The state of medical education and practice in the UK. Workforce report 2023

General Medical Council

This report contributes to the efforts led by the UK governments and healthcare organisations across the UK to secure the future workforce that health services need. It presents an analysis of workforce trends, observed in the medical register, in order to provide a data resource for policymakers and workforce planners.

The report shows that the number of licensed doctors continues to grow. Since 2019, the number of doctors joining the workforce each year has been more than double the number who leave. In 2022, 23,838 doctors joined and 11,319 left. This growth continues to be strongly driven by international medical graduates (IMGs) joining the UK medical profession.

The number of IMGs joining the General Practitioner (GP) Register has almost tripled (+192%) from 2018 to 2022, whereas the number of UK graduates becoming GPs has fallen slightly (–4%). The report states that the UK’s healthcare systems must address why general practice appears to be less attractive to UK graduates, which will require efforts to resolve the persistent issues in workloads and other indicators of burnout that GPs report.

Full report: The state of medical education and practice in the UK. Workforce report 2023.

Press release: GMC says doctors choosing greater career flexibility can benefit UKs health services

Pharmacy Workforce Wellbeing

Royal Pharmaceutical Society

The Royal Pharmaceutical Society (RPS) and Pharmacist Support have published a report examining the impact of workforce wellbeing on pharmacy teams and how it can be addressed. The report is the outcome of a roundtable event in May 2023 attended by representatives from the NHS, professional bodies, employers, trade unions, education and regulators.

The report offers a comprehensive overview of the key insights shared during the event and highlights the critical themes that emerged from the discussions.

It provides an overview of the current wellbeing situation being faced by pharmacy teams, the evidence of the impact of poor wellbeing and provides some recommendations on how to support the pharmacy workforce. It states that the responsibility for the wellbeing of pharmacists and pharmacy teams does not sit with one body, it requires a system wide approach that includes the NHS, professional bodies, employers, trade unions, education, charities, regulators and individual pharmacy team members.

Full report: Workforce Wellbeing Roundtable Report

Implications of the NHS workforce plan

Institute for Fiscal Studies

In June, NHS England published its much-awaited long-term workforce plan. The plan sets out official estimates of how many staff the NHS will need in the future and proposes a range of actions and targets to achieve this. The plan aims to increase the number of staff employed by the English NHS from around 1.5 million in 2021–22 to between 2.3 and 2.4 million in 2036–37. This report examines the potential implications for NHS funding.

Full report: Implications of the NHS workforce plan

See also: NHS workforce plan implies one in eleven workers will be employed by the health service by 2036 | Institute for Fiscal Studies

Train, retain, reform: does the NHS Long Term Plan provide a coherent map for the future?

Via The King’s Fund

The NHS Long Term Workforce Plan includes plans for future growth in the numbers trained, how the service hopes to improve retention, and how the workforce of the future will be different (and trained differently) to that of today. It also ticks the box that other workforce strategies and plans (most recently the NHS People Plan) have failed to do, which is set out forecasts of future supply and demand for staff and the way in which these were derived.

This article explains that if it manages to do the things it says it will do then this could be the point at which the NHS starts to overcome the repeated workforce crises that have periodically plagued it over the past 75 years.

Full article: Train, retain, reform: does the NHS Long Term Plan provide a coherent map for the future?

Related: NHS Long Term Workforce Plan

NHS Long Term Workforce Plan

The NHS Long Term Workforce Plan was commissioned and accepted by the Government, which has backed the plan with over £2.4 billion to fund additional education and training places over five years on top of existing funding commitments | NHS England

For the first time the Plan sets out long term workforce projections. Staffing shortfalls have been an issue since the foundation of the NHS and vacancies now stand at 112,000. The growing and ageing population, coupled with new treatments and therapies, means that without action, the gap could grow up to 360,000 by 2037.

However, with demand for healthcare staff rising around the world the Long Term Workforce Plan sets out the path to:

• double medical school training places to 15,000 by 2031, with more places in areas with the greatest shortages
• increase the number of GP training places by 50% to 6,000 by 2031
• almost double the number of adult nurse training places by 2031, with 24,000 more nurse and midwife training places a year by 2031.

Taken with retention measures, the NHS Plan could mean the health service has at least an extra 60,000 doctors, 170,000 more nurses and 71,000 more allied health professionals in place by 2036/37.

Other measures to boost the NHS workforce include:

• Trainees will be on wards and in practices sooner, with plans to work with the GMC and medical schools to consult on the introduction of four-year medical degrees and medical internships, allowing students to start work six months earlier.
• More student nurses will be able to take up jobs as soon as they graduate in May, rather than waiting until September, with more reaching the frontline and treating patients more quickly.
• New medical schools could also open up in areas of the country where there is the greatest staffing shortfall, with similar plans for postgraduate medical training places.
• Train around 150 additional advanced paramedics annually, including to support the delivery of same day emergency care.
• Expand training places for clinical psychology and child and adolescent psychotherapy, on a path to increasing by more than a quarter to over 1,300 by 2031.

Full detail: NHS Long Term Workforce Plan

See also:

• Workforce plan is long overdue but so far lacks substance on retention | BMA
• NHS Long Term Workforce Plan | The Health Foundation
• NHS workforce plan response | Healthwatch
• The King’s Fund responds to NHS England’s workforce plan | The King’s Fund
• NHS Workforce Plan ‘a significant step forward for the NHS and its people’ | NHS Employers
• Workforce plan welcome but details will be crucial |  NHS Providers
• Nuffield Trust response to announcement on NHS Long Term Workforce Plan | Nuffield trust
• RCN comments in anticipation of the NHS Workforce Plan | Royal College of Nursing

NHS equality, diversity, and inclusion improvement plan

The aim of this plan is to improve equality, diversity and inclusion, and to enhance the sense of belonging for NHS staff | NHS England.

This improvement plan sets out targeted actions to address the prejudice and discrimination – direct and indirect – that exists through behaviour, policies, practices and cultures against certain groups and individuals across the NHS workforce. It has been co-produced through engagement with staff networks and senior leaders.

Full detail: NHS equality, diversity, and inclusion improvement plan

Consequences of the closure of general practices

British Journal of General Practice | 2023; 73 (731): e399-e406. | DOI: https://doi.org/10.3399/BJGP.2022.0501

Two general practices close every week in the UK. Given the pressure on UK general practices, such closures are likely to persist. Yet little is known about the consequences. The aim of this study was to explore whether practice funding, list size, workforce composition, and quality change in surviving practices when surrounding general practices close.

GP closures refer to mergers, take overs, and practices ceasing to exist. The study examined the consequences of GP closures, and found that closures of general practices result in increased list size, changes in workforce composition, and a reduction of patient satisfaction for surviving practices. At present, closures of UK general practices are increasingly common and are likely to continue into the future. This new research improves our understanding of the consequences of these closures for practices and patients.

Full paper: Consequences of the closure of general practices: a retrospective cross-sectional study

The present crisis in general practice

Fit for the Future: GP pressures 2023 | Royal College of General Practitioners (RCGP)

Data from a new survey of general practice staff paints a worrying picture of a service struggling under rising demands. 2,649 general practice staff members responded to the RCGP survey between December 2022 and January 2023, which included GPs, GP trainees, practice managers, clinicians, and non-clinical staff from across the UK.

Key findings include:

• 91% of general practice staff were concerned or very concerned about their practice’s ability to deliver the level of care that patients needed this winter.
• 95% of general practice staff said additional clinical staff over winter would help them deliver the care that patients need.
• 27% of general practice staff said their practice was at risk of closing over the next few months. The factors most commonly identified for this were:
  • Unmanageable workload and rising demand (89%)
  • GP partners leaving (67%)
  • A shortage of salaried GPs (63%)

The RCGP are calling on politicians and decision makers to urgently commit to a bold new plan to provide GPs and patients with the support that they need. This should include:

• A new recruitment and retention strategy
• An NHS wide campaign to free up GPs to spend more time with patients by cutting unnecessary workload and bureaucracy
• Improving patients’ experience of accessing care, making it easier for patients to choose to see the same GP or the next available member of the team
• Allocate a bigger share of the NHS budget to general practice

Further detail: Fit for the Future: a new plan for GPs and their patients

Full report: Fit for the Future: GP Pressures Report 2023

New personalised care workforce development frameworks

NHS England has published the workforce development frameworks for health and wellbeing coaches and care coordinators.

The frameworks provide guidance for people employed in these roles and those employing them helping to increase understanding of where they can have most impact in supporting and empowering people to improve their health and wellbeing. They also set professional standards and competencies, give guidance on supervision, training, and continuous professional development.

This completes the suite of three frameworks following the publication of the workforce development framework for social prescribing link workers last month.

• Workforce development framework for health and wellbeing coaches
• Workforce development framework for care co-ordinators

Workforce development framework: social prescribing link workers

via NHS England

The purpose of the social prescribing link worker (SPLW) workforce development framework is to: 

• Provide clear and consistent standards for SPLW practice, including their knowledge, skills and behaviours 
• Provide guidance on the support, supervision, and learning and development offer required from employers to support SPLWs 
• Promote the development of a strong and capable workforce of SPLWs and their future development
• Support improved quality and consistency of social prescribing and reduced variation in outcome and access standards. 
• Demonstrate the benefits of SPLWs working as part of a multidisciplinary team (MDT).

The framework includes core competencies for the role and links to resources to support employers to recruit and embed SPLWs in services. Organisations employing SPLWs, including primary care networks, can use this framework to support recruitment and retention. It will help them develop a greater understanding of the role, its scope of practice and the training and development SPLWs need to enable them to practice safely and effectively.

Full detail: Workforce development framework: social prescribing link workers