The NHS is a UK institution, which fills the nation with pride, concern and optimism in equal measures.

As the largest employer in Europe and the largest professional employer in the world, its future is rightly the subject of a lot of working groups, think tanks and reports. To understand its current strengths and weaknesses, to keep what is good and to tackle problems head on will allow the NHS to prepare and be prepared for the future, with all its uncertainties.

The workforce challenges in the NHS now present a greater threat to health services than funding. The NHS has not been a sufficiently flexible employer, with too often a ‘one size fits all’ approach. There is a current staff shortage of over 100,000, with prediction of this number reaching close to 250,000 in 2030.[1] Staff shortages take a significant toll on the health and wellbeing of current staff and pose a number of threats to care, including growing waiting lists and deterioration in the quality of care. The young doctors of today are pursuing different career paths from their older colleagues. Rates of burn out are high.

The UK has traditionally relied on the world market to attract and retain a high-quality medical workforce; however, this ‘supply’ might be changing. The demand for health care and therefore workforce time is growing fast and predicted to grow faster than the population growth. In the future, it is expected that 80% of the additional need in workforce time will be driven by increasing need for health care and support for chronic conditions.[2]

Patient safety is central to all health care and depends directly on doctors’ wellbeing. Stress affects quality of care and one recent GP survey showed the lowest levels of job satisfaction among GPs since the start of the survey.[3] One in 4 doctors in training felt burn out, according to the GMC survey. Wellbeing does not only lead to safer patient care, but also to retention of staff.

Digital healthcare technologies (including genomics, digital medicine, artificial intelligence and robotics) are new means of addressing the health care challenges of the 21st century. Technologies will not replace but enhance and augment the medical workforce. Within 20 years, 90% of all jobs in the NHS will require some element of digital skills.[4] All medical staff will need digital and genomics literacy.

Advanced technology needs to improve efficiency, not replace human interaction, and mechanisms must be in place to ensure care is not dehumanised. As new technologies appear and genetic medicine expands, there will be a need for doctors to understand the ethical implications, the governance, the financial and public health implications and how to communicate with the public. This needs leadership skills for the future.[5]

Learning from the present

The Health Education England Future Doctor Programme[6] has identified eight emergent themes to help with prioritising the next stage of medical education reform:

1. Patient-Doctor Partnership
2. The Extensivist and Generalist
3. Leadership, Followership and Team Working
4. The Transformed Multi-Professional Team
5. Population Health and Sustainable Healthcare
6. Adoption of Technology
7. Work-life Balance and Flexibility Throughout a Career
8. Driving Research and Innovation

We are the NHS: People Plan for 2020/21[7], published in July 2020, sets out what people working in the NHS in England can expect from their colleagues and leaders for the rest of 2020 and into 2021. Overall, the emphasis on flexible working and supporting the workforce is positive, alongside actions with clear timelines that span local, regional and national levels. The urgency with which equality, diversity and inclusion work is set to be addressed is important, given the huge impact of inequality and discrimination on NHS staff and patients. however, this Plan lacks clarity on how many of the actions will be achieved by systems and employers. Furthermore, a lack of reference to paediatrics and children and young people’s health stands in contrast to the Plan’s focus on generalist skills and its forward-looking approach.

Similar strategies for the NHS workforce have also been published in Wales (A healthier Wales: our workforce strategy for health and social care), Northern Ireland (Health and Social Care Workforce Strategy 2026), and Scotland (Everyone Matters: 2020 workforce vision). More information about the paediatric workforce in each of the UK nations is available in nation-specific reports produced by the RCPCH workforce team.[8]