The NHS Long Term Workforce Plan was finally published last week.  It came in at a meaty 151 pages, but what does it mean for general practice?

Well as with most NHS documents, there is a lot of talk and sell and so it is not easy to get underneath what is actually written.  Equally, it is important to consider what is not being said as well as what is in the document.  But despite all that there are some important takeaways for general practice, as well as clues as to what is planned for the future.

There is no mention of the previously promised 5,000 (which became 6,000) additional GPs.  However, the current problem is at least acknowledged, “the model assumes some boost in GP numbers as a result of interventions in recent years, but the projected growth over the long term fails to keep up with expected demand. In 2022/23 the overall FTE GP workforce (including GPs in training) grew by 1.4%; however, there were 512 (1.8%) fewer FTE fully qualified GPs in April 2023 compared to April 2022. The shortfall in fully qualified GPs is projected to be around 15,000 by 2036/37 without intervention” p35.

The plan to close this gap appears to be threefold.  First to train more GPs:

“To meet the demand for GPs, this Plan outlines a need to increase the number of GP specialty training places by 45–60% by 2033/34. Our ambition is to increase the number of places by 50% to 6,000 by 2031/32. In 2018 the government expanded the number of medical school places by 1,500 and the first of these graduates are now starting to join the workforce. This Plan commits to initially growing GP specialty training by 500 places in 2025/26, timed so that more of these newly qualifying doctors can train in primary care. Further expansion of GP specialty training places will then take place with 1,000 additional places (5,000 in total) in 2027/28 and 2028/29. This will offer the same opportunity to a bigger pool of doctors graduating as a result of the increase in undergraduate places outlined in this Plan.” p41

Second, the use of more specialty and associate specialist (SAS) doctors, with a modelled increase “particularly targeted” towards general practice.  Third, to continue the introduction of new roles into general practice.  The document contains this very interesting paragraph about the ARRS:

“In general practice, we will seek to extend the success of the Additional Roles Reimbursement Scheme (ARRS), which has delivered an additional 29,000 multiprofessional roles in primary care. This would build extra capacity and free up available appointments by increasing the number of non-GP direct patient care staff by around 15,000 and primary care nurses by more than 5,000 by 2036/37.” p95

Extending the success of the scheme is not quite the same as extending the scheme, but it does point to there being some continued growth of funds for additional roles into the future (albeit at a much slower rate, introducing approximately half as many new staff again over an extended 13 year time period).

This also appears to be separate from a further increase in “personalised care roles”, with this expansion quantified as follows (p98):

• Care co-ordinators: Increase from over 4,000 current posts (September 2022) to 12,000 by 2036/37
• Health and wellbeing coaches: Increase from over 1,000 current posts (September 2022) to 6,000 by 2036/37
• Social prescribing link workers: Increase from over 3,000 current posts (September 2022) to 9,000 by 2036/37
• Peer support workers (mental health services) 4,730 staff in post by the end of 2023/24. Extend growth so there are over 6,500 by 2036/37 (NHS Mental Health Implementation Plan)

Whether or not this is the same thing being reported twice is unclear, but the promised increases do not match up so they could well be separate.  It may also point to a future separation of these personalised care roles from the other roles within the ARRS.

We also get a hint in the document that plans are being developed behind the scenes to bring general practice and the delivery of community services much closer together.  It states, “ICSs will be encouraged to work with partners to support the recommendations of the Fuller Stocktake for innovative employment models and adoption of NHS terms and conditions in primary care” p62.  This does have the feel of wanting general practice to come under the wider NHS umbrella, which would suggest a move away from the independent contractor model (although our current understanding of this is that it will be an option as opposed to mandatory).

It also talks about bringing primary and community care workforce development together, “In 2023/24, NHS England will work with partners to develop a national, multiprofession, integrated community and primary care core capability and career framework to support workforce development” p67.  Whether this is to be applied via PCNs, integrated neighbourhood teams, or some other form remains to be seen.

What appears to be most lacking from the document is any concrete plan to deal with the retention of staff that has proved the biggest challenge in general practice in recent years.  Despite the widespread strike action by NHS staff there is no commitment to improve pay.  There is no recognition that much of the cultural problems in the NHS come from the top and how performance management and regulation are implemented.  Instead, when it comes to retention, the document is full of platitudes like,

“However, there is much more to do to make progress through systematic improvements to recruitment and promotion practices, leadership diversity, disciplinary processes, governance and accountability, and training and education. The NHS must embed a compassionate culture built on civility, respect and equal opportunity” p60

Overall, the document does consistently recognise the increasing role that general practice will have to play in the NHS in future, and has some welcome plans to increase training and capacity.  But as we have seen over the last few years increasing the numbers coming in only helps if we can reduce the numbers leaving, and there is precious little to suggest that this will be changing any time soon.