Long read: Why does the NHS need all these extra staff?

The Government’s workforce plan sets out the rationale for why the NHS needs to expand its staffing by so much.

While the population of England is set to grow by 4.2 per cent in the next 15 years, the number of people over 85 years of age will increase by 55 per cent, many of them frail and with many diseases.

Two-thirds of people over 65 years will also have multiple health problems and a third of the population will have some form of mental health condition. NHS staffing has increased by 25 per cent since 2010 – but as we all know, it can’t keep up with demand. 

Despite many policy attempts to persuade the NHS to take more interest in preventing people from becoming ill, it still remains primarily an acute illness service. Put all that together and, unless action is taken, the NHS could have a shortfall of over a quarter of a million staff.

It is no coincidence that the current Chancellor is a former health secretary, who understands that the workforce is the NHS, and that the right people with the right skills have to be in place if care is to be provided safely and effectively.

Train, retain, reform...

The plan is set out under three themes: Train, Retain and Reform. Doubling the number of medical school places, increase adult nurses by 92 per cent, expand dentistry by 40 per cent, and, to the relief of many, increase the number of pharmacists by 29 per cent by 2028/29 as well as a yet-to-be-revealed increase in pharmacy technicians – all feature.

But it is the Reform section that caught my eye. From producing more generalists across the professions who can help people with multiple conditions more effectively, addressing skill mix within and across professions, and a focus much more on prevention, to reducing the length of training courses now the UK is no longer bound by EU rules. There’s a lot in there.

Apprenticeships in all professions will increase, not least because more will stay in the NHS after being trained. And there will be a much bigger effort to train people from less well-off backgrounds where health inequalities are often stark, and to place training schools in areas that are particularly short of health professionals.     

Will this mean there could finally be a school of pharmacy in the far south west of England?

Light on detail

So what does it all mean for pharmacy? I think it is fair to say the plan is light on detail here. Some of the right words are there – so congratulations to all those involved in securing those; I know how difficult that can be – but the dominance of the medical and nursing professions continues throughout the plan, which can lead to a lack of focus on anything else at the decision-making table. So here’s some friendly advice from an ex-chief pharmaceutical officer. 

• Embrace the plan 

There is no point campaigning against certain aspects. ARRS, for example, is set to increase, not go away. But the plan also commits to the development of staff passports to enable professionals to work across employers. Pharmacy could, if it wanted to, create a single professional service across all sectors. The future is about collaboration, not mud slinging. 

I suspect my successor will be thinking about how best to implement the plan and deliver the transformation expected – so pharmacists should get in among the various national and ICS working groups that will inevitably form to oversee the plan’s implementation.

Pharmacy leaders across all sectors should get organised, share out the work, create a common narrative and make sure every group hears the same key messages. It has to be a team game.

• Find some experts in productivity 

Productivity will be king of the future NHS. Pharmacy has a good track record here. Hospital pharmacies were one of the first to use automation of any type to free up clinical staff from dispensing and community pharmacy is on the verge of doing the same. Be ready to measure the impact and to share the rewards with the NHS. And be prepared to do more. 

• Make the ICS chief pharmacist your new best friend 

Integrated care systems will be central and critical to implementing the workforce plan. If the ICS hasn’t got a chief pharmacist yet, make sure it gets one soon. They will be thinking about system wide, inclusive, multi-professional teams, so pharmacy should too – because that’s how most staff will work in the future if they aren’t already. 

• Be on top of new technology

Digital therapeutics are emerging and genomics will have a far-reaching impact on workforce deployment. We all see the potential of AI but how can it be used effectively in pharmacy? That, with full deployment of automation including hub and spoke and extending hospital pharmacy automation to ward level to free up staff, together with improvements in data analysis capability, will get pharmacy ahead of the productivity game. 

• Recruitment

We are heading for a once-in-a-century bulge of 18-year-olds. Take a co-ordinated recruitment effort into schools and colleges at a scale never seen before. Because have no doubt, others will. 

• Clear the decks of old arguments 

Supervision, hub and spoke, original pack dispensing – all have to be sorted, and quickly, otherwise community pharmacy will be caught looking in the rear-view mirror rather than on the way ahead. 

“Throwing more bodies at the problem is not the answer”

A word from the wise

Of course, many of these activities would normally be co-ordinated and influenced by a well functioning Royal College. We may have one of those one day too, but for now it means reliance on effective collaboration across a range of pharmacy leadership organisations.

Sir John Bell, a very senior Government adviser, has said that training thousands more staff is akin to the approach taken at the Battle of the Somme. What he means is that throwing more bodies at the problem is not the answer. Instead, if we embrace and use technology in its various guises, the NHS will run much more effectively and efficiently. He has a point. 

In the lifetime of the NHS Workforce Plan a point will come when more people are no longer the answer. Pharmacy has to be ready for that.