In this piece, Dr Sarah Logan, Director of the RCP Medical Workforce Unit, reflects on the past year since the NHS Long Term Workforce Plan was published, and calls for more robust modelling of medical specialty places in future iterations of the plan.
It’s now been over a year since the NHS England (NHSE) Long Term Workforce Plan (LTWP) was published. This landmark document committed to encouraging plans to put staffing on a sustainable footing and improving patient care, such as the expansion of medical school places to 15,000 by 2031/32 – something the RCP had called for since 2018 – alongside modelled projections for workforce demand and supply over the next 15 years. NHSE also committed to refresh the LTWP at least every 2 years and to independently verify the modelling underpinning it to inform future updates.
At the time, the RCP said the publication was an important first step towards a sustainably resourced NHS – and we still think that’s the case. We were one of over 100 health and care organisations in the Strength in Numbers campaign calling for independently verified projections of the staff needed now and, in the future, to meet patient demand. We welcome that NHSE has moved to this way of workforce planning and that the LTWP’s modelled projections and the independent analysis of those projections are in the public domain so they can be scrutinised. But ahead of the planned 2025 revision there are some key updates and changes we need to see when it comes to the modelled projections of the staff we need.
The first iteration of the LTWP didn’t cover the demand and supply of medical specialties and didn’t project specialty place increases as part of the expansion of secondary care doctors. While the plan said that this was due to a lack of ‘sufficiently granular data’ and the challenges involved with predicting demand in 15 years’ time, the LTWP did also say that ‘the objective for future iterations was to establish the data and methodologies needed to form a richer range of information from across the NHS’. Improving granularity of specialty data must be a priority for the next revision of the LTWP.
Modelling the health workforce is no easy task. Designing services and teams based on population demand, and understanding the workforce needed to deliver the best care to patients with different medical conditions across different regions is a massive challenge – anyone who has tried to set up a new service, plan a rota or deliver training appreciates this. Each medical specialty faces its own workforce challenges, population demands are changeable, we know we have a leaky pipeline with doctors leaving the NHS, and many doctors are changing the way they work, including more training and working less than full time. These challenges all need to be understood and accounted for when projecting how the workforce will expand and change in the future. The LTWP still remains a huge opportunity and we cannot let this aspect of it go unaddressed.
It is so important that future versions of the LTWP set out robust modelling for the numbers of postgraduate medical specialty training places needed to meet population demand. We consistently hear this feedback from our Fellows, members and other clinicians. Projections for the supply and demand of medical specialties are key to ensuring that our health service can meet the needs of the changing population. We know our population is ageing and more people are living with multiple conditions; the Health Foundation has estimated that 2.5 million more people will be living with serious illness by 2040. Without comprehensive workforce planning for medical specialties, the NHS will not be able to give patients the high-quality care they need. Modelling these places is central to better workforce planning that is focused on meeting the needs of local populations, improving population health and reducing health inequality.
It is vital for those going through medical school as part of the LTWP expansion to see a clear career pathway laid out in the next version of NHSE’s workforce plan and know there is a job for them – this will help to retain our early career doctors. Foundation and specialty training places must be sufficiently expanded so that our doctors can continue to develop their careers. The 2025 revision of the LTWP must set out the progress that has been made since 2023 and provide details of the work that is underway to build more detailed and granular specialty workforce data that will enable future projections.
NHSE must also review the LTWP projections for growth in the physician associate (PA) workforce. The RCP is calling for a limit in the pace and scale of the PA roll-out that was set out in the plan in 2023.
Transparency around the modelling process should also be improved in the 2025 LTWP, including limitations, uncertainties and indications of where assumptions should and will change over time. The National Audit Office (NAO) report on NHSE’s modelling in the LTWP – published earlier this year – rightly highlighted this, alongside a range of other recommendations to improve the assumptions and methodology used in the plan.
It is positive to see that the plan has been subject to this independent analysis. NHSE has committed to improve the modelling as part of the regular planned updates to the LTWP, and we hope that the NAO recommendations will be accepted by NHSE in full. In particular, we hope NHSE will take on board the NAO recommendation that assumptions should ‘be generated in transparent and systematic consultation with external stakeholders’ – we agree and hope NHSE will set out what it needs from stakeholders to improve its assumptions. The RCP is keen to engage with NHSE and other organisations to make sure future modelling reflects the needs of our medical specialties.
Representing over 30 different medical specialties, we have data and first-hand views from our members about the workforce challenges they are facing. Our physicians are key to understanding demand as a whole in each specialty area, not just supply, and the types of workforce roles needed to meet demand and provide the best care possible for patients. Not only do we need to consider the additional consultant doctors needed to meet demand in each specialty, but all the roles that add value to delivering high quality patient care, from SAS (specialist, associate specialist and specialty) doctors and LE (locally employed) doctors to other members of the multidisciplinary team. These perspectives can mean future modelling and projections created by NHSE are as informed as possible. We’ve said NHSE must engage with clinicians on how it plans to implement the LTWP, and we stand ready to help.
As we said during the Strength in Numbers campaign, workforce projections alone won’t solve the workforce crisis, but they will give the best foundation for making long-term workforce decisions that can be scrutinised. We still think a long-term workforce planning approach is a key step towards a health service that is sustainably staffed for the future – comprehensive workforce planning, with modelled projections and independent analysis of them, will help to ensure that we have the health workforce we need to meet health needs now and for the future.
We look forward to the 2025 revision.
Dr Sarah Logan
Director of the Medical Workforce Unit
