We answer your most frequently asked questions on the NHS England workforce plan
Are there any commitments on increasing the supply of registered physios?
- The plan assumes this growth will continue and is within the growth target for training places for allied health professionals (AHPs) of 25% by 2031/32
- The supply of registered physiotherapy graduates in England is already very healthy, with a 42% increase in the last decade and room for further growth with competition for places.
- Though going in the right direction, this is not enough. England and the UK are far behind international norms on physio numbers – for example, in England there is one registered physio for every 1,136 people, compared to one for every 450 people in Germany (who have one of the highest) and one for every 742 in Australia (who are average). And there remains significant unmet need for rehab in the population.
Are there any commitments in the plan on increasing registered physio numbers in the NHS?
- Yes. Following CSP lobbying there is now a commitment to a 3.3 per cent annual increase in registered physiotherapy posts in NHS services. It will be part of an additional 71,000–76,000 AHPs by 2036/37.
- This is more than average annual increases across all NHS staff, which is 2.6-2.9% because the plan recognises physiotherapists as having a particularly diverse range of skills.
- This is a welcome step forward from draft plans which did not give any target. However, it is not ambitious enough given the scale of need. Given the success we have had to date in growing the registered workforce a higher target is eminently doable alongside action to retain NHS staff.
Are there any commitments in the plan on increasing physio support worker staffing numbers in the NHS?
- Yes. Overall, the plan says that in 15 years there will be a need for around 47500-56500 more healthcare support workers (both nursing and AHP).
- The plan specifically talks about the importance of expanding AHP support worker roles. This was something that the CSP asked for following an initial focus on nursing support workers.
- There are also commitments to developing AHP support workers, through growth of assistant practitioners and degree apprenticeships and a new Competency, Education and Career Development Framework.
- However, the plan stops short of prioritising AHP support worker development on a par with Nurse Associates. This is something that the CSP will continue to campaign for along with apprenticeships for Rehabilitation Assistant Practitioner roles.
What does the plan say about the workforce in the community sector?
The plan refers to the need for rehabilitation in the community, and the increased workforce required in community care settings including:
- A doubling of the community workforce. While this is not specific to the physiotherapy workforce, this is welcome news after fears that there would again be only a target on the primary care workforce. The target in the community setting is set at 3.9% growth annually.
- establishing community advanced practitioner rehab roles, which is something the CSP proposed. Initially the focus of these roles will be to support the development of intermediate care expansion.
- improved and earlier management of major conditions, such as cardiac and respiratory, by community services through rehabilitation and supported self-management.
What does the plan say about growth of the workforce in primary care?
- The plan commits to increasing additional roles in primary care by 19 000 and explicitly commits to funding every GP practice to have has an MSK FCP by 2032.
- The CSP warmly welcomes this commitment. However, we are clear that expansion in primary care FCP roles, advanced and consultant level practice will require backfill and the planned 3.3% growth may not be ambitious enough for this.
- The Plan describes MSK FCP roles as ‘enhanced practice’. This is consistent with the CSPs firmly held position that MSK FCPs require advanced level in clinical practice, but not necessarily advanced practice level across the other pillars (leadership, research, education).
- The Plan makes it clear that new advanced practice roles working in primary care can be employed and supported by the community provider. This is the CSP’s preferred employment position for physiotherapy roles in primary care, which and will continue to promote.
- The Plan also says that ICSs will be encouraged to work with partners to support adoption of NHS terms and conditions in primary care.
Will advanced practice roles be open to physios and other AHPs?
- The CSP welcomes the increase in advanced practitioners of 39,000 by 2031
- The plan is clear on the importance of this being inclusive of AHPs, including physiotherapists.
- It also commits to a career pathway for physios with enhanced practice, advanced practice and consultant level practice, with an emphasis on the generalist and core skills needed to care for people with multi-morbidity.
- Areas for advanced practice highlighted for growth are emergency medicine, primary and community care, mental health, learning disability and autism services, acute care services and specialist services like those for breast cancer.
- The Plan announces work to develop formal pathways to facilitate the transition from advanced to consultant level practice through a pilot programme with an initial focus on MSK, learning disability and autism and cancer pathways.
What does the plan mean for apprenticeships?
- The plan commits to funding apprenticeships for physiotherapy. This is something the CSP argued for as essential to the diversity of the profession and to support career progression and therefore support retention. Initially the plan only committed to funding apprenticeships for professions with a problem of supply of graduates.
- The plan assumes that around 5% of the future registered physio workforce will qualify via a degree apprenticeship. We fully support this and would be comfortable if even more people chose this route. There are already successful apprenticeships at different levels within physiotherapy.
- The plan references the agreement reached with the NHS Staff Council to ensure that existing NHS staff, who have agreed development plans in place through apprenticeships, are not financially penalised.
- All ICSs will be developing apprenticeship strategies. CSP members who are AHP leaders or involved in AHP Councils and Faculties should be seeking to influence these.
What does the plan say about staff health and wellbeing?
- The Plan says that ICSs will need to develop and implement plans to invest in occupational health and wellbeing services for NHS staff.
- It suggests that a core offer could include rapid access to mental health and musculoskeletal advice, guidance and treatment services – showing a further reason why the growth in the physio workforce is necessary.
- This is a potential opportunity for CSP members in occupational health services as well a potential benefit for physio staff in the NHS.
Why is the CSP calling for more physio posts in the NHS when we are struggling to recruit and retain our workforce?
- The CSP recognise recruitment and retention of physio staff is a major problem and it is essential that physio staff feel valued and have career opportunities to stay in the NHS.
- However, the CSP knows from what members have said that the problem of retention and recruitment goes hand in hand with low physio staffing levels. The Plan itself recognises the direct link between staffing levels and staff leaving the NHS.
- The only way to address this problem is in the round – giving permission to systems to expand physio staffing numbers, encouraging graduates to go into and retaining staff in the NHS through improving conditions and investing in them.
Is the plan fully funded?
- The CSP is calling for a long-term commitment from all political parties for both the training and staffing funding needed to implement the plan.
- The NHS Workforce Plan can only be delivered if NHS England are giving the funding to do this.
- The Government has committed to fund the training elements of the plan and the additional roles in primary care until 2028.
- Because the plan is for 15 years, it extends beyond the life of the current government. It will be for future government spending reviews to commit to ongoing funding for additional posts.
Will the funding enable more physios and support workers time and funding for development?
- The plan commits to maintain the national funding of £1000 over 3 years for CPD (personal development budgets) for physiotherapists (along with other AHPs, nurses and midwives) to supplement local employer investment in staff CPD.
- National CPD funding will be kept under review. The CSP will continue to argue for personal development budgets to also be available to AHP support workers.
Why are professions being treated differently in the plan?
- Physiotherapy has been successful over the last ten years in expanding the number of pre reg training places, which is not the case for all professions.
- Physiotherapy also has a relatively young age profile so does not face the immediate retirement crisis some others face.
- These and other factors mean what we need, and what other professions need, is different.
Where will the additional educators come from to expand pre-reg physio numbers and apprenticeships?
- The plan commits to a new approach to workforce planning and redesign with service providers, ICSs and NHS England playing an active role in leading and commissioning sustainable education supply, including the supply of educators.
- While staffing of HEIs is not something the NHS workforce plan can directly control. increasing the number of training places results in more funds being available to HEIs. Universities should recruit appropriately to respond to growing student numbers.
Where will additional placements come from to expand pre-reg physio numbers and apprenticeships?
- Physio education has been expanding constantly over many years in England. So the available workforce to support placements is itself growing.
- The CSP has provided advice on how to diversify placements and extend supervision ratios so that we can provide more placements.
- Ultimately, we can only solve the physio workforce crisis if all services and employers of physios play their part and offer placement opportunities.
- The Plan recognises inequities in funding excess travel and accommodation costs incurred by students undertaking placements. It proposes to introduce a single consistent policy for this.
- This is one way that the Plan suggests can help address the imbalances in geographical distribution of training posts and improve the attractiveness of jobs and retention of staff in rural and coastal areas.
- The Plan commits NHSE to develop a national core standard that placement providers must meet.
How will the plan help with recruitment of physio staff to NHS services?
- The NHS Digital Staff Passport is expected to be rolled out in full by August 2025 to make it easier for physio staff to move easily between NHS organisations
- The Plan seeks to increase entry level roles with recruitment exercises at scale in partnership with Jobcentre Plus where appropriate and improving recruitment processes to reduce the loss of good candidates due to delays.
- They will continue the national careers campaigns under the ‘We are the NHS’ banner and support local NHS systems and organisations to take targeted action. The national campaign has included physio and the CSP will push for this to continue.
- Ultimately the NHS needs to become a more attractive career choice for physio staff through improving conditions and providing career opportunities.
Is the plan only for the NHS? What about other sectors?
- The CSP has promoted the importance of addressing workforce demand across all sectors.
- It is the first time that workforce planning for the NHS has been so clear in recognising that clinical education pipelines do not exclusively support the NHS.
- This is particularly significant for physiotherapy with around a third of HCPC registered physios work outside the NHS. The CSP encouraged this shift in their approach.
What does this mean for Wales, Scotland, Northern Ireland and Isle of Man and Channel Islands?
- All parts of the UK face similar workforce challenges. The CSP is lobbying in all UK countries for a larger workforce, expanded training and better working conditions.
- This plan only covers the NHS in England, however physiotherapy is a UK wide profession and many of the developments in England will need to be considered in the other nations and also by the crown dependencies.
- The reform of professional regulation (see below) extends across the whole of the UK, and as such, suggested changes would have an impact on and need to be agreed with Scotland, Wales and Northern Ireland.
Does the CSP support reducing reliance on internationally qualified physios?
- Internationally trained physios are valued colleagues who play an important part in the NHS and other sectors.
- Around 15% of the registered physio workforce studied outside the UK. Intentional mobility helps spread learning and diversifies the profession.
- But relying on intentional migration to address workforce shortage isn’t sustainable because there is a global, not just a UK, shortage of physios.
- We therefore welcome a shift to training more physios in the UK rather than relying on recruiting more international physios to make good the deficient in supply.
How long is the plan for?
- The plan is for 15 years but there is a commitment to review the plan every two years.
- This provides the opportunity for the CSP to exert further influence and secure changes where we think the plan needs to be strengthened.
Does the CSP agree with how the plan has been calculated?
- The CSP believes there are flaws in how workforce supply and demand have been calculated in relation to physiotherapy.
- For supply it assumes that the proportion of physio graduates going into the NHS should remain the same as it has over the last 5 years. But we know that the NHS has underutilised the growth in physio graduates during this time and demand outside the NHS has been high.
- For demand it looks at temporary staff use, and vacancies and acknowledges that unmet population need is not currently factored. Given the unmet need for rehab services, this is a concern.
- Issues with the underlying assumptions on supply and how demand have been defined is something that the CSP will be actively challenging.
What are the CSP’s next steps now that the workforce plan has been published?
- The CSP will continue to hold NHS England, the Government and local systems to account for the commitments in the Plan.
- Next month the CSP are meeting Will Quince MP, the health minister with responsibility for workforce. The CSP has organised this and is attending with colleagues from the Community Rehabilitation Alliance.
- This Autumn the CSP will be publish our assessment of workforce data and hosting a member webinar on influencing workforce plans.
- Looking ahead to the general election in 2024 the CSP is briefing MPs and political parties on physiotherapy staffing and seeking their commitments to improve staffing levels.
What is the proposed change to registration?
- There are no proposals to change registration arrangements for physiotherapists.
- The plan announces changes to the regulatory framework to modernise the regulatory system (for example speeding up fitness to practice cases) and make powers between the different regulators more consistent.
- These will come in first for anaesthesia associates and physician associates (who will join the GMC register by the end of 2024), followed by legislation to allow changes for the regulation of doctors and for professions regulated by the NMC and HCPC over the following 2 years, subject to agreement across devolved nations.
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