ISSUE 54 EWJ web - Journal - Page 12
Improvements Needed in NHS England’s
Modelling for the Long Term Workforce Plan
The NAO has assessed NHS England’s modelling for the Long Term Workforce Plan, which
sets out projected staffing needs over the next 15 years
Weaknesses in the modelling underpinning NHS
England’s (NHSE’s) first Long Term Workforce Plan
(LTWP) need addressing if the LTWP modelling is to
be a reasonable basis for regular strategic workforce
planning, according to a new National Audit Office
(NAO) report.
The modelling also assumes increases in NHS productivity above the long-term historical average and a
significant change in how general practice operates,
with much more work done by trainee GPs. The latter means that, while the total number of doctors in
primary care will increase substantially, the LTWP
foresees there being only 4% more fully-qualified GPs
in 2036 than there were in 2021. The number of consultants in the NHS would grow by 49%. The NAO is
recommending that future versions of the modelling
should do more to explore the uncertainty of these
assumptions and what might happen if they do not
fully come to pass.
NHSE has for the first time produced modelling that
brings together its planning of future NHS health services with its longer-term assessment of the workforce
it thinks it will need to deliver them. This is a significant achievement. The LTWP, published in June
2023, estimates that the NHS’s 1.4m full-time equivalent (FTE) staff in 2021-22 will need to grow to between 2.3m and 2.4m FTE workers in 2036-37. The
NAO’s report focusses on the modelling behind the
LTWP.
The NAO makes numerous other recommendations
aimed at improving NHSE’s modelling, including full
integration of the different parts of the modelling
pipeline so that manual adjustments can be minimised. While the decisions taken as part of the LTWP
are out of scope of our review, we note that government has only committed funding up to 2028-29 and
that NHSE plans to make changes in stages. This gives
NHSE a built-in opportunity to make adjustments to
its workforce plans after it has revisited the modelling.
From a technical perspective, the NAO found significant weaknesses with the modelling. The use of manual adjustments and limitations in how modellers
documented their work increased the risk of errors.
The LTWP modelling took the form of a pipeline: a
structured sequence of steps involving a series of distinct models. The NAO was able to replicate the outputs from one part of the modelling, conducted in the
Python code, which represented a reasonable technical approach to health workforce modelling. However,
it could not replicate the outputs of another part of
the modelling, conducted in Microsoft Excel. Overall,
this meant the NAO could not replicate the numbers
that feature in the published LTWP.
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The NAO found that some of the modelling assumptions may be optimistic, including assuming that a
planned doubling of the number of undergraduate
places in medical school can be achieved by 2031-32.
Such a rapid expansion in capacity presents challenges, which the modellers did not factor in. These
include the impact of rapid expansion of student
numbers on the quality of training, and whether existing staff have capacity to provide on-the-job training
to that number of students. The full increase in student numbers is some years away, allowing some time
for NHSE to adjust its plans.
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NHSE intends that increased domestic education will
reverse an historical and growing reliance on the recruitment of professionals trained overseas. In broad
terms, NHSE expects the number of international recruits to fall as domestic training grows. NHSE’s modelling projects that there will be no international
recruitment of doctors at all from the mid-2030s. In
our view, this is not a reasonable modelling assumption and, if the rest of the plan is implemented in full,
risks too many medical students being trained from
the early 2030s onwards.
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