Future workforce goal

Objective 1 - Support delivery of domestic education and training supply to meet NHS need with the required placement capacity expansion

Our Multi-professional Education and Training Investment Plan (METIP) is a multi-year view of our future NHS workforce investment. It optimises domestic education and training by balancing professional, geographical, and clinical service demand with education capacity. We will:

• Work with DHSC and NHSE to agree the main growth priorities for service need
• Promote undergraduate and postgraduate courses through Health Careers, building on recent university application and admission increases
• Support new professions such as physician and anaesthesia associates to provide additional expertise and capacity in patient care
• Increase placement capacity through new networks to make more use of primary care, private, voluntary, and technology-based placements combined with alternative supervision models
• Help systems and providers innovate and learn from each other
• Build on our blended learning nursing and midwifery programmes with more professions in primary and community care
• Explore new NHS entry routes such as part time education and medical apprenticeships
• Support and promote clinical academic careers to increase the skilled educator and clinician numbers to grow future healthcare graduate numbers.

The METIP provides transparency and rigour to ensure value for money and help align available funding, workforce requirements and the desired geographical distribution of activity.

Measuring progress

Board Assurance Framework Opportunities supported: 2, 3 and 4

Objective 2 - Develop a new strategic planning framework based on integrated workforce planning

This is HEE’s future focus writ large. We will work with stakeholders to produce a Long-term Strategic Framework for Health and Social Care Workforce Planning – a new Framework 15. It will analyse the key drivers of long-term workforce demand and supply, and how they impact on the shape and size of the future workforce. It will be completed in summer 2022.

Integrated planning aligns service, finance and workforce with long-term demand and supply trends and enables shorter term planning assessments. Our ‘all levers, all levels’ framing integrates workforce planning with population health, service and financial planning. This will be central to the new organisation.

HEE will develop and promote modelling tools and provide high-quality workforce data to ICSs and other partners which, along with Framework 15, the integrated planning framework and new operating model, will support better system workforce planning to meet demand.

Measuring progress

Board Assurance Framework Opportunities supported: 1, 2 and 4

Objective 3 - Continue to deliver the NHS Long-Term Plan priorities and Manifesto commitments

This objective demonstrates HEE’s contribution to cross-system work contained in the LTP and manifesto commitments, with particular regard to:

Primary and Integrated Care

To help deliver primary care with expanded multidisciplinary teams HEE will:

• deliver 4,000 GP trainees to help secure 6,000 more GPs by March 2024
• increase to 24 months the time new GP trainees spend in primary care during training
• help secure 26,000 more primary care professionals by funding and delivering Primary Care Training Hubs across ICSs to ensure workforce skills match changing patient needs
• train more physician associates and encourage them to work in general practice
• train more clinical pharmacists and pharmacy technicians to expand the primary care wider workforce. This is facilitated through the 18-month Primary Care Pharmacy Education Pathway (PCPEP)
• with the Royal College of Anaesthetists develop the educational capacity and infrastructure to support workforce expansion. Grow anaesthesia associates (AAs) in training
• commission a blended learning programme for anaesthesia associates to take advantage of current and emerging innovative technologies to widen participation and deliver expanded AA course provision into areas with the largest anaesthetic workforce gaps
• increase nurses through a new pre-registration programme focusing on first destination jobs in primary and community care.

Mental Health, Learning Disability and Autism

We will help increase mental health staff, including nurses, clinical psychologists, and child and adolescent psychotherapists by:

• developing advanced clinical practice programmes for mental health nurses and allied health professionals
• recruiting additional physicians into core psychiatry training
• improving access to psychological therapies by increasing staff trained in psychological techniques, especially for children and young people, and new perinatal mums and families
• delivering the priority actions assigned to HEE in the Psychological Professions Workforce Plan for England
• tackling the shortage of learning disability nurses by educating and training more of them
• ensuring health and care staff are trained to treat and care for people with autism and people with a learning disability through our Oliver McGowan mandatory training programme

We will also continue to support DHSC in the drafting of the Mental Health Act Strategic Workforce Plan which will set out proposals for ensuring the required workforce is in place to enact the Mental Health Act reforms.

Nursing and midwifery

We will build on undergraduate and postgraduate growth over the last three years (2021 nursing applications up 38% on 2019 (http://www.ucas.com Next Steps: Who are the Future Nurses)) to maximise domestic supply in meeting the commitment to 50,000 more nurses. To do this we will:

• promote alternative routes into training, including converting nursing associates and assistant practitioners into registered nurses, nursing apprenticeships, blended learning degrees and return to practice. This will increase diversity and widen access to nursing
• promote, inform and guide applications for nursing and midwifery courses through our Health Careers service
• create a new blended learning programme to strengthen the specialist critical care nursing workforce in adult intensive care
• seek to reduce pre-registration nurse attrition by tracking student engagement
• continue to deliver additional midwifery training places (1,000) to meet the 3,650 target by 2023, continue to deliver the Maternity Workforce Transformation Plan
• support the system response to the Ockenden Review recommendations and the Health and Care Select Committee Inquiry into maternity safety. This will include the provision of additional specialist support to maternity centres through pre CCT physician expansion from one to four posts
• develop a framework for Advanced Clinical Practice in midwifery and midwifery ACP credential
• develop the career, competence and education development framework for midwives from the point of registration, through enhanced practice, advanced practice and consultant level practice
• continue to explore new routes into midwifery training.

Allied Health Professionals

We will tackle AHP shortages across the fourteen professions to support the NHS Long-Term Plan by:

• with partners (OfS and NHS Careers) increase awareness of AHP disciplines and produce resources (e.g. quick guide resources) to stimulate interest and broaden routes into the professions
• grow targeted pre-registration training and placement recovery to expand placements and apprenticeships, support workers and career development
• optimise the role of the support worker within each profession through the development of career framework and educational review
• support a national programme of ethical international recruitment
• reform education across each of the professions to develop clinicians to meet the complex, changing needs of populations.

Cancer and Diagnostics

To help meet NHS priorities we will contribute to the new Cancer Strategy due to be published in the summer 2022,focusing on the initiatives being implemented and supporting partners with their delivery plans.

To help meet the demand for diagnostics and the recovery of diagnostic activity we are working with NHSE to develop Community Diagnostic Centres (CDCs). HEE will ensure a pipeline of key staff in imaging; endoscopy; pathology and healthcare science; physiological measurement; and genomics. To deliver this we will:

• recruit additional medical trainees in priority professions
• implement regional academy-style training infrastructure for imaging and endoscopy
• boost capacity and skill mix for clinical endoscopists and reporting radiographers
• pilot new roles in endoscopy and imaging, including care navigator and practice educator roles to better integrate education and training into service delivery
• increase histopathology capacity by upskilling biomedical scientists and increasing scientific
• training places
• increase training places for key genomic professions.

To further support increased capacity across the cancer pathway we will:

• train more radiographers and advanced practice radiographers to support radiologists
• increase the number and capabilities of the cancer support and assistant practitioner workforce
• increase access to, and mobility through the workforce to maximise staff skills and offer rewarding careers
• increase the skill mix in MDTs and free up doctors’ time for more complex oncology and breast cancer cases through new advanced practice roles
• develop cancer nurse specialists, chemotherapy nurses and cancer support workers
• promote genomics for early screening, especially where a family history of cancer exists
• train more NHS staff about the relevance and potential of genomics to their roles.

Measuring progress

Board Assurance Framework Opportunities supported: 1, 2, 3 and 4

Objective 4 - Through global health partnerships, we will facilitate an increase in the quantity and quality of staff working in the NHS

International graduates will continue to make an outstanding contribution to patient care. The exchange of healthcare workers between nations is desirable with the NHS enriched by the experiences of those who have trained in different contexts. To support the Government’s global health priorities, we will:

• develop NHS Global Health Solutions through piloting ethical recruitment models and education pathways which meet local needs and the WHO Code of Conduct on International Recruitment of Health Personnel, supporting transition of successful pathways to the system
• increase global learning opportunities for NHS staff through mutually beneficial co-developed programmes with our overseas partners
• develop a global learning outcomes framework which supports NHS staff and systems to understand the learning which is gained from engagement in global health
• develop partnership programmes between GHP and ICS organisations in England to explore and deliver global health workforce solutions
• strengthen partnerships between NHS systems and overseas partners, building on our Managed Educational Partnerships model, and successful models of technical collaboration
• continue to support the contribution to patient care made by international graduates.

Measuring progress

Board Assurance Framework Opportunities supported: 1, 2, 3 and 4

Objective 5 - Deliver education and training reform to address health inequalities and facilitate multi-professional team working

Our education reforms will develop professional competencies that are responsive to changing health needs, address health inequalities, overcome professional silos, and harness digital technology in learning whilst strengthening professional identity and leadership values.

The Future Doctor Programme enhances doctor’s generalist skills to support population health, better treat multimorbidity in patients with complex needs, improve the quality of care and support ICS ambitions. COVID-19 showed how crucial generalist skills are for all clinicians.

Enhancing Junior Doctors Working Lives will continue to embed greater training flexibility to address exhaustion via Out of Programme Pause and Less than Full Time initiatives. To address health inequalities, we are changing the geographical distribution of postgraduate medical training investment so future doctors align with population health needs more equitably. We will also embed innovations from the pandemic by reforming recruitment, progression, and assessment.

We will also work with medical schools to increase recruitment from disadvantaged and diverse backgrounds through an undergraduate medical degree apprenticeship. Further reforms will ensure graduates are better prepared for Foundation Programmes.

Dental education reforms outlined in the Advancing Dental Care Review Report will support skills development, widen access and participation and improve training flexibility to produce a skilled multi-professional oral healthcare workforce supporting patient and population needs. The reforms will include the establishment of a Lead Employer for Dental Education trainees.

We will also do more to train clinicians to help patients and families to make informed decisions about their own health and care. The NMC’s Future Nurse Standards for registered nurse education places a much greater emphasis on health promotion and self-care.

New standards and reforms to pharmacy education and training will enable pharmacists to play a greater clinical care role from their first day on the register, including independently prescribing. Clinical pharmacists and pharmacy technicians are being developed and deployed in Primary Care Networks and ICSs to support primary, secondary and urgent care, specialist practice, and ambulance services. Community pharmacists are also providing expanded services including medicines optimisation, prescribing and urgent care for minor illnesses.

Our reforms to undergraduate medical education, will include a final year six-month placement or ‘internship’ under the auspices of the medical school. This work with medical schools will help to ensure graduates are better prepared for their transition to the Foundation Programme.

We will also support the development of multi-professional working, supervision and training through various initiatives including the development of multi-professional credentials, a multi- professional supervision workstream and the roll out of the multi-professional Leading Through Education to Excellent Patient Care (LEEP).

Measuring progress

Board Assurance Framework Opportunities supported: 1, 3 and 4