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Health journalist Andy Cowper says the new long-term workforce plan raises too many questions
One of the big bits of health policy and political news of recent times was the NHS long-term workforce plan (LTWP), published at the end of June.
It is an (inevitably) unfunded way of telling people ‘don’t worry – it’ll all be absolutely fine in a couple of parliaments’ time, honest’.
So now we’re all reassured. Except, perhaps for staff in PCNs, because they were not explicitly mentioned in the LTWP. Nor were they obviously covered in the 6% pay deal for NHS staff (of which only 3.5% is funded).
At a time when the rhetoric is about taking the pressure off primary care, this feels problematic. LibDem research released to The Times shows that in May, 1.3 million people waited over a month for a GP appointment (up from 912,000 in May 2022).
In the LTWP, NHS England pledged to introduce more than 20,000 additional clinical staff to general practice by 2036/37, building on ‘the success’ of the additional roles reimbursement scheme (ARRS). The national quango plans on bringing in 15,000 non-GP direct patient care staff and more than 5,000 primary care nurses ‘to extend the success’ of the ARRS.
Alas! NHS England did not specify whether it would introduce new roles or add to the total available funding pot. This was later clarified – it will indeed uplift finding to cover this, but the detail will reward close attention, as 2.5% of the 6% pay rise is unfunded and is meant to be delivered by ‘reprioritisation and greater efficiency’, according to the Department for Health & Social Care.
Looking to new contract negotiations for 2024/25, the BMA’s GP Committee (GPC) called for a unified new contract, with all funding coming through one route with sufficient resource to enable practices to deliver core services. It also called for QOF, Impact & Investment Fund (IIF) ‘and all other micro-targets’ to be scrapped along with the PCN direct enhanced service, as it has proven to be ‘a failed project’ to be replaced with a quality improvement-based contract. This also means removing general practice from the CQC’s remit, if the GPC prevails. Lots of uncertainty.
What about the clinical director PCN workforce?
What does the future hold for the 1,250 clinical directors (CDs)in PCNs? Having asked GPs to care for practice populations differently, what are the plans for CDs now?
The LTWP raises another question for people trying to make PCNs and GP federations work: ‘where’s the money for me as an employer to hire these newly trained people?’ It is worth noting that the entire promised increase in workforce training money is less than the NHS lost in real-terms funding in April when the Government failed to uprate the NHS budget by inflation.
There is also the issue of retention. How much point is there in having new trained staff, if there’s no one left for them to work with beyond those who couldn’t get a job elsewhere?
This feels like a lot of unanswered and important questions.
Andy Cowper is editor of Health Policy Insight and a columnist for the BMJ and Civil Service World