers. Although each medical school will have its own views on which are the key issues that need to be addressed, generally there is a need to look at explicit details of timing and funding, including the availability of capital to support infrastructural developments and the definition of the under-doctored areas where the expansion should ideally take place. There is also a real need to develop a collaborative, transparent commissioning framework. However, none of this can be done without accurate assessments into placement capacity, the impact of increased capacity in England on applications to the devolved nations, and on applications to other clinical courses.

Despite the multiplicity of issues, MSC was encouraged by NHS England’s commitment to a genuinely joint enterprise and its intention to develop an outline delivery plan by the end of November. It is now December and said plan did not materialise, but greater clarity is emerging around Ministerial priorities. Central to these and to the financial modelling involved, is a 4-year school leaver programme. A tender document was released on 28 November and due in by 12 January. MSC is intending to submit a collaborative proposal for the development of such a framework. Immediate concerns include protecting intercalation, enhanced supervision in Foundation year 1 and the need for an increase of 25% in permitted numbers at all schools reducing from 5 to 4 years in order to provide sufficient income to maintain staffing levels on the intensified courses.

Another Ministerial priority is the Medical Doctor Degree Apprenticeship. Pilots are due to commence in 2024 with plans for expansion dependent on the outcomes.

The NHS Workforce Plan will continue to be discussed in London Higher’s Medicine Group, and members will look to collaborate and support each other through an ambitious and difficult time of change.