Modelling the medical specialty workforce – considerations for the 2025 iteration of the NHS Long Term Workforce Plan

Overview

In June 2023, NHS England published the first-ever Long Term Workforce Plan (LTWP), with independently verified projections of the numbers of staff needed to meet demand. The Royal College of Physicians (RCP) had been calling for a workforce plan with staffing projections for some years and its publication was broadly welcomed. The government has confirmed that the LTWP is due to be refreshed in 2025, following the release of the government 10-Year Health Plan.

The 2023 iteration of the LTWP did not cover the demand and supply of medical specialties nor project specialty places – but said that ‘the objective for future iterations was to establish the data and methodologies needed to form a richer range of information from across the NHS’. Improving granularity of specialty data must be a priority for the next revision of the LTWP.

Introduction

On 26 November 2024, the RCP held a specialty workforce roundtable with representatives from most medical specialties as well from the NHS England (NHSE) workforce, training and education (WTE) directorate and the GMC.

The aim was to bring specialties together to understand the shared and unique challenges facing their workforces and to learn about the approaches being taken to address future workforce modelling.

We heard presentations from cardiology, sport and exercise medicine, immunology and gastroenterology, before moving to facilitated discussion in smaller groups framed around three areas:

• Future demand for specialist medical care over the next decade
• Unique workforce challenges in each specialty
• Innovative approaches to deliver care.

Through the facilitated discussion and feedback from a survey after the event, several common themes were identified around the future demand for the medical specialty workforce that must be considered in the 2025 iteration of the LTWP. The 10 Year Health Plan must also consider the barriers and enablers in these common themes and recognise the role of NHS staff in delivering the government’s vision for the three shifts from hospital to community, sickness to prevention and analogue to digital.

Key themes emerging from the discussion

The role of a specialist as an adviser to the generalist

Many specialties described the increasing demand to offer advice and guidance both to primary care and to the emergency department and acute medical units. There were comments that we need to think innovatively about the way in which we work to address this increasing demand. This needs to be reflected in job planning and in care pathways, for example moving away from the patient seeing multiple specialists in different outpatient clinics. Involvement of patients in those pathways to ensure that the model of care is truly patient centred is key. The RCP is due to shortly set out its thinking on what a reformed outpatient service could look like.

The physician as the leader of a multidisciplinary workforce

Physician leadership of a multidisciplinary workforce that spans primary and secondary care and involves social care provision was predicted as a changing pattern of working that will impact the demand on our workforce. The need to train future medical professionals for roles beyond traditional hospital walls was emphasised.

From sickness to prevention

Prevention of illness and the role of the specialist were also noted as growing areas of demand for specialty involvement. Specialists play a vital role in supporting programmes that address alcohol, smoking, exercise and obesity and that work across primary and secondary care as well as services provided by the charity sector.

The role of physicians in research

All specialists have a role to play in clinical research in their field. Some specialties are more research active than others. The importance of supporting physicians to do research alongside clinical practice was seen by many specialties as an area where collective influencing would extremely helpful.

Geographical variation in access to specialty care

This was a common theme described by smaller specialties such as clinical genetics, allergy and immunology and nuclear medicine. The overall increase in demand for specialty input (for example in accessing and interpreting genetic testing) means that it is particularly challenging to meet needs equitably across the UK. Models of care pathways using virtual platforms, and hub and spoke models of training may be part of the solution.

Changing patterns of working by doctors

The impact of doctors wanting to work less than full time was mentioned by many specialties. In our 2023 census data of UK consultant physicians, 30% of respondents said that they were contracted to work less than full time (LTFT). If we also take flexible working into account, just under a third (32%) of UK physician consultants said that they either worked flexibly or LTFT. This breaks down into 46% of female consultants and 21% of male consultants. 

The number of doctors working this way varies by specialty and career stage. Physicians report that improved flexibility can increase job satisfaction – but it poses additional challenges for workforce planning that must be accounted for in modelling the workforce. The employment of consultants and numbers of specialty training places has not kept pace with changing patterns of working.

Transparency of data

A theme across all specialties was the need for increased visibility on both demand and workforce supply. An open access interactive dashboard where specialties could see by provider and by specialty the demand for procedures/outpatient clinics was mooted as way of enabling better workforce planning across integrated care systems.

Many specialties have undertaken work to calculate their own workforce projections for the years ahead, using a variety of methods. NHS England should consider some sort of framework or support to help specialties and royal colleges map and model their healthcare workforce in a standardised way. For example, recommending specific questions for all royal colleges and specialties to ask their members would ensure a consistent approach and increase the usability of specialty and royal college workforce data and projections in future LTWP modelling.

The generalist and the specialist

The longstanding tension between the role of a physician in delivering both general medical care and specialist care to patients was identified across all group 1 specialties. Acute medicine workforce leads highlighted the challenges of filling both training and consultant posts and approaches taken to make these roles more attractive. Portfolio training, offering the chance to combine clinical training with additional training in medical education and leadership could help to address this. Consultants working across providers and between the NHS and industry (for example in pharmaceutical companies) were possible solutions. Other proposals to improve the attractiveness of working as a generalist included offering higher pay.

The front door of the hospital always takes priority

The significant rise in unselected general medical admissions and their impact on the workforce of specialties was identified as an enormous challenge. Some lesser-known impacts were also highlighted. For example, in palliative medicine, doctors applying to be accredited via the Certificate of Eligibility for Specialist Registration (CESR) being unable to meet the requirements of the new curriculum for palliative care training. In other group 1 specialties, the changes in curriculum and implementation of IMT3 have shortened specialty training. This has raised concerns about being able to train doctors to meet the needs of the subspecialty demand by the time they complete their CCT.

Several specialties are exploring fellowship pathways to train consultants to deliver increasingly supra specialised care, such as in cardiology and renal medicine.

Other innovations around workforce planning, such as focusing on teams rather than individuals, were discussed and warrant further exploration. For example, ‘who needs to be in X team in order to deliver a Hospital at Home service that meets the need of the population in Y area?’. This would open up the opportunity to workforce plan across all parts of the care sector, including primary care and social care.

Piloting innovative care pathways with evaluation of their impact prior to any national roll-out was seen as an important aspect of workforce planning that is often missed.

From analogue to digital

Many specialties recognised the need to empower the patient to manage their own care. Specialists play a crucial role in educating and supporting patients to manage long-term conditions, potentially reducing demand in both primary and secondary care. Innovative technology solutions and app-based communication and patient information were identified as areas that could help deal with this. Better data sharing across providers is also key to enabling different approaches to managing the demand on specialist care.

Conclusions

The RCP represents over 30 specialties of varying size. These roundtable discussions highlighted that while there are unique challenges for specialties, there are also many challenges common to all. An increasingly complex and ageing patient population requires innovative approaches to manage the demand for care, rather than simply increasing the workforce based on current practice. The NHS faces significant challenges – an ageing population with increasingly complex healthcare needs, the growing challenges of health inequalities and the provision of a well-resourced workforce in all regions of the country to meet those needs. These challenges must be acknowledged and addressed in the 2025 LTWP update to manage rising demand and provide timely care. The 10 Year Health plan must recognise the role of NHS staff in delivering the government’s vision and account for the impact of current workforce capacity on delivering reform over the next decade. Current assumptions about staffing numbers, capacity and retention in the short, medium and long term must feed into the plan to ensure that the vision is ambitious but feasible. Modelling the health workforce is not an easy task, but the LTWP update presents an opportunity to try and get this right, and we need to grasp it.

Transparency, openness and engagement are key. As the National Audit Office recommended, it is vital that stakeholders – such as medical royal colleges and specialist societies – can feed into the modelling. We urge NHS England to proactively involve the medical community in developing its revision and plans for implementing the 2025 iteration.

The RCP and the medical specialties we represent look forward to working collaboratively and transparently with NHS England and other stakeholders to model and support a workforce that will meet future patient need and be critical to delivering the government’s three shifts.

 

For further information, email policy@rcp.ac.uk. The event is organised by the MWU team, which can be contacted via medicalworkforce.unit@rcp.ac.uk or by calling 020 3075 1340.