Find out what the College is doing to ensure the future of the mental health workforce – and how you can support our work.
National workforce planning
Accompanying the Five Year Forward View for Mental Health is HEE’s workforce plan, Stepping Forward to 2020/21: Mental Health Workforce Plan for England, which sets out how an additional 19,000 posts will be created by 2020/21 to staff the new services it pledges.
We are leading the work on Physician Associates, and you can find guidance for employing bodies, prospective and existing Physician Associates – as well as information on our Physician Associates in Mental Health network – on our dedicated pages.
Stepping Forward has now reached its target deadline, and while good progress has been made on growing the overall mental health workforce, psychiatric and nursing workforce targets have been missed.
The NHS Long Term Plan was published in January 2019 and outlines the additional workforce needed to deliver the ambitious commitments on mental health and beyond. We engaged with national leaders to develop a vision for how people working in the NHS will be supported to deliver the plan. The Interim People Plan was published in June 2019, and The People Plan 2020/21 was published in July 2020.
The 2020/21 People Plan commits to making progress in addressing the most pressing workforce shortages in areas with the highest demand, including mental health. As a result, HEE are expanding psychiatry, starting with an additional 120 core psychiatry training programmes for 2021/22. We also called for continued expansion of core psychiatry posts for 2022 in our recent Spending Review submission.
What is the College doing next?
We are continuing to make the case for a bigger psychiatric workforce.
At a local level, we are monitoring the roll out of the community mental health framework and ICS workforce planning. As ICSs take on greater responsibility for people planning and transformation activities, we will support our members who are clinical leaders in working with local decision makers to influence and engage with the implementation of the NHS Long Term Plan in their region.
At a national level, we monitor progress on Stepping Forward and both NHS People Plans. We are looking forward to working with NHS England and Improvement on their future people strategy.
We are also currently working with HEE on their work to update their 15-year strategic framework for workforce planning – Framework 15 – to help ensure we have the right numbers, skills, values and behaviours for the future. We submitted a comprehensive response to their call for evidence, which set out what we think will have the most impact on workforce demand and supply over the next 15 years.
Following publication of HEE's strategic framework in 2022, we will be calling for a comprehensive NHS workforce strategy, accompanied by a multi-year settlement for workforce training and education.
Our most recent workforce census provides important evidence of the challenges facing the psychiatric workforce.
What else does the College want to see happen?
Since 2018 the government has funded an additional 1,500 medical training places per year. This was a welcome step to increase supply over the long-term, however did not go far enough to put long-term workforce planning on a sustainable footing.
COVID-19 has created an unforeseen growth in medical school places as a result of an unexpectedly high number of students qualifying for an offer to study medicine in 2021. In response, the government decided to provide extra funding to medical and dental schools across England and to increase the number of available places to 9,000 (of which 8,032 for medicine).
We are recommending the uplift in medical school places be retained for 2022/23 and expanded year on year, with 10,000 in 2023/24 and 11,000 in 2024/25, towards reaching 15,000 in 2028/29. This should be accompanied by assertive action over the longer term to ensure medical students become trainees in under resourced specialties, including psychiatry.
This article highlights key findings from our project on understanding what interventions at undergraduate level might have an impact on students choosing psychiatry as a career.
We are working with over 50 organisations to campaign for an amendment to the Health and Care Bill.
Currently, the Bill includes a clause mandating the publication of a report describing roles and responsibilities for workforce planning and supply. This will bring clarity to an opaque system but doesn’t go far enough. Crucially, it fails to clarify whether we are training and retaining enough people to deliver services.
We are supporting an amendment to strengthen workforce planning, so that the Secretary of State must also publish independent assessments of current and future workforce numbers every 2 years. Regular, independent and public workforce projection data will not solve the workforce crisis, but it will provide strong foundations to take strategic long-term decisions about funding, workforce planning, regional shortages and the skill mix required to help the system keep up with rising patient need, based on evolving changes in patient demand and in working patterns among staff, such as a growing proportion of doctors working part-time.
We broadly welcome the proposed reforms to the Mental Health Act. They provide an opportunity to modernise mental health law, tackle racial disparities, and improve support for people in a mental health crisis. However, the proposed reforms will result in significant changes to the way psychiatrists work and will place more demands on their time.
We have told the Government that changes to the Mental Health Act cannot be absorbed within the existing workforce. You can read more about our work.
Assuming that implementation of the reforms will begin in 2023/24, we recommend that the Government invest a cumulative £82m by 2024/25 to cover the 349 psychiatrists that are required. Following 2024/25, the Government should also commit to further annual investment in the psychiatric workforce to reach £60m (at current prices) by 2033/34, to ensure continued implementation of the reforms is successful.
Investment should be accompanied by a workforce plan to ensure the required workforce is in place at the time of implementation.