Towards a healthcare workforce utopia

Just in the same way that Quentin Tarantino explains how “spaghetti westerns shaped modern cinema”, the publication of the Interim NHS People Plan lays the foundations needed to deliver the NHS Long Term Plan, with a focus on a number of immediate actions on people and workforce priorities during 2019/20.

The final, fully costed five-year People Plan report is expected at the end of the year following the development of the five-year Integrated Care System plans and after the Government Spending Review.

The Interim NHS People Plan sets out the new way of managing the 1.3 million people in the NHS. It is an optimistic plan about how the NHS can make meaningful progress on fixing the existing workforce crisis but one that has been criticised because of the lack of detail on issues of international nursing recruitment, continuing professional development investment and manager regulation. In its defence, many workforce commitments are interwoven and dependent on the Spending Review.

The People Plan is structured around five themes, with each theme having a set of immediate actions for NHS organisations in 2019/20 – a table of actions with timescales is set out at the end of the Plan document (pages 66-74 inclusive).

Key workforce plan headlines

  1. Making the NHS a better place to work: The Plan sets out a vision for developing an inclusive and compassionate culture, valuing, supporting and investing in the workforce. The commitment is to design a new offer to staff that could see changes to the NHS Constitution.
  2. Improving the leadership culture and the working environment: This forms part of the review of the regulatory and oversight frameworks with a new “balanced scorecard” to become a central part of the NHS Oversight Framework and work with the Care Quality Commission so that this balanced scorecard can inform the future development of the CQC’s Well-led assessment. The Kark review and its recommendations will also inform this theme of work, in particular developing an explicit set of competencies, values and behaviours required in different senior leadership roles. We can also expect an independent review of Human Resources and Organisational Development practice in the NHS.
  3. Addressing the urgent workforce shortages in nursing: There is an immediate commitment to address this challenge through better retention and recruitment programmes, with the aim of growing the nursing workforce by over 40,000 by 2024 and reducing vacancy levels to 5 per cent by 2028.
  4. Developing a workforce to deliver 21st century care: The Plan accepts that we need to grow the overall healthcare workforce and points to the need for a more varied and richer skill mix, specifically having multidisciplinary healthcare teams, more flexible working and careers, widening routes into NHS careers, particularly for scarce roles. Other initiatives include implementing post-foundation Internal Medicine Training to expand the number of doctors with generalist skills together with making greater use of technology as outlined in the Topol Review.
  5. A new operating model for workforce: This is about devolving more responsibility to ICSs for some workforce and people functions that have traditionally been carried out at regional or national level. A key action is the co-production of an ICS maturity framework that benchmarks workforce activities in ICSs and informs decisions on the pace and scale at which ICSs take on workforce and people activities.

More flexible pensions for NHS doctors

An overhaul of the NHS pension scheme has been announced by the Government, which would enable clinicians to “freely take on additional shifts to reduce waiting lists, fill rota gaps or take on further supervisory responsibilities”. It will consult on proposals to offer senior clinicians a new pensions option. This would allow them to “build their NHS pension more gradually over their career by making steadier contributions towards their pension, without facing regular, significant tax charges”, the statement from the Cabinet Office and Department of Health and Social Care added.

Retaining the NHS’s skilled clinical workforce is an important part of delivering the NHS Long Term Plan and a key feature of the People Plan.


The Plan has been widely welcomed by representative bodies, think tanks and other health organisations – describing it as hitting the “right note in calling for a better, kinder culture in the NHS”. Allowing local areas to plan their own workforces is also widely seen as a good idea.

But the Achilles heel remains the workforce shortages and the “only way to stem the damage in the next few years is immigration of trained staff”, comments Nigel Edwards of the Nuffield Trust. He adds: “Yet the tough new rules suggested for the period after Brexit risk making it impossible to fill at least 40% of nursing roles from abroad, putting the entire plan into jeopardy.”  

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