“A once-in-a-generation workforce opportunity”.

…the pity is that this opportunity wasn’t taken  a decade ago – during the previous generation.

According to the front page of the Daily Telegraph (30/06/2023) the NHS workforce plan published last Friday is the “Biggest NHS Reform in its history “.


Only last week I posted about sizeable NHS reforms – so this is a big claim (to which I will return) but for the moment let’s examine it in the context of it being a very important workforce plan.

There are indeed some very significant issues involved here, but the most important thing about the plan is that it actually exists.

Long-term plans for the NHS are very important, but, as the name suggests, it takes a long time to create them. And since this is a very long-term plan it would have been best if it had begun to be implemented a long time ago.

The plan is very much the brainchild of ChancellorJeremy Hunt (yes, that same Jeremy who was Health Secretary from 2012).

Let’s allow him a whole year to get his feet under the table back then.  That still means that a long-term workforce plan could have started to be implemented in 2013. This would in turn have meant that the plan would have been producing nurses and GPs for some years by now.

And we could really use them.

But let’s set aside the fact that it’s a decade late. It does contain some very important reform developments.

Its central theme proposes big increases of numbers in the workforce (doubling the number of medical school places by 2031), but there are also three significant reforms. So, it’s not just about numbers – acceptable to most – but also about reforming the way in which we train staff.

Developing clinical apprenticeships at scale.

The plan is that in 15 years from now 2000 people per annum will be gaining a medical degree through an apprenticeship. The first scheme starting next autumn with 200 students. Apprenticeships will also be ideveloped across the board and by 2030 a fifth of all clinical staff being trained will be being trained as apprentices. (Up from 7% today). Doctors, nurses, midwives and allied health professionals. This is branded as “earning whist  learning” – potentially attracting very different people from very different backgrounds into these professions (and we need them).

Once you reach one fifth of a total you have developed a real new model of all clinical training. By 2030 we will be able to compare the different training models.

Development of apprenticeships – at this level – is a serious reform.

Development of many more clinical roles around clinical associates.

By 2030 the plan aims to deliver three times as many physician associates and five times as many nurse associates. As a proportion of all clinical staff this increases the size of this group from 1% to 5%. As the plan argues, this allows staff with a higher level of training to concentrate on the work that only they can carry out.

This degree of skill substitutions is a serious reform.

Creating new qualifications.

The plan pledges to discuss with the GMC and the NMC creating a 4-year medical degree and a 2-year nursing degree.

The nature of knowledge and where it resides (and potentially all recorded human knowledge is available on the machine I am using to write this post) can radically change the way in which training takes place. Ara Darzi, amongst others,  has argued that medical degrees can be shorter.

This will now become a real national debate.

Whilst I am not sure these three sets of reforms are ‘the biggest NHS reforms in history” they are extensive.

Those in favour of the status quo (and some significant organisations will take that position) will argue against change. Some will argue about the potential safety risks brought about by these training reforms. Others will claim that we are dumbing down great professions. You will be hearing a lot about this over the coming days.

As I set out out last week, reforms do not happen unless the Government – from Prime Minister, through Secretary of State, to other ministers – argue for them. Not just once in a press conference at Number 10 but, between them, every week for the next 6 months. If the Prime Minister wants his ‘biggest reform in NHS history’ to actually happen he will have to come out and argue for it. Strongly and frequently.

Some significant organisations will disagree with these reforms. The Government are going to have to argue with them.

As I suggested last week, having a plan is only small part of the process of change. Just the first step. Only by possessing a clear argument and winning it can it be brought into being.