NHS England People Plan Promises Pensions Action

Nicky Broyd

June 03, 2019

Solving NHS staffing problems isn’t just about numbers, the chair of NHS Improvement said at the launch of England's interim NHS People Plan.

Staffing and recruitment issues are a major concern for many NHS staff made worse by the pensions taper, making it uneconomic for senior doctors to do extra shifts, and concerns around Brexit.

The report promises action to increase overseas recruitment and to "rapidly address" pension concerns: "The government is listening to these concerns and will bring forward a consultation on a new pension flexibility for senior clinicians."

The report says: "The proposal would give senior clinicians the option to halve the rate at which their NHS pension grows in exchange for halving their contributions to the scheme. We will work with the government to seek changes that encourage individuals to stay within the NHS and ensure the right incentives are in place for them to maximise their contribution to patient care."

Once in a Generation Challenges

A news release announcing the interim plan described it as designed to address the "once in a generation workforce challenges the service is currently facing".

Chair of NHS Improvement, Baroness Dido Harding, said: "The NHS needs more staff to meet the ambitions for patients set out in the NHS Long Term Plan. But that, on its own, is not enough. We need to change the way people work in the NHS to recognise the changing needs of patients and to create a modern, caring and exciting workplace that should be the best place to work in England. This will take time but this interim plan sets out a clear direction of travel and commits to the immediate actions available to us."

The report was developed after consultation with groups including NHS staff unions, the Academy of Medical Royal Colleges, the Royal College of Nursing (RCN), and the British Medical Association (BMA).

It focuses on recruitment, "making the NHS a great place to work", and equipping the NHS and its staff to "meet the challenges of 21st century healthcare".

A fully costed People Plan is to follow the interim report after the Government confirms budgets in the next Spending Review.


Elements of the plan are already underway, Baroness Harding said. The initial focus is on nursing where vacancies are highest.

The plan sets out to:

  • Increase the number of nursing undergraduates with more than 5700 extra hospital and community placements for student nurses

  • A rapid expansion of new roles, including nursing associates to 7500, and offering a career paths from healthcare support roles to registered nurse jobs

  • Launching a campaign to encourage more nurses to return to the NHS

  • Using 'lead recruiter' agencies to "quickly grow" overseas nurse and doctor recruitment

Best Place to Work

The plan attempts to ease pressures for frontline staff to help with retention rates, including:

  • Offering enhanced access to flexible working, career development, and managerial support

  • New leadership guidelines on standards and behaviours

  • Doubling the size of the NHS Graduate Trainee scheme

21st Century Healthcare

Digital technology, genomics, and innovation feature strongly in the NHS Long Term Plan, and equipping staff and NHS organisations for the future is addressed in the report, including:

  • Expansion of the NHS Digital Academy to deliver training for senior managers and board members

  • Devolving "significant responsibilities" for workforce planning to new integrated care systems

  • Developing new models of multi-disciplinary working to help integrate primary and secondary care

  • A consultation to establish what is required from 21st century medical graduates 


Health Secretary, Matt Hancock said we must "make the NHS an employer to be proud of. We want to eradicate blame culture, deliver massively improved mental health provision and provide greater protection from violence and harassment.

"The success of the health service is rooted in the incredible people who dedicate themselves around the clock and we must show our staff the NHS values them as much as they value their patients."

BMA Chair of Council, Dr Chaand Nagpaul said: "We welcome that in his announcement the Secretary of State has stated that in addition to the 50:50 proposal in the interim People Plan, he is willing to discuss with the BMA other models for pension flexibility in order mitigate the current disincentives for doctors to provide NHS services."

He added that "it is essential that these options are no more than a short term mitigation whilst the much needed reform of the pensions taxation system is undertaken".

Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: "We welcome the focus on retaining existing, experienced GPs in the workforce, and appreciate the commitment in today’s plan to address barriers to this, such as current pensions rules, and on making the NHS a workplace that people want to work in."

She cautioned: "Whatever the next iteration of the plan looks like, it's essential that the forthcoming Spending Review ensures there is sufficient funding to deliver it."

Professor Carrie MacEwen, chair of the Academy of Medical Royal Colleges welcomed the collaborative nature of the report: "We are encouraged too that the plan addresses the three essential pillars of any workforce strategy - workforce supply, improving working lives to support retention of staff and new ways of working and job roles."

Patricia Marquis, the RCN's director in England, said: "This document begins to tackle the real issues but many will reserve final judgement until funding levels and practical details are revealed.

"The NHS - and the people who use it - deserve a detailed solution to the current crisis, including a new legal framework on accountability for the workforce. When there are 40,000 unfilled nurse jobs in England, we need to see urgency from ministers.

"To attract the very best professionals into nursing and the NHS, it must be a world class employer that pays fair salaries, pensions, and demonstrates the flexibility employees increasingly need and expect."


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