The Royal College of Physicians (RCP) has responded to the government’s consultation on the 10-Year Health Plan.
Lord Ara Darzi’s independent investigation into the state of the NHS in England showed a health service in desperate need of reform. The report highlighted many of the problems the RCP have raised for several years, from a demoralised and understaffed workforce to the importance of prevention and the need to use the resources we do have more effectively.
The government is now developing a 10-year health plan for the NHS, focused around three strategic shifts: hospital to community, sickness to prevention, analogue to digital. The RCP has responded to the government’s consultation around the biggest challenges and enablers to achieving each shift. It is vital that the voice of physicians is feeds into the development of the plan.
We understand the plan is due to be published in Spring 2025. The RCP will continue to engage with key stakeholders as the plan is developed. Members and fellows have until 5pm on 2 December 2024 to respond to the consultation as individuals - we encourage you to share your experiences and ideas for change as physicians on the ground. Physicians’ voices and first-hand experiences are vital to inform government about what is working, what is not working and what improvements need to be made.
Summary of the RCP’s consultation response
In the 10-year plan, the RCP wants to see patients put first by ensuring there are enough NHS staff who have time to deliver high-quality care, as well as plans to transform healthcare services to meet population need, deliver a cross-government strategy to reduce health inequalities and prevent ill health, as well as bold action to facilitate innovation and create a sustainable net zero NHS.
Throughout, the RCP’s response emphasises the need for the government’s three shifts to be underpinned by robust actions to address NHS workforce challenges. The 10-year plan must recognise the role of NHS staff in delivering the government’s vision and account for the impact of current workforce capacity on delivering reform over the next decade. It must consider the goals and implications of the NHS Long Term Workforce Plan (LTWP), while also ensuring these two strategic plans remain distinct from each other.
The RCP’s response makes recommendations across each of the three shifts and workforce as a key enabler and barrier to ‘fixing the NHS’, including:
• Workforce:
- Support and funding the 2025 revision of the LTWP, with revised independently verified workforce projections, continued funding for the expansion of medical school places, and a plan to increase capacity for medical education and training.
- Fund the expansion of foundation and specialty training places based on population need.
- Delivery of a plan for retention, valuing staff, balanced professional activities, prioritising workforce wellbeing and getting the basics right (e.g. ensuring staff can access hot food and drink).
- Work with NHS employers to ring-fence time for education, career development, clinical research, and quality improvement in job plans.
- Limit the pace and scale of the physician associate (PA) roll-out, working with NHS England to review the projections in the LTWP for growth in the PA workforce.
- Commission a review of postgraduate medical training that looks at how doctors will want to learn and work in the future.
- Reverse the declining number of clinical academics at all career stages.
• Hospital to community:
- Recognise the leadership role for physicians in delivering care for local populations as part of the neighbourhood health team.
- Prioritise initiatives to reduce the environmental impact of healthcare delivery within the NHS, ensuring these are appropriately funded, including capital investment where necessary.
- Expand integrated models of care by commissioning services in a way that incentivises joint working across primary, community, and secondary care and shift payment mechanisms to focus more on outcomes, rather than activity.
• Sickness to prevention:
- Deliver a cross-government strategy to reduce health inequalities that considers the role of every government department and policy lever to tackle the wider determinants of health, with clear measurable goals and metrics, underpinned by the necessary funding settlement. The government's mission delivery boards should be the vehicle that develops this.
- Deliver funding to ensure equitable access to weight management services across the country.
- Fund and deliver opt-out NHS smoking cessation services at any point of contact with the NHS to help smokers quit.
- Prioritise preventative interventions that deliver combined health, environmental, financial, and social benefits, ensuring that these wider benefits are measured, tracked, and reported in order to inform future decision-making and prioritisation.
• Analogue to digital:
- Invest in well-functioning, interoperable IT systems, NHS equipment, facilities, estates and digital infrastructure with an ambitious multi-year capital funding settlement.
- Commit to funding optimisation of existing systems, considering the functions of electronic patient records that should be standardised across the system (e.g. NEWS chart).
- Ensure access to training for NHS staff to ensure they feel confident using new technology or digital clinical systems and committing to value clinical input to iteratively improve workflows.
- Develop a dedicated government/NHS England ‘AI in healthcare’ strategy to set out a vision for the use of AI in the NHS.