Response to the NHS Long Term Workforce Plan

NHS England has today released its first Long Term Workforce Plan. The Royal College of Anaesthetists (RCoA) recognises this as a very welcome and significant first step towards putting NHS staffing on a sustainable footing.

Dr Fiona Donald, President of the Royal College of Anaesthetists said:

“The NHS has for years been asking for a long-term plan for its most valuable asset – its people – so this 15-year strategy, with iterative reassessment to keep it on track, is a huge step forward. The plan sets out ambitious targets to train record numbers of doctors, nurses, dentists and other healthcare staff, backed with £2.4 billion of new money. This investment is to be celebrated, and the RCoA stands ready to help fully develop and implement these plans, to secure the future of the specialty, protect and enhance the prospects of our membership, and to ensure better care for patients.

“The RCoA has consistently and vigorously campaigned for the expansion of specialty training, and we are pleased to see NHS England’s acknowledgement that an increase is necessary. We now need to see more detail on training numbers and a commitment to the expansion of anaesthetic training places to cope with demand, immediately and in the future.”

Our initial response to key parts of the plan

A doubling of medical school places to 15,000 by 2031/32, with the first new places coming online in September 2025.

This is a positive step, as the provision of medical school places has long been a limiting factor to increasing the number of doctors. However, it must be accompanied by an increase in the number of specialty training places to avoid bottle necks in future.

A move to reduce medical school training from five or six-year degree programmes to four years.

The decision to reduce the duration of medical degrees can only be implemented if it does not negatively impact on quality and consequently on patient safety and NHS productivity. This will require a robust evidence base, and we are pleased that clinicians will be involved in the exploration of this concept.

A renewed focus on retention and wellbeing, with better opportunities for career development, flexible working options and rest and refreshment facilities.

We welcome moves to boost retention, including allowing for more flexible working, which was a key issue identified in our Respected, Valued, Retained report, and access to better rest and refreshment facilities. We are keen to see swift and substantial action on these points. However, these are not the only factors affecting morale and wellbeing – more must be done to make staff feel valued, and pay and conditions are important parts of that.

Acknowledgement of the need for growth in foundation year placements and expansion of specialty training in future years, commensurate with the growth in undergraduate medical training.

The shortage of anaesthetic training posts is not only a concern for the future, it is a huge problem here and now. Students beginning medical degrees in 2025 will not enter higher training until the 2030s, but anaesthesia is oversubscribed now. The lack of adequate training places for anaesthetists is having an adverse impact on the ability of the NHS to meet its current targets for reducing waiting times. It is also creating huge uncertainty and anxiety for those currently in, or hoping to enter, core training.

Plans to boost NHS productivity, including through better perioperative care, incorporating earlier preoperative health screening and optimisation, and increased access to day surgery, enhanced recovery pathways and enhanced care services.

We welcome the renewed commitment to perioperative care, which is good for patients, clinicians and the efficiency of the NHS.

Plans to expand Anaesthesia Associate training numbers

This proposed increase in the number of anaesthesia associates must go hand in hand with a proportional increase in the number of anaesthetic doctors who will lead on the education and development of AAs within a proper supervisory framework.

We will continue to analyse the plan in detail, especially with regard to investment in the anaesthetic workforce. We would also like to see similar plans developed across the devolved nations.