The roles and responsibilities of non-medical NHS staff would be dramatically expanded over the next five years under the NHS Five Year Forward View.

The vision for the future of the NHS, published today, says the health service would “lock itself” to “outdated models of delivery” if it did not invest in workforce changes to support “necessary change”.

Among the national NHS oversight bodies’ proposals is expanding primary care leadership to include “nurses, therapists and other community based professionals”.

It describes “nurses working from community bases equipped to provide a much greater range of tests and treatments” and calls for pharmacists and ambulance staff to be allowed to treat and refer patients in a more “flexible” manner.

Nurse treating patient

NHS leaders have proposed expanding primary care leadership to include professionals based in the community

Midwives would be given the chance to take over and run NHS funded maternity services, under the forward view.

The document says the NHS workforce has grown by 160,000 full time equivalent posts since 2000 but there had been only a 0.6 per cent shift from acute to community settings.

It says: “Since it takes time to train skilled staff the risk is that the NHS will lock itself into outdated models of delivery unless we radically alter the way in which we plan and train our workforce.”

NHS England medical director Sir Bruce Keogh welcomed moves to give staff “responsibility that matches their capability”. He added: “There is plenty of work to go around; almost any doctor will tell you they are pretty busy, and people don’t have to be protectionist.

“In reality we need to do this in way that doesn’t frighten the horses, and the horses will be a combination of professional fears at one level and patient fears at another.”

The forward view also appeared to make a subtle change in national NHS bodies’ “seven day services” policy. It says there should be access to seven day services “where this makes a clinical difference to outcomes”.

Sir Bruce told HSJ in relation to additional hours of working that the focus was on urgent and emergency care, but that seven day elective services were likely to develop over the longer term “in the wake” of changes to urgent services.

He said: “I think [elective care] is a longer term game, the trouble is if we get bogged down in that debate we’ll derail getting even the urgent and emergency care stuff, so we need to get that right.”

In relation to NHS staff pay the forward view says: “As the economy returns to growth, NHS pay will need to stay broadly in line with private sector wages in order to recruit and retain frontline staff.”

British Medical Association council chair Mark Porter said there should not be a “blank cheque” on experimentation with new roles for staff, but if it was done “properly” the BMA “would not rule out things that are good for patients if they have been developed by and in conjunction with doctors”.

He said the biggest barrier to service innovation was the “tremendous resource restrictions going on at the moment”.