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Exclusion of pay in NHS workforce plan is “laughable”, says Adam Kay

As the government sets out its public sector pay deal, the former doctor told MPs that there is no clear strategy for staff retention.

By Harry Clarke-Ezzidio

The NHS workforce plan’s lack of attention to staff pay is “borderline laughable”, the former NHS doctor and author Adam Kay told MPs last week.

Kay, a former obstetrician and author of the acclaimed memoir This is Going to Hurt, was giving evidence to the Health and Social Care Committee. He highlighted that there is no new funding in the plan to entice workers to stay in the NHS; there is “no ambition” and “no detail whatsoever” on staff retention, he said.

Kay was speaking alongside representatives from the NHS, the regulator the General Medical Council (GMC), the Royal College of General Practitioners (RCGP), and the Royal College of Nursing (RCN).

What is the NHS Workforce Plan and what does it contain?

The government finally released the NHS workforce plan on 30 June, the week before the health service’s 75th anniversary on 5 July.

The core elements of the plan, six years in the making, are “train, retain and reform”. It includes commitments to: double the number of medical school training places to 15,000; double the number of nursing and midwifery student placements; and increase GP training places by 50 per cent, all by 2031-32. To fund these measures, the government has committed £2.4bn of new spending to the NHS over the next five years.

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None of this money, however, appears to be allocated to retention. “It’s achingly vague,” Kay told the committee’s MPs. “I don’t know what’s realistically being proposed to retain all these doctors.”

He added: “What are we actually doing to keep the staff in? Well-being is a huge part of it, but so is pay. I think it’s borderline laughable that pay gets not a single sentence [in the plan]. It needs to be acknowledged as a crucial thing. And I know, ‘This is for the government; this is for the unions [to resolve]’, but you can’t have two pages on AI and not a single sentence on pay. You have to respect your staff and they have to want to stay.”

[See also: Can apprenticeships solve the NHS workforce crisis?]

Are there other potential issues with the plan?

Charlie Massey, chief executive of the GMC, told MPs that medical staff who train students need to be better supported because they are “one of the most burnt out and stressed and dissatisfied groups within the medical workforce”.

Alongside worries that there will not be enough trainers for so many new students are concerns over plans to shorten medical degrees to four years, and to introduce an apprenticeship scheme for doctors. The NHS has over 112,000 vacancies (which, according to the plan, could reach 360,000 by 2037). The plan aims to expand the total NHS workforce from 1.4 million to between 2.2 and 2.3 million by 2037. This would include an extra 60-70,000 doctors and 170-190,000 nurses.

Kay said he felt like the proposal to shorten the qualifying period for new staff was “change for the sake of [boosting] numbers… not change for what’s best for patients”. 

Kamila Hawthorne, chair of the RCGP, noted that around 1,000 GPs a year are leaving the NHS. She told MPs that “on retention, this plan is just not ambitious enough” and added that the strategy anticipates that only 700 GPs who would have otherwise left will be retained.

[See also: A depleted NHS workforce is holding back cancer diagnosis]

What has the government said about the plan?

The government called the workforce plan a “once in a generation opportunity to put staffing on a sustainable footing”, and has committed to refreshing the workforce plan every two years to “help meet future requirements”.

On 13 July the government announced that pay for millions of workers in the public sector would rise between 5 and 7 per cent. Doctors will get a rise of at least 6 per cent, with junior doctors also receiving a one-off payment of £1,250; other NHS workers, including nurses, will get a 5 per cent rise, with some also receiving an extra £1,655. The doctors’ union, the British Medical Association (BMA), has rejected the offer, having originally called for a 35 per cent rise. Pat Cullen, chief executive of the RCN, has also expressed outrage that nurses are getting the “lowest pay rise in the public sector”.

Rishi Sunak, who announced the pay deal in a speech at Downing Street, said that the offer was “final”. It has been broadly welcomed by most unions. “There will be no more talks on pay,” the Prime Minister said. “We will not negotiate again on this year’s settlements and no amount of strikes will change our decision.”

[See also: Can the NHS workforce plan rescue the health service?]

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