Health Education England has unveiled a national workforce plan aimed at ensuring the NHS has the right mix and numbers of staff.

The unprecedented plan describes how £5bn will be invested in education and training to ensure 110 separate staff roles are filled.

It also reveals trends in the development of the health service’s workforce - currently numbering 1.3 million - and names areas of possible future staff shortages.

HEE was most vociferous in ordering changes to the nursing workforce. It believes local providers have inaccurately predicted their future needs, particularly within community services.

Providers’ projections of their staffing needs were collated by HEE’s regional arms - the 13 local education and training boards - and assessed nationally to consider the impact of national policies and other evidence, leading to the final national plan contradicting providers’ projections.

Although providers predicted there would be an overall 2 per cent increase in the community workforce in 2013-14, this was boosted by the government commitment to increase the number of health visitors by 4,200 in the five years to March 2015. If health visitors are excluded, employers predicted the community workforce would reduce by 1.5 per cent in 2013-14 and 2.1 per cent in 2014-15, and then be flat up to 2018.

HEE rejected these projections. “We believe that the current forecast demand for nurses does not appear to sufficiently reflect the move towards more integrated care with more services provided in a community setting or the need to provide services that are more responsive to the needs of vulnerable older people and those with mental health needs,” its plan stated.

“It is therefore our collective judgement that we should not take these projections of future demand at face value. Our assessment is that because of this dissonance with national policy we will assume a higher degree of demand is likely.”

HEE stipulated there should be an extra 500 training places for nurses on top of the 594 proposed by employers. Its plans equate to an overall 9 per cent rise. Health visitor training places have been slashed by 63 per cent.

Employers had predicted a fall of 1.4 per cent in the number of nurses from 2012 to 2014. However, this prediction appears to be inaccurate as the nursing workforce has grown 1 per cent so far over this period. The employers’ projection may indicate a belief in the acute sector that activity would shift to the community quicker than reality has shown to be the case, as well as predictions being weighted more towards affordability rather than need.

Following the debate on safe staffing levels after last year’s Francis report, employers reversed their predictions and now intend to increase the acute nursing workforce by 4.7 per cent in the year to March 2014 – an in-year growth of 3,700 full time equivalent nurses if all posts were filled.

HEE also moderated plans for midwives after past predictions fell short. Numbers rose by 10 per cent, roughly 500 a year between 2008 and 2013, with actual 2012-13 growth of 2.2 per cent compared to an employer forecast of 1.3 per cent.

The local education and training boards recommended a 0.5 per cent reduction in midwife training places in 2014-15, a drop of 14 places overall. However, HEE overruled them, leaving the number unchanged due to a “tendency for under forecasting” and the increased use of evidence-based staffing tools which may increase the midwife to patient ratios in future years.

The number of medical and dental undergraduate training places commissioned remained unchanged, with significant expansion of the medical workforce built into the system in part due to the length of time it takes doctors to complete their training. HEE says this will result in an average increase in the consultant workforce of 1,800 a year up to 2020.

The most significant medical increase was the commitment to train an additional 222 GPs annually, an increase of 2.7 per cent, in recognition of the aim to get at least half of trainee doctors to become GPs. This reflects the existing and future pressures primary care faces, with an increasingly elderly population with complex comorbidities.

HEE has also launched a separate action plan to alter training in emergency medicine to cope with a shortage of middle grade doctors and consultants in the specialty. The number of emergency trainee posts has increased by 5.6 per cent due to a three-year drive to increase posts by 75 each year.

The plan enisages a 3 per cent increase in training of allied health professional staff, a category covering 11 different roles. However, this is skewed by the 198 extra places for paramedics - a 30 per cent rise.

HEE chief executive Ian Cumming said the workforce plan was a significant advance on what came before. “In the past each strategic health authority produced their own workforce plan of what their needs were but now we can look at England as a whole with both medical and non-medical workforce considered together,” he told HSJ.

“We have been able to moderate the [local] plans as well. Only time will tell whether we are right or not.”

HEE accepts data gaps could impact on its projections. These include the level of unfilled vacancies at providers, how staff working across employer boundaries are coded within the national staff record and the data quality on workforce levels within primary care and the independent and voluntary sectors.

Mr Cumming added: “One of the areas where we have to do more work is assessing the demand from the independent sector which is increasingly delivering NHS care.

“But to produce this within the first 10 months [since HEE was created] is a tremendous achievement.”

 

Staff group2014-15 placesIncrease/decrease on previous yearPercentage change
Adult nurses13,2281,0949%
Practice nurses218169344.9%
Paramedics85319830.2%
Health visitors1,041-1,746-62.6%
Medical Undergraduate6,07100%
Emergency medicine359205.6%
GPs8,0892222.7%
Core surgical training1,268-71-5.6%