Association of Anaesthetists response to the NHS Long Term Workforce Plan
3 July 2023
The Association of Anaesthetists is pleased to see the release of the NHS Long Term Workforce Plan.
This is our immediate response and we will be following it up in due course with an open letter to the Secretary of State for Health with our questions about the plan.
It is good at last to see a set of long-term goals for the National Health Service which present a vision of increased staffing and increased capacity to provide care for our patients. The health care professions have been calling for this for a very long time and all of us hope that this signals a real focus on improving the National Health Service both as a place to receive care and as a place to train and work.
Our hope is tempered by some concerns:
- A workforce plan was originally promised by the Government on 8 Nov 2017, with a draft promised by the end of that year. The delivery of this plan is therefore disappointingly five years late and comes at a time of great political turmoil and with a General Election likely within the next year. Consequently, we have concerns that there may be no opportunity to implement any of the work outlined in the plan. We also note the plan is only funded for five years with the reliance on future governments to continue that funding. This is an oversight that renders the title “long-term” meaningless. The Government must make every effort to ensure that its good intentions are rapidly translated into actions and that their good intentions survive into the next administration.
- The plan is presented as a series of aims and objectives. Large developments are presented as though they will spring full-armoured into existence from nowhere without necessary planning and legislation. It is in large part light on detail and lacking concrete explanations how those aims and objectives will be achieved. We reserve comment on the detail that lies behind the plan’s aims and objectives until it is actually published or consulted upon.
- The plan relies heavily on recruitment of very large numbers of staff. This is much welcomed as we are laggards in respect of per capita provision of health care staff. However, to set out such expansive plans without addressing the key issue of retention is folly. The NHS is an increasingly unattractive place to work, confirmed by recent staff surveys. Multiple staff groups are currently engaged in industrial action focused on fifteen years of pay erosion. Failure of the plan to address the underlying issues affecting retention is a major omission and without doing so, we do not see how the great recruitment outlined can succeed.
On topics of specific interest to anaesthetists and the specialty of anaesthesia:
- Anaesthesia Associates: The plan envisages a large increase in this staff group. The Association is well aware of and empathetic to the concerns of its members and will continue to advocate in the future. It is of concern that this expansion appears to be planned in advance of regulation. It is also of concern that the majority of AAs appear to move to the role from the operating department practitioner cadre, itself an important staff group without which theatres cannot function. We reiterate our stance that: AAs must be an addition to the anaesthetic workforce and not a substitute for medically-qualified physician anaesthetists; a robust system of training, examination and regulation must be put in place; the costs of this must not be borne by medically-qualified physician anaesthetists. It remains for individual departments to decide whether or not they wish to employ AAs based upon their own circumstances, following the joint guidance of the Association and College (of which a revised version will be released soon).
- Training places: Expansion of the medical workforce requires expansion of training places. There is a growing deficit in the number of consultant anaesthetists in the NHS with the 2020 workforce census carried out by the Royal College of Anaesthetists showing over 1400 posts unfilled and 90% of departments recording at least one unfilled post. It is therefore invidious that every year large numbers of medical graduates who wish to enter training in anaesthesia are unable to gain a place, despite being appointable, whilst non-medical anaesthesia posts are planned to increase in number. The Government should address this.
- SAS doctors and locally-employed doctors: We welcome the acknowledgement of the huge pool of talent that exists in this group of doctors. Still much more could be done to develop their skills and enthusiasm. We continue to advocate for greater recognition of alternate routes to specialisation in anaesthesia.
- Undergraduate training: We welcome plans to examine the fitness for purpose of the traditional five-year medical course. With high-level and continuous involvement of experts in medical education, it may be possible to optimise the time taken from starting medical school to becoming a specialist. We have grave concerns about the introduction of an apprentice-model medical degree. We are unaware of any such model being used anywhere in the world and we do not know how any such degree could be delivered. Without knowing much more about this proposal we cannot support it.
The Government bears the ultimate responsibility for delivering a sustainable, modern and safe health care system with a stable workforce suitably equipped to staff it. The NHS Long Term Workforce Plan is a much needed, bold first step towards this.
Whether the aims and objectives in the plan can be turned into sustainable actions remains to be seen. The Association has the interests of patients and anaesthetists at its heart and is ready, as ever, to work with policymakers to the benefit of both groups.