The NHS Long Term Workforce Plan recognises many of the challenges facing the workforce in England in the coming years. We welcome the move to address issues with recruitment and retention but this will need to be underpinned with adequate funding, both to increase workforce numbers and to ensure staff are sufficiently compensated, if these plans are to be realised.
Train
Key points:
- Education and training places for the AHP workforce are estimated to need to grow by 19–25% by 2030/31.
- More than a third of AHPs could train through apprenticeships, compared to 6% now
- Increasing the number of advanced practitioners and independent prescribers, and AHPs acting as senior decision-makers in appropriate settings.
- More than 47,000 new healthcare support workers will be required to meet demand over the next 15 years
We welcome the commitment to increasing the workforce, including the 60-74,000 extra AHPs. However, it is essential that Orthoptists are included in these numbers. While there is a recognition of the increasing healthcare need, driven in large part by ageing, outstripping the growth in the workforce, there is very little specific mention of eyecare. Primary eye care providers are identified as having the skills and knowledge required to deliver more services in the community, alleviating pressure on both general practice and hospital eye services. However, this will not address all of the shortages in eyecare; a significant expansion of the hospital eyecare workforce is needed on top of this.
Indeed, there is a focus on expanding enhanced and advanced roles to deliver care, but this is only possible if there is an increase in the number of trained professionals such as Orthoptists able to take them on. Conversely, our workforce survey from May 2023 highlighted a shortfall of 84.7 WTE, over 10% of the workforce.
Part of the answer to meeting this demand is through increased recruitment to Orthoptics. There is a promising commitment in the Plan to opening up diverse routes into healthcare, with an increase in training places for the AHP workforce of 25% to over 18,800 places by 2031/32, which includes a significant 35% through apprenticeship routes. We are currently working on developing an apprenticeship route into Orthoptics, and fully support the diversification of the workforce this offers, but it is essential that traditional routes, through undergraduate and postgraduate course at HEIs, are not reduced.
We were extremely encouraged to see the specific commitment to the expansion of the support workforce by over 200,000. Huge progress has been made recently in recognising the role of the support workforce, but in order to ensure recruitment and retention of these staff, more has to be done to ensure they are rewarding careers where it is clear how they can develop.
Retain
Key points:
- Ensure our staff, learners and volunteers are treated fairly within a compassionate and inclusive culture
- Everyone working in the NHS should be recognised and rewarded fairly
- Ensure that all staff are working within an environment that supports their health and wellbeing
- Reforming the system of regulation for healthcare professionals, making it faster, fairer, more flexible and less adversarial
- Continuing national CPD funding for nurses, midwives and AHPs
- To go beyond statutory requirements for flexible working
The Plan also recognises the need for greater staff retention if workforce shortages are to be countered, with the aim of ensuring up to 130,000 fewer staff leave the NHS over the next 15 years. This includes welcome commitments to deliver on the actions from the HGS People Plan, such as ensuring staff can work flexibly, have access to health and well being support, and work in a team that is well-led. In particular, we welcome the commitment to being ‘compassionate and inclusive’, with a focus on tackling prejudice and discrimination experienced by staff.
We also welcome the ongoing commitment to CPD funding for AHPs. This needs to be combined with clear career pathways so that Orthoptists can identify a variety of areas and roles for them to train towards. This also requires that staff are provided with the guaranteed time to take advantage of these funds.
However, without addressing the issue of pay, these changes are unlikely to have the necessary impact on staff retention. While there is a statement that staff should be “recognised and rewarded fairly”, significant investment would be required to reverse the real-terms pay cuts that have contributed to the current shortages.
Reform
Key points:
- Deliver higher level of productivity, within range 1.5-2%
- Make use of technological and digital innovations, including AI
- Addressing geographical inequalities in distribution of staff, by reviewing distribution of training posts
- Embed digital technology in learning pathways, including £300,000 for simulated learning
- Increase clinical academic posts
- Over 6,300 clinicians starting advanced practice pathways each year by 2031/32
- Broadening training to shift care towards prevention and early intervention
We are supportive of many of the suggested ways for reforming the way staff work, drawing on innovation and multi-disciplinary working. We welcome the focus on advanced and enhanced care, with the aim of more than 6,300 clinicians starting advanced practice pathways each year by 2031/32. Orthoptists are already making significant progress in this area and are ideally placed to take on these roles within Ophthalmology. However, again, this will only be possible if there are sufficient numbers of staff to take on these roles.
Linked to this, we are pleased to see a focus on increasing the number of AHPs who are independent prescribers. This would be a significant change for Orthoptists, enabling them to provide more timely care for patients and better support overstretched eye health services. Over 81% of Orthoptic Heads of service felt this would enhance practice. We await a clear timetable from the government as to when this change will be implemented for Orthoptists. The ability for Orthoptists to prescribe glasses within a hospital setting will also be key to freeing up stretched services.
Much of the focus on innovation and technology is particularly pleasing to see, particularly relating to practice-based learning. The targets for increased workforce numbers can only be achieved through increasing educator and placement capacity. We have already made huge progress in diversifying clinical placement experiences, through the development of the Placement Expansion Resource Library (PERL) and the use of HoloLens technology. We also welcome the £300,000 that is being made available to support the development of simulated learning.
One further concern we have is that the target of increasing productivity by 2%, while largely premised on technological and infrastructural improvements, could place a further burden on an already exhausted workforce. Over 67% or Heads of Service reported to us that staff were experiencing a significantly increased workload compared with a year ago, and over 62% reported that staff were experiencing a significantly increased workload. This will only be eased significantly with the necessary increase in resources.
Next steps
Much about the NHS Long Term Workforce Plan is extremely encouraging and shows a real recognition of the challenges facing the workforce over the coming years. However, delivering on the Plan will require a real commitment from the government to invest in the workforce and make the necessary changes, such as enabling independent prescribing responsibilities, to empower healthcare professionals across the service.
We look forward to hearing more detail on the implementation of the Plan and working with NHS England to ensure that Orthoptists receive the recognition and support they need to fulfil their considerable potential within the NHS workforce.