This is our summary of the key points affecting occupational therapists from the 150-page NHS England Long Term Workforce Plan, which was released last week.
Over the coming days and weeks, we will be providing further analysis and commentary to members on how these changes impact the profession.
We are continuing to have conversations with NHSE and the Department for Health and Social Care to ensure the interests of our profession are heard as it moves to implementation.
Key Points
-
There will be an estimated 3.4-3.7% growth in occupational therapists by 2036/37
-
The proportion of entrants joining the occupational therapy workforce via an apprenticeship route will be 25-50% by 2031/32
-
There is no plan to increase the number of occupational therapists in primary care, which needs to increase by at least 2000 by 2036
-
Rehabilitation and reablement is fundamental to tackling waiting lists and improving patient care. As more people will be living with long-term health conditions, a 3.4-3.7% growth will not provide enough occupational therapists to meet their ongoing health and care needs
-
Prescribing rights are being extended to various groups, but no mention of extension to occupational therapy
-
Whilst we welcome the commitment to advanced practitioners, we would want this to include occupational therapist advanced practitioners and not exclusively advanced clinical practitioners
-
There will be a continued focus on supporting the recruitment and retention of support workers, such as occupational therapy assistants
Detail
Enhanced practitioners
Enhanced practitioners are qualified health and social care practitioners who have attained specific applied knowledge and skills in their field.
We welcome the commitment to advanced practitioners. We would want this to include occupational therapist advanced practitioners and not exclusively advanced clinical practitioners, so occupational therapists don’t get left out because of their limited prescribing responsibilities. This could lead to a fundamental gap in expertise in rehabilitation and primary care.
Support Roles
Support workers, both clinical and administrative, are an important part of wider multidisciplinary teams, enabling more effective and efficient working. They contribute to addressing critical workforce capacity constraints while providing high quality, personalised care to patients. These include assistant practitioner and technician roles, such as occupational therapy assistants, which can be key integrators across health and social care.
There will be a continued focus on supporting the recruitment and retention of these groups, including:
-
Maternity support workers through the Competency, Education and Career Development Framework226
-
AHP support workers, through growth of apprenticeships and the development of a Competency, Education and Career Development Framework227
-
Healthcare support workers, through the NHS England programme228 (recruitment, induction and career pathways)
-
Cancer support workers, through the ACCEND (Aspirant Cancer Career and Education Development) programme.
Workforce Figures
The Plan sets out an expansion of new and extended roles to increase the breadth of skills within multidisciplinary teams; better meet the needs of patients, their families and unpaid carers; and enable more care to be delivered in primary and community settings.
Key roles for expansion
|
Roles |
Estimated supply by 2036/37 |
|
Nursing associates |
64,000 |
|
Physicians associates |
10,000 |
|
Anaesthesia associates |
2,000 |
|
Advanced practitioners |
39,000 |
|
Approved clinicians (mental health) |
1,000 |
|
Roles covered by further expansion of primary care MDTs |
15,000 |
|
Roles covered by primary care nurse expansion |
5,400 |
Overall, the Plan will increase the proportion of these wider team roles from 1% in 2022 to 5% by 2036/37.
In addition, this Plan focuses on expanding those roles that have a particularly diverse range of skills and can contribute in many care settings, including 3.7–4.0% growth in paramedics, 3.4– 3.7% growth in occupational therapists and 3.3% growth in physiotherapists.
Retention
The plan makes many bold ambitions and claims around retention of the workforce, which were heavily referenced during its announcement.
Flexible Working
Every staff member should be given the opportunity for regular conversations to discuss their wellbeing and what will keep them in work, including discussions about pension flexibilities, flexible working options, and health and wellbeing.
From 2023/24, it is proposed that NHS organisations work with system partners to develop a clear employee value proposition (EVP) and promote this across the workforce
We will support Integrated Care Systems (ICSs) to agree plans across their system for implementing flexibilities – where permissible – within national terms and conditions (such as local incentives for new recruits and bank rates), to facilitate a more strategic and aligned approach to improving reward and recognition for staff. ICSs will be encouraged to work with partners to support the recommendations of the Fuller Stocktake for innovative employment models and adoption of NHS terms and conditions in primary care.
Education and Training
Expansion by profession
The proposed increase for each profession depends on the identified shortfalls, the routes to employment and the level of reliance on international recruitment, in addition to the factors outlined above.
Occupational therapists (Increase required in education and training by profession)
|
Baseline (2022) |
2025 |
2026 |
2027 |
2028 |
2031 (Plan) |
|
2,610 |
2,788 |
2,788 |
2,875 |
2,966 |
3,500 |
*Approximately 34% increase by 2031
Expansion by apprenticeships
The Plan articulates that apprenticeships are an effective way of both growing the workforce and widening participation, as expanding these routes appeals to a broader diversity of applicants and particularly those who have wider life experience.
The size and speed of the increase in delivery of apprenticeships for each profession depends on:
-
The student conversion rate for courses; for professions where this is already high, there will be less opportunity to expand via undergraduate routes, and so a greater proportion of the expansion set out would need to be via apprenticeship routes. These professions include adult nursing, learning disability nursing, mental health nursing, podiatry, operating department practitioners and occupational therapy.
-
Whether apprenticeship standards already exist for professions or need to be developed.
-
The availability of ‘feeder’ support professional groups such as nursing associates for the registered nurse degree apprenticeship.
The Plan sets out the following assessment for proportion of entrants joining the AHP workforce via an apprenticeship route by 2031/32:
25–50% for paramedics, diagnostic radiographers, occupational therapists, dietetics, prosthetists and orthotists .
International Recruitment
The plan maintains that following a commitment to the domestic education and training expansions outlined, as well as service reshaping, we will see a corresponding decrease in international recruitment across the NHS from the current one in four staff joining annually to one in 10 annually by 2036/37. It is acknowledged that the NHS will always retain international recruitment as an option of flexibility and source of talent, but this reliance is intended to be scaled back. In the short term, international recruitment will continue to ease shortages. Any reduced long-term international recruitment will be more targeted if there is a need/shortage.
AHP international recruitment levels are not quantified in this report – only nurses & doctors.
Recent significant investment from NHS England to establish pipelines of international AHPs to be recruited – will this work now be wasted?
Primary care
The Plan proposes to build on the success of the Additional Role Reimbursement Scheme (ARRS) roles in primary care but there is no clear plan to increase the numbers of occupational therapists in primary care, which need to increase by at least 2000 therapists by 2036 (see page 95).
We welcome the Plan’s adoption of NHS terms and conditions in primary care - this will be a key factor in retaining occupational therapists who have already made the move (see page 62).
There is also an aim to expand placement capacity in primary care so more occupational therapy learners are exposed to this setting and will help to ensure a pipeline of placements (see page 81).
Finally, the Plan proposes to extend NHS occupational health and wellbeing services to cover the growing primary care workforce (see page 64).
However, the Plan does not name occupational therapy as one of the specific roles in primary care as part of service and workforce redesign to support patients developing the knowledge, skills and confidence to effectively manage their conditions. Occupational therapists can and do support and manage link workers, health and wellbeing coaches, and peer support workers.
Rehabilitation and Reablement
The plan notes new and emerging roles are growing, but not fast enough to make a significant difference. In future, healthcare teams will continue to be led by clinical experts, but wider skills will be needed to help offer personalised, responsive care to patients, supporting them to be independent. This may involve digital monitoring of remote care and coaching to help patients manage their health, as well as expert practitioners to support rehabilitation, and drive care planning and decision-making.
Rehabilitation and reablement is fundamental to tackling waiting lists and improving patient care. If you have an operation or receive a diagnosis you then need advice and support to know how and what adjustments you can make to continue to go to work, manage day to day activities, continue to be a parent, spouse. etc. We are the answer to the ‘so what?’ question that follows medical interventions. In 15 years' time more people will be living with long-term health conditions and this plan is the government’s opportunity to modernise a workforce that has the expertise to help people manage their ongoing health and care needs. A growth of 3.7% is not sufficient investment into occupational therapy to meet future demographic need.
The modelling for this Plan assumes that the balance of care between the NHS and social care will remain broadly the same. It recognises that alongside social care and community care, NHS rehabilitative services play a vital role in supporting people to leave hospital-based care at the right time and recover in their communities - where is the investment in rehabilitation experts?
Social Care
There is little to no ambition within the Plan to expect that the care system will improve and have additional capacity over time. It makes the default assumption that the balance between health and care will remain the same in the future. As we have an ageing population, this is wildly insufficient for future demand.
As expected, this Plan just reiterates the need for dedicated action on social care as the lack of capacity in the care system is going to impact many of the ambitions laid out. This is why we have been calling for a Social Care People plan as part of the Future Social Care Coalition, to ensure that it is seen as a priority when it comes to long-term health planning.
Technology & Innovation
The Plan sets out that it will take practical and sustained action to retain existing talent, and that NHS England will recruit and train hundreds of thousands more people and continue to accelerate the adoption of the latest technology to give its workforce the tools to provide high-quality care to millions of people across the country each day. Despite being told we need occupational therapy more than ever, the Plan does not set out ambitions for significant expansion of occupational therapy.
The Plan outlines the need for 10,000 virtual ward beds by winter 2023, and longer-term 40–50 virtual ward beds per 100,000 population and covering a broad range of health conditions. Virtual ward workforce models benefit from a range of professionals, drawing on the talent across sectors. Again, there is no mention of occupational therapists or AHPs, although they will be required to meet rehabilitation needs.
Other general points
The plan acknowledges that even if it delivers on the proposed increases in staff, there will still be significant reliance on temporary staff and international recruitment, which is not sustainable (pg 38).
The plan talks about “education and training expansion and reform”. This includes considering decreasing the length of training and required placement hours for nurses and doctors - should this happen for occupational therapists too? (pg 46)
ICSs are developing collaborative staff banks across the ICS and all ICSs now have a primary care flexible pool that allows staff to work across different primary care settings - this approach could work well for occupational therapists and other AHPs too (pg 55).
The plan proposes to support ICSs to implement flexibility within national terms and conditions to reward and recognise staff - we need more detail and discussions with Unison about this (pg 62).
The plan proposes that in 2023/24, NHSE will work with partners to develop a national multi-professional integrated community and primary care core capacity and career framework to support workforce development, which will build on existing frameworks. We look forward to being part of this work (pg 67).
We support increase in the number of clinical academic posts (pg 85).
Prescribing rights are being extended to various groups, but no mention of extension to occupational therapy (pg 10).