RCoA response to NHS Improvement’s Interim Workforce Implementation Plan

NHS Improvement was tasked in March 2019 by the Prime Minister and Secretary of State for Health and Social Care to develop an Interim Workforce Implementation Plan, as part of the overall Implementation Plan for the NHS Long Term Plan (LTP).

The review, led by Baroness Dido Harding, the Chair of NHS Improvement, and Julian Hartley, the National Executive Lead for the NHS Workforce Implementation Plan, has been seeking views from stakeholders on the emerging vision, potential 2019/20 actions and some key questions on each of the five emerging themes.

The RCoA has responded with a number of recommendations for each of the five themes. It is hoped that the interim plan will be published in early April.

Theme 1: We can make a significant difference to our ability to recruit and retain staff by making the NHS a better place to work

• The Department of Health and Social Care, in coordination with the relevant devolved organisations and arm’s-length bodies, should support the development without delay of a national morale and welfare strategy for all NHS staff.
• The Spending Review in 2019 should be used to provide dedicated capital funding  for improving NHS staff facilities, including provision of adequate rest, catering and study facilities.
• The practice of charging staff to use facilities that are essential to their safety and welfare, including rest facilities, should be banned with immediate effect.
• All employers should support a cultural shift towards a ‘no-blame’ learning environment that prioritises the safety of patients.
• There should be prompt and accurate payment of salaries for trainees.
• An urgent review of pension regulations is required to stop the haemorrhaging of experienced clinicians from the NHS.
• The benefits of clinical excellence awards (local and national) are well recognised and Trusts should be encouraged to award CEAs annually.  Clinical excellence awards should be looked at across the workforce spectrum.

Theme 2: If our workforce plan is to succeed, we must start by making real changes to improve the leadership culture in the NHS

• More should be done to encourage the further development of clinicians in leadership roles.
• Trusts should be encouraged to support their clinicians in medical leadership roles, for example in work for Medical Royal Colleges, as an examiner, or council member, which benefit the specialty and ultimately, patients and the wider NHS.

Theme 3: Although there are workforce shortages in a number of professions, disciplines and regions, the biggest single challenge we currently face nationally is in the nursing and midwifery profession

• Although there is an issue with recruitment to nursing, this should not be dealt with to the exclusion of other workforce areas, and specialities, which also have shortages. Ensuring the provision of a sustainable medical workforce is a vital component in the long-term planning process for health and social care services.
• By calculating the current rate of retirement combined with the increased demand from specialty growth, we believe that there will need to be a pipeline supply of between 430 to 650 new anaesthetists each year. However, over the last five years, the number of ST3s starting in anaesthesia has averaged 340.
• More needs to be done to match the gaps in training rotas with provision for MTI in the UK, in addition to the significant investment that is necessary if the UK is to become ‘self-sufficient’ in doctors by 2025.
• The use of the MTI scheme could be extended to provide a temporary solution to the current workforce situation, but efforts must continue to grow the domestic workforce.
• Growing a domestic workforce will require time and in the interim the NHS should still be able to recruit talent from abroad to fill gaps and maintain adequate staffing levels. We recommend a review of the proposals in the recently published Immigration White Paper for a salary threshold of £30,000, as this will make recruiting from abroad for lower nursing grades very difficult in the future.

Theme 4: To deliver on the vision of 21st century care set out in the LTP will not simply require ‘more of the same’ but a different skill mix, new types of roles and different ways of working

• Developing anaesthetists as ‘perioperative physicians’ improves patient care and outcomes.
• Flexible working, including flexible ‘end of career’ development should be encouraged.
• For the specialty of anaesthesia, the RCoA does not see that there is scope or positive benefit in shortening the training programme without risking patient safety.
• Medical Associate Professions – including Physicians’ Assistants (Anaesthesia) (PA(A)s) and Advanced Critical Care Practitioners (ACCPs) – can make a valuable contribution towards a sustainable anaesthetic workforce throughout perioperative care, but only if these roles are properly regulated.

Theme 5: We must look again at respective roles and responsibilities for workforce across the national bodies and their regional teams, ICSs, and local employers, to ensure we are doing the right things at the right level

• We support the proposals for the development of a single real-time workforce dataset available to national, system and local bodies.
• All roles must have national standards but decisions on numbers and exact roles can be devolved regionally to be decided in the local context.

Our full response to NHS Improvement can be viewed here.