Prescription: Apprenticeships
James Farr reflects on the publication of the NHS Long Term Workforce Plan and its implications for apprenticeships
The new NHS Long Term Workforce Plan (LTWP) marks a significant statement of intent to address longstanding health service staffing issues that have reached crisis point in recent years.
The sheer scale of the NHS workforce requirement outlined within the plan is remarkable. The LTWP’s proposals are designed to address an anticipated shortfall in clinical staff of between 260,000 and 360,000 by 2036/37. This expansion in the NHS workforce is equivalent in size to the resident working population of a large UK city such as Manchester or Leeds.
And unlike practice over recent years, the LTWP is clear that an expansion in NHS training will reduce reliance on international recruitment and temporary staffing – cutting the latter from nine percent now to around five percent by 2032/22; and scaling back the former so that around 1 in 10 new joiners are from overseas by 2036/37, compared to almost 1 in 4 now.
Growth by occupation appears to be highest in nursing, with the number of training places set to expand by between 65 and 80 percent by 2030/31. This rises to a 93 percent expansion within mental health nursing training places.
Apprenticeships sit centre stage within the LWTP. The proportion of all clinical training places accounted for by apprenticeships will rise from seven percent now, to 16 percent by 2028/29 and 22 percent by 2031/32. Equivalent figures for nursing training places (28 percent by 2031/32) and allied health professionals such as dieticians, paramedics, prosthetists (35 percent by 2031/32) are much higher. Within the latter, apprenticeships will account for 80 percent of podiatrist, operating department practitioner and therapeutic radiographer training places by 2031/32. Based on the LTWP’s proposals, the nursing degree apprenticeship appears likely to generate more starts on an annual basis than any of the other 650+ available apprenticeship standards in the market – overtaking well-established apprenticeship market staples such as Team Leader and Business Administrator.
The implications of this shift to large-scale apprenticeship training for clinical occupations will be profound. Below are five early takeaways on what it might mean:
Normalising entry to professions via the apprenticeship route. The LTWP will add a long list of medical professions to those that can already be accessed via an apprenticeship. A new medical doctor degree apprenticeship is set to launch, joining a host of other existing clinical apprenticeship standards. This is consistent with an emerging pattern among the key professions. Outside of health, we are seeing apprenticeships becoming established as an employer-led entry route to professional occupations in surveying, accountancy, teaching, social work, solicitors (etc) which have previously been overwhelmingly the preserve of graduates undertaking professional qualifications as a career entry route. At a time when universities are under increasing pressure to ensure that graduates enter highly skilled employment, the growing use of apprenticeships as a career entry route offer could challenge institutions to adapt their proposition in response.
Reorientating NHS Apprenticeship Levy spend. NHS employers have reportedly used a higher than average proportion of their available Apprenticeship Levy funds – often dabbling in clinical roles and investing more heavily in improving project management, service improvement and leadership capacity (commonly among clinicians). However, the LTWP will likely lead to NHS employers prioritising their apprenticeship investment in clinical training places over other uses, with implications for providers. The scale of growth planned for clinical apprenticeship training may also risk exhausting the available Levy funds of NHS employers, potentially constraining growth. This may also present a headache for DfE, which relies on Levy underspends from larger employers to bankroll SME apprenticeship training costs. DfE’s apprenticeship budget was 99.6 percent spent in 2021/22, so there is little headroom for a substantial increase in large employers’ use of their available Levy funds.
There will likely be a myriad of practical challenges for NHS employers, Health Education England, providers, DfE and potentially IfATE to consider. It is worth remembering that nursing apprenticeships only started to grow in earnest thanks to £172m of additional support announced in 2020, which enabled NHS employers to better support apprentices to learn on the job. There may be similar challenges in other key clinical occupations, whereby hospitals and other NHS providers could struggle to maintain service levels while supporting an enlarged cohort of new starters who are in training and therefore not yet occupationally competent. Meanwhile professional registration requirements, such as in relation to minimum practice hours, will also need to be accommodated.
More NHS organisations may consider delivering apprenticeships to their own staff using Levy funding rather than using an external private training provider, college or university. Employer-led delivery of training was common in the 1970s and 1980s especially in relation to nursing, where large hospitals would regularly feature an attached school of nursing. DfE is reportedly lukewarm in their support for this, while accompanying Ofsted and ESFA audit requirements may deter some employers from pursuing this route. But there are already 44 NHS organisations listed by DfE as registered apprenticeship providers (16 as Employer Providers able to deliver only to their own staff; 13 as Main Providers able to deliver to their own and other employers’ staff; 15 as Supporting Providers, able to operate only on a modest scale as subcontractors) and we might see more follow as clinical apprenticeship volumes gather pace.
LTWP will challenge NHS employers and ICSs (Integrated Care Systems – partnerships of health organisations tasked with planning and delivering joined up health and care services) to strengthen their own talent recruitment and development strategies. Each of the 42 ICSs in England will be supported by the LTWP to develop a system-level apprenticeship strategy, which will require close work with providers through development and into delivery. This may be new territory for ICSs, ensuring that apprenticeships play a central role in not just transforming clinical training, but also helping to driving change within primary, community, mental health and acute care.
It is still early days for the NHS LTWP but there is plenty for universities to be doing and thinking in response. This includes:
Working with ICSs to translate the ambitions of the LTWP into the local apprenticeship strategies for clinical roles.
Working with NHS employers and their clinicians to understand the operational barriers to delivering the expansion in clinical apprenticeship training places set out in the LTWP.
Liaising with NHS employers, DfE, DH and professional regulatory bodies to explore any issues and barriers to apprenticeship growth.
Considering the potential implications of the growth in apprenticeship training for clinical occupations on universities’ existing medicine UG provision and graduate progression routes.
Exploring the implications of the shift towards apprenticeships for universities’ relationships with NHS employers in the development and delivery of learning programmes.