BMA commentary on the NHS People Plan 2020/21

We summarise the commitments made in the NHS People Plan with a focus on those most relevant to BMA members. We also give commentary and analysis on each section of the plan.

Location: England
Audience: All doctors
Updated: Tuesday 8 September 2020
NHS Structure Article Illustration

The NHS People Plan sets out expectations and commitments for national and local action for the remainder of 2020/21. The plan includes priorities for change which are to be reflected in local people plans to be developed by systems – namely ICSs and STPs – and provider organisations. It seeks to build on the positive learning and innovation that has happened in the NHS as a result of the COVID-19 crisis.

The following will give the BMA's commentary of the plan section by section.

 

Our overall view of the plan

  • The plan reflects many of the BMA’s key priorities for the workforce, but detailed plans for how these ambitions will result in real, meaningful change for staff are urgently needed.
  • The plan does not provide a strategy for how the government will address long-term workforce supply or make education and training fit for the future and address chronic understaffing. We expect these issues to be covered in a further iteration of the People Plan.
  • The plan highlights several areas for improvement that the BMA has long been calling for – a focus on wellbeing, research and education, and flexible working.
  • The plan calls on employers to focus on health and safety, and this must be a top priority, especially now. Urgent action to protect our most vulnerable staff including those from BAME backgrounds and those who have been shielding. We must also do more to protect the psychological health of our workforce.
  • Initiatives such as the appointment of wellbeing guardians, boosting the mental health workforce, tackling violence against staff and improving occupational health standards will make an important difference to lives of staff and the development of a more open and inclusive culture.
  • The plan’s focus on equality and diversity is especially welcome. Diverse and compassionate leadership is essential to an inclusive, person-centred culture. It is encouraging that the plan emphasises this and sets out ambitions to increase placements for clinical leaders and enhance training and skills for leaders across the NHS.
  • The plan highlights several measures to help address workforce shortages. There must be a serious focus on recruitment and retention of staff both in the short and long-term. The plan does not address long-term workforce supply, nor is it clear how international recruitment will be impacted by Brexit and the current pandemic.
  • The BMA has concerns about training doctors as generalists. This could cause significant disruption to progression through training and the future supply of consultants. It is also not clear how this links with the career framework for medical associate professions which appears to be pushing generalist physician associates towards specialisation.
  • We welcome the prioritisation of improving workforce data quality to enable effective workforce planning – something the BMA has long called for – and we stress the importance of clinical engagement in the process.
  • The plan recognises the acceleration in digital transformation that has happened as a result of the pandemic and the need to shift to providing more remote consultations. However, many doctors in both primary and secondary care are still without adequate IT hardware and software to facilitate this. We strongly emphasise the need for substantial investment in digital transformation in both primary and secondary care.
  • We welcome the commitment to measure and evaluate the plan and its effectiveness. The metrics and evaluation should be published on a regular basis to ensure transparency.

Looking after our people

View the complete list of commitments and expectations on health and safety.

BMA views

Risk assessments and occupational health

It is good to see the commitment to risk assessments for vulnerable people (including BAME staff) and the announcements of OH pilots.

Risk assessments need to be provided as soon as possible to at-risk staff, including staff from BAME backgrounds who are disproportionately impacted by COVID-19 and those who have been shielding.

We are concerned that not all doctors have received these and the process and tools used vary across organisations.

Occupational health services are variable and should be provided consistently, especially in primary care where access to OH services is not available to all staff. 

Read our guidance on risk assessments.

PPE

As well as ensuring there is adequate supply of PPE to protect all frontline healthcare workers, it is vital that the PPE available takes account of diverse needs. This includes for staff who wear hijabs or beards for religious reasons and the needs of disabled workers.

As we move to restart non-COVID services it is vital this is not done at the expense of staff safety. It is crucial that staff have access to PPE that is appropriate for the environment in which they are working. Any changes to PPE requirements should be based on nationally agreed standards developed in consultation with staff representatives.

Resilience hubs

We welcome the piloting of resilience hubs to help boost local capacity and improve access to mental health support and treatment. It may take some time for staff to realise the impact of the COVID-19 crisis on their mental wellbeing and therefore it is essential that the support put in place for staff is sustainable and adequately resourced.

Wellbeing guardians

There is a need for board-level leadership when it comes to mental wellbeing of staff and we welcome the introduction of wellbeing guardians. However, a common framework or role profile would be helpful to ensure the role is standardised across organisations.

Car parking and transport

Free car parking and assistance with travel costs were well received by doctors during the pandemic. We have called for these to be funded for the long-term so that workers are not financially penalised with expensive charges as they provide essential services to patients.

Flexible working

The opportunity for all doctors to apply for flexible working without having to provide justification is most welcome and the BMA has long advocated for more flexible working.

Access to flexible working across all specialties and roles is an essential step towards narrowing the gender pay gap in medicine.

Encouraging employers to support those with caring responsibilities is also welcome and another step needed to close the gender pay gap.

Enabling doctors and staff to work flexibly will improve work-life balance and should help with staff retention.

While flexible opportunities for all are welcome, putting this into practice will be challenging and the plan does not make it clear how this will be done with the need to increase staffing levels across the NHS.

Belonging in the NHS

View the complete list of commitments and expectations on equality and leadership.

BMA views

Medical workforce race equality standard

The launch of the MWRES focused specifically on doctors, was due to be published in February this year and was delayed by NHSEI. The BMA would like to see the MWRES published as soon as possible. We would also like to see a similar, medical-specific standard developed as part of the next phase of work on the workforce disability equality standards.

Workforce disability equality standard

The plan makes passing reference to the WDES but gives no detail on what action will be taken, either on the findings from the first annual WDES reporting round or on wider issues faced by disabled healthcare workers. We would like to see more evidence of what tangible action will be taken on the issues identified.

The BMA has surveyed over 700 disabled doctors and medical students to identify their key priorities for action and would be happy to work with NHS England to develop action plans.

Speaking up

We welcome the plan to recruit more BAME (black, Asian and minority ethnic) staff to freedom to speak up guardian roles. The BMA’s bullying and harassment project also recommended improving the awareness of and reach of guardians.

We welcome plans to develop a 'listening up, speaking up' culture. Our COVID-19 tracker survey data consistently highlighted issues with BAME staff feeling pressured to work without adequate PPE. Another survey in 2018 found that BAME doctors were twice as likely as white doctors to say they would not feel confident about raising safety concerns.

Diversity and inclusion

We would also like to see diversity and inclusion work consider how to best support staff with religious beliefs.

We were very pleased to see the NHS uniforms and workwear guidance published earlier this year, which provides much needed guidance on inclusive dress codes, and we would like to see NHS England do more to promote this guidance to employers.

We welcome the expectation that the ethnicity gap in likelihood of entry to formal disciplinary processes will be eliminated. We have been exploring how a ‘just culture’ approach could reduce formal disciplinary processes.

This section also briefly mentions the ongoing challenges faced by LGBTQ+ healthcare workers but does not specify any action to be taken. Again, we would be happy to work with NHS England to develop action points to address these challenges.

Leadership

We welcome enhanced training for leaders and a focus on improving diversity in leadership. This is essential to an inclusive, person-centred culture. We also welcome an increase in placements for clinical leaders which could also have positive impacts on morale, wellbeing and retention.

New ways of working and delivering care

Redeploying existing staff

We expect that the need to move staff to high-need areas of the NHS will continue and potentially accelerate in the coming months as we approach winter and non-COVID services resume.

The BMA have been clear that this should only be done on a voluntary basis with the consent of the doctor. Read our guidance for staff who have been asked to be redeployed.

Generalist training

Pushing the UK’s system of postgraduate training towards generalism will require significant changes in the approaches taken by HEE, trusts and royal colleges. It will impact trainees that are currently progressing, as well as current and future medical students that will later enter training.

There is a risk of significant disruption which could negatively affect progression through training, hampering the future supply of consultants.

It is also not clear how this proposal links to HEE’s proposed career framework for MAPs (medical associate professionals).

Remote working and consultations

The People Plan rightly recognises the benefits that greater use of remote consultations can bring to patients and staff alike. They offer more flexibility to engage with the system at a time and place that is more convenient and less at risk from COVID-19 transmission.

The expansion of remote consultations due to the ongoing pandemic has demonstrated what is possible, with primary care providers receiving rapid central resourcing to work remotely.

However, problems still persist in both primary and secondary care. Doctors across the NHS have told us they still face problems with broadband speed, IT hardware and software and insufficient training and support. These issues must be addressed as soon as possible if the NHS expects to maintain the levels of remote consultation reached during spring and summer 2020.

Finally, there must be an evaluation of remote consultations and evidence of their clinical effectiveness in a range of populations. There should also be significant caution taken not to heighten inequalities – for example, high speed internet access is not available to large portions of the population.

Growing for the future

View the complete list of commitments and expectations on workforce and recruitment.

BMA views

Medical staffing in the NHS

The NHS is looking to accelerate the return to non-COVID services and tackle a growing backlog of millions of non-COVID patients who have not received care during the pandemic. However, doctors and staff are exhausted from working in an already pressured environment made worse by the ongoing crisis.

The plan does focus on expanding workforce numbers in some staff groups and specialties, which we welcome as an important step. It does not, however, provide a strategy for addressing widespread medical workforce supply gaps. The next iteration of the People Plan must detail serious steps to address chronic understaffing in the NHS.

The BMA has called for legislation setting out Government accountability for safe staffing levels in law (similar to that published in Scotland in 2019).

Recruitment and retention

The plan provides some sensible suggestions, including initiating discussions about future plans well ahead of staff retirement and the development of a return to practice scheme.

It is less clear that international recruitment will play a significant role any time soon given the impact of COVID, Brexit and in light of the recent decision to halt the international GP recruitment scheme.

Doctors returning to clinical practice

The NHS relied heavily on thousands of doctors and nurses who returned to clinical practice who were retired, working outside of the NHS or in academia.

We have heard from some, however, that the process to return was inefficient and many were not given placements.

If the NHS wishes to retain those who have voluntarily returned to work, it must ensure that:

  • placement, registration and revalidation is not burdensome
  • they are able to undertake meaningful work
  • they are supported to work, including having access to any training that may be required for the role.
International workforce

We welcome the introduction of the health and care visa, which opened for applicants from 4 August 2020, and forms a part of the skilled worker route of the new points-based immigration system.

The BMA believes that all health and social care workers provide invaluable services and therefore this policy should apply to all equally, as it can exacerbate the current social care workforce shortages. 

The COVID-19 pandemic has highlighted how much we depend on our international healthcare workforce. To truly reflect their value and contribution to our communities, the BMA is calling on the Government to grant all international doctors currently in the UK and on the route to settlement automatic indefinite leave to remain, and for their dependents. 

Workforce and data planning

The long-awaited prioritisation of improving workforce data is extremely welcome. The BMA has long called for for a single, transparent, publicly available national healthcare workforce dataset, which includes regional staffing levels and consistent vacancy data. Comprehensive data enables effective logistical planning, improved workforce flexibility and best use of staff resources.

Giving providers the resources they need to ensure terms and working conditions are attractive will entice more staff into them. Ensuring we have sufficient workforce numbers overall will reduce overreliance on agency health and care staff.

The plan indicates a shift in responsibility from national to regional bodies. However, the 42 ICSs and STPs across England, while often providing important leadership at a system level, are at widely varying stages of development. For many frontline clinicians these bodies often appear to be disengaged from their daily experiences.

Neighbouring STPs and ICSs need to work closely together as medical labour markets can span wider regional areas. There is a need for national oversight to ensure supply responds to demand.

Interim People Plan summary

The Interim NHS People Plan was published in June 2019 and forms part of the NHS Long Term Plan. It includes a range of high-level commitments around the future of the NHS workforce ahead of further work to develop a full People Plan.

We have summarised and provided brief commentary on the commitments made within the interim plan. A further NHS People Plan was published in July 2020.