• Interim workforce plan sets out vision to devolve more responsibility to integrated care systems
  • Government expected to announce fix for major pensions problem later today
  • Nursing numbers to grow by 40,000 by 2024 through improved retention, international recruitment and training
  • Changes to NHS oversight framework to focus managers on leadership and culture
  • 360 degree review of regional and national teams 

Workforce planning policy will be devolved to regional integrated care systems as part of sweeping changes to the way the NHS manages its 1.3 million staff, the long-awaited interim NHS workforce plan has revealed.

Under proposals published today, ICSs will be expected to take on a greater role in workforce planning while organisations will be expected to improve working conditions for staff.

NHS England and NHS Improvement, along with the Care Quality Commission, will adapt existing procedures for holding local organisations to account with more of a focus on leadership and culture in the NHS oversight framework and well-led assessments.

While the plan sets out some actions to be taken this year to improve retention and recruitment it has delayed many of the most pressing issues such as international recruitment, CPD training, and regulation of senior managers, until after the government’s spending review. This is because education and training budgets were not part of the long-term funding deal agreed for the NHS last summer.

The government is expected to announce changes to the NHS pension scheme today to allow senior clinicians to reduce the pension contributions to avoid tax penalties that have been driving senior staff to retire or cut their hours.

NHS Improvement chair Baroness Dido Harding, who is leading the national workforce review, told HSJ ahead of publication that while some issues had to wait until questions about funding were settled there was much the NHS could do now to improve its people management which she said would make bids for Treasury funding “more credible”.

The review’s publication, initially due early in the spring, has been delayed several times and seen several major leaks.

She said she would like to see ICSs take on education and training policy in their areas arguing: “You will get more accurate and real time assessments of what you really need. No one can guess from Whitehall the specific needs in specific local systems.”

The new NHS England and Improvement regional teams will become responsible for coordinating recruitment and five-year system workforce plans.

While some issues such as professional regulation, credentialing, and prescribing rights, will remain nationally controlled along with pay policy and the pension scheme, the plan said accountability arrangements will be developed “to enable ICSs to take on greater responsibilities for these activities, while ensuring we do not push ICSs to take on greater responsibility than they are ready to do”.

The interim plan, published today, will be followed by a final five-year plan after the spending review which is expected this autumn/winter.

The plan makes clear the vision for a more multidisciplinary workforce with less linear careers and greater use of technology to automate routine tasks.

While acknowledging “there will undoubtedly need to be growth in all the established professions” the document makes clear nursing vacancies require urgent action as they are “critical to delivering the 21st century care set out in the NHS long-term plan”.

The document includes an ambition to grow the nursing workforce by over 40,000 by 2024 with the full plan aiming to cut the proposed vacancy levels to 5 per cent by 2028. 

While it sets out the need for international recruitment and an increase in supply, the plan does not reveal any specific targets on these areas.

On NHS leadership the document said: “We have seen remarkable and rapid improvements in culture in some of our most challenged organisations with the right leadership, so we must not fall into the trap of believing that it takes years to change culture.”

It added middle managers were critical and said “most importantly national bodies must more visibly model the behaviours we want to see from leaders in our interactions with each other”.

Key proposals for the NHS workforce

  • All local NHS systems and organisations will set out plans to make the NHS a better place to work as part of long-term plan implementation plans.
  • An independent review will be commissioned this year into HR and OD practices in the NHS.
  • A new compact between national bodies and senior leaders along with 360 feedback on regional and national teams by local organisations.
  • A new offer to NHS staff will be developed over the summer of 2019 and could see changes to the NHS Constitution.
  • A new ‘balanced scorecard” for workforce issues will be added to a new NHS oversight framework, for use by regulators, and used by the CQC in well-led assessments.
  • More metrics will be added to the oversight framework on staff engagement to promote a focus on leadership and culture.
  • Wellbeing guardians in all providers and primary care networks.
  • New multiprofessional credentials will be developed for staff to widen skills and develop careers.
  • To encourage more generalist medics, a new internal medicine training model for doctors will be created to deliver two-thirds of postgraduate medics having generalist training.
  • There will be a consultation on introducing prescribing rights for physician associates within 24 months of their regulation.
  • More streamlined induction for new starters with passports allowing staff to move to providers without having to repeat training.


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