Responding to analysis by the National Audit Office (NAO) of workforce modelling in the NHS Long Term Workforce Plan, Dr Latifa Patel, chair of the representative body and workforce lead at the BMA, said:

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“The BMA has long called for regular credible and publicly available projections of the long-term workforce challenges facing the NHS, and a plan to fill the shortfall of staff.

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“Today’s report from the National Audit Office echoes many of the concerns the BMA has about the approach taken by NHSE in the workforce plan: that it is ‘optimistic’, ‘unrealistic’ and based on a limited understanding of what life on the frontline is really like on a day-to-day, practical basis. Importantly, the report notes that the total supply of doctors in primary care is projected to increase substantially over the modelled period, but the total number of fully-qualified GPs is projected to be less than 2015. The NAO report underlines the need for independent assessments of future plans and the modelling underpinning them, as this report has brought to light key issues that need addressing.

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“At the very least, NHS England needs to be honest about the challenges facing the healthcare workforce and amend its plan accordingly, in the expected 2025 update. Going back and making changes isn’t a failure, but continuing on a course that many have said isn’t going to work surely will be.”

ENDS

Notes to editors

For a copy of the report please contact [email protected] 020 7798 7400

​Issues the BMA would highlight include:

• Implementation of medical school places

The headline commitment to double the number of medical school places is a welcome one – extra doctors are much needed. But as the NAO makes clear, NHSE did not adequately consider how this commitment was to be implemented. These students need academics to teach them, spaces to learn in, and consultants and GPs to supervise them when they graduate.

• Changes to primary care roles

In general practice, the suggestion that SAS and GP registrars can take on more work can’t happen without qualified GPs to supervise them, many of whom are now reducing their hours or leaving. As the report correctly acknowledges, NHSE needs to understand the real-world effects on general practice of changes in primary care roles.

• Doctor supply

The modelling also notes that the total supply of doctors in primary care is projected to increase substantially over the modelled period, but this includes trainees, registrars, and SAS doctors. The total number of fully-qualified GPs is projected to be less than in 2015.

• GPs in training treated as 1/5 of a fully-qualified GP

The report shows that NHSE has treated GPs in training as equivalent to 19% of a full-time, fully-qualified GP. As per their contracts, they should be treated as supernumerary and the effective running of practices cannot be dependent on them. Five junior doctors are not equivalent to one fully-qualified GP. Until qualification, they are not yet legally competent to carry out the full range of GP tasks unless under close supervision by an experienced, qualified GP, so it’s unsafe and disingenuous to artificially inflate GP workforce numbers in this way.

• Pay

Both the Long-Term Workforce Plan and NAO acknowledge the importance of retention, and the close relationship between the need for new NHS workers and the service's ability to hold on to those it already has. But the elephant in the room, which neither NHSE or NAO mention, is pay, and the feasibility of holding on to the staff we need without improving pay after a decade of real-terms pay cuts.

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The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.