The NHS Long Term Workforce Plan, issued by NHS England and the government in June 2023, is a long-delayed but welcome document. On the 75^th anniversary of the Founding of the NHS, it re-commits to the basic principles that care and treatment remain free to all at the point of use, that it is funded from the public purse, and that it needs reform and expansion to reach targets by 2031/2. It is certainly big on aspiration and promise, does include target figures for staff, but fails on details and omits key issues.

It wants to recruit and retain an additional 60,000- 74,000 doctors. This is an acknowledgement that there is a current shortfall. It also wants most of these to be Home grown – domestically educated and trained. Again, a recognition of the increasing dependence of the NHS medical workforce, on overseas recruits. It promises to double the medical school places, and to seek to expand these in regions of most need. A similar set of ‘plans’ are outlined for GPs, dentists, nurses, and other health workers. It pays attention to the growing demand for NHS services as the population ages, and as other (unspecified) causes of ill-health, especially mental well-being, are not being met.

Most observers have given a guarded and lukewarm welcome to the document. The main worries are the lack of detail, but also a failure to address pay and funding. About 70% of NHS current costs are associated with labour, and at the moment doctors, nurses, and radiographers are or have been on strike over pay. Pay levels have fallen relatively and absolutely in real terms and represent the biggest threat to recruitment and retention. No mention of either pay or reform of the pay setting systems.

In addition, the education and training of doctors, for example, also requires more medical school places There are both physical and staffing constraints on this – the facilities available for medical education remain limited and no plans are afoot to bankroll any expansion. The staff needed to train doctors throughout their education in medical school and later on-the-job supervision in hospitals, are not available. In other words, who will teach and train the new medics? In addition, those trainee doctors were struggling to find time to learn since they were plugged in to fix the doctor shortage challenge. The government needs to pay more attention to ensure this group who are already in the pipeline. GMC 2023 national training survey shows working environment among trainees, especially among Foundation years doctors deteriorated. One in five has experienced negative behaviour.  A supportive culture is urgently needed to retain these doctors- this is what our project focus on. Trainee doctors just want to be able to ‘learn and to become a doctor safely’, as stated by one of our research participants.

The plans are welcome, the statement of keeping the NHS as a properly funded public service is welcome, but the actual plans for educating and training more doctors lack clarity and realism. Furthermore, hanging hopes for productivity improvements on one peg, the quantity and quality of labour, without addressing pay is a woeful avoidance of duty. The government must answer the how of more home-grown doctors, and the why of better recruitment and retention.