NHS Long Term Workforce Plan: NAO report exposes weaknesses, RCGP warns of shortcomings for GPs

Professor Hawthorne says LTWP will not work if “concerns around plans to grow the GP workforce are not listened to.”  

Responding to a new National Audit Office (NAO) report that indicated that NHS England’s Long Term Workforce Plan (LTWP) needs improvements, the Royal College of General Practitioners (RCGP) has expressed concerns that the plan may not adequately address the needs of GPs.

Published in June 2023, the workforce plan estimated that the NHS’s health workforce will need to grow from 1.4m full-time equivalent (FTE) staff in 2021-22 to between 2.3m and 2.4m FTE workers in 2036-37, an increase of 65 per cent to 72 per cent.

However, the NAO report highlighted that the workforce modelling has significant weaknesses, including a complex design; manual adjustments; optimistic future assumptions and limited public communication of their uncertainty; and modelling outputs that could not be fully replicated.

To improve the modelling, the report recommended exploring the uncertainty of these assumptions and considering potential outcomes if they do not materialize as expected. Additionally, it suggested including full integration of the different parts of the modelling pipeline to minimise manual adjustments.

Gareth Davies, head of the NAO, said: “The creation of the modelling that underpins the Long Term Workforce plan has been a significant undertaking. However, NHS England must strengthen its workforce modelling next time around to make better-informed decisions about the NHS’s future workforce.”

As revealed by the National Audit Office, NHS England has recognised the need to improve the modelling, and is committed to regularly refreshing it and publishing the results.

Reacting to this report, Professor Kamila Hawthorne, Chair of the Royal College of GPs, remarked that when the NHS workforce plan was launched, they had cautioned that “the devil would be in the detail.”

The NAO report has revealed that many of those details “fall far short of what is needed for patients struggling to access our services, and hard-working GP teams working in the face of intense workload and workforce pressures,” she noted.

Particularly, she expressed concern over the “stark disparity” between the number of qualified doctors expected to be working in general practice compared to secondary care over the next decade.

She welcomed a substantial increase in training places for general practice being central to the LTWP plan, but emphasised that relying solely on trainees to address workforce gaps is not ideal.

Professor Hawthorne elaborated: “They are in training to learn - and while this includes delivering vital care for patients, this is not the primary purpose of training. It is also the case, as the NAO report makes clear, that supervising GP registrars has significant workload implications for qualified GPs - and this risks decreasing the amount of time they are able to spend with patients.”

Furthermore, she highlighted that the current job pressures are prompting many to leave earlier than planned, with 25 per cent of GPs in a recent survey indicating their intention to leave in the next four to five years. Therefore, she stressed the need for implementing “urgent and radical” retention strategies to keep qualified GPs at all stages of their careers in the profession.

The NAO report cited that NHSE is placing a high reliance on SAS doctors for fulfilling the aims of the LTWP, but Professor Hawthorne has expressed doubt as to “how these doctors could and would safely and effectively be integrated into general practice.”

“Trainees and SAS doctors are not experienced, fully trained GPs but the concerns repeatedly raised by the College about this have not been addressed at all,” she said.

Professor Hawthorne’s other concern, which was also highlighted in the NAO report, is the lack of adequate space for training more GPs.

“Recent polling by the College found that two in five GPs said their practice was not fit for purpose, of these, alongside safety and access concerns for patients, 75 per cent said there wasn’t enough space to take on additional trainees,” she noted.

While she acknowledged that the NHS Long Term Workforce Plan is crucial for ensuring an adequate workforce in the health service, Professor Hawthorne emphasised that it will not work if “concerns around plans to grow the GP workforce are not listened to.”

The RCGP general election manifesto for England has set out seven solutions for safeguarding the NHS, including a national retention scheme to keep GPs at all stages of their career longer, delivering patient care, as well as significant investment in GP infrastructure.