The BMJ Commission on the Future of the NHS

ANALYSIS

review, and full implementation of the parliamentary recommendations on clinical academics

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Contributors and sources: All authors are members of the BMJ commission. MD-W leads a programme of work to improve the evidence base for improving quality and safety in the NHS and has longstanding research interests in issues relating to workforce, teams, employee voice, and culture and behaviour. She is a member of the BMJ International Advisory Board. CS is a clinical academic with a longstanding interest in embedding research into NHS care. She was deputy director/director of clinical academic training for Cambridge (2017-2022) until she became director of the Victor Phillip Dahdaleh Heart and Lung Research Institute, a new University-NHS collaboration that brings together more than 450 population health, laboratory, and clinical researchers with the aim of improving cardiovascular and lung health. MM is an adjunct clinical professor at Curtin University, Australia, an honorary senior research fellow at Cardiff University, UK, consultant in intensive care medicine in Cardiff, an author, and an editor of BMJ OnExamination. KP is chief medical officer of one of the largest NHS trusts in the NHS in England with over 24 000 staff and has been a responsible officer for over 10 years, covering not only secondary care but also primary care while he was medical director for NHS England (West Midlands). In each of these roles he has led the implementation of programmes to recruit, retain, and reward the workforce and also participated in initiatives to promote innovation at a workforce level. MD-W produced the first draft of the paper, and all authors contributed to ideas and revisions. All authors agreed the final draft. MD-W is guarantor. Competing interests: We have read and understood BMJ policy on competing interests and declare: MD-W is currently undertaking evaluative work for the Care Quality Commission. She is an unpaid director and founder of THIS Labs. CS gave oral evidence to the House of Lords Science and Technology Committee Inquiry into Clinical Academics and the NHS. She is employed by the University of Cambridge, is an honorary consultant at Cambridge University Hospitals NHS Foundation Trust, and is director of studies in clinical medicine at Selwyn College, Cambridge. MM is an employee of TheBMJ andhas acted in various advisory roles for the health service including for the Welsh government. KP has no interests to declare.

Provenance and peer review: Commissioned; externally peer reviewed.

This article is part of The BMJ Commission on the Future of the NHS (https://www.bmj.com/nhs-com- mission). The purpose of the commission is to identify key areas for analysis, lay out a vision for a future NHS, and make recommendations as to how we get there. TheBMJ convened this commission, which was chaired independently by Victor Adebowale, Parveen Kumar, and Liam Smeeth. TheBMJ was responsible for the peer review, editing, and publication of the papers of the commission. The BMA, which owns TheBMJ , grants editorial freedom to the editor in chief of TheBMJ . Theviews expressed are those of the authors and may not necessarily comply with BMA policy. We thank Rosie Lindsay for help with the bibliography for this article. The Healthcare Improvement Studies (THIS) Institute, which is led by Mary Dixon-Woods, is supported by the Health Foundation — an independent charity committed to bringing about better health and healthcare for people in the UK. 1 Rolewicz L, Palmer B, Lobont C. The NHS workforce in numbers: Nuffield Trust. 2022 https://www.nuffieldtrust.org.uk/resource/the-nhs-workforce-in-numbers 2 Baker C. NHS key statistics: England. House of Commons Library. 15 Nov 2023. https://common- slibrary.parliament.uk/research-briefings/cbp-7281/ 3 Care Quality Commission. The state of health care and adult social care in England 2022-23. 2023. https://www.cqc.org.uk/sites/default/files/2023-10/20231020_stateofcare2223_print.pdf. 4 NHS Survey Coordination Centre. NHS staff survey 2023: national results briefing. March 2024. https://www.nhsstaffsurveys.com/static/3b9bd4686a7075ed186a377e918c117b/National-Results- Briefing-2023.pdf 5 Hart JT. The inverse care law. Lancet 1971;297:-12. doi: 10.1016/S0140-6736(71)92410-X pmid: 4100731 6 O ’ Dowd A. NHS temporary staffing bill “ skyrockets ” to £10.4bn. BMJ 2024;384:. doi: 10.1136/bmj.q140 pmid: 38237935 7 Stringer G, Ferguson J, Walshe K, etal. The use of locum doctors in the NHS - results of a national survey of NHS Trusts in England. BMC Health Serv Res 2023;23:. doi: 10.1186/s12913-023-09830-9 pmid: 37612669 8 Zaranko B, Sanford NJ, Kelly E, etal. Nurse staffing and inpatient mortality in the English National Health Service: a retrospective longitudinal study. BMJ Qual Saf 2023;32:-63. doi: 10.1136/bmjqs-2022-015291 pmid: 36167797 9 NHS England. NHS long term workforce plan. 2023. https://www.england.nhs.uk/publication/nhs- long-term-workforce-plan/ 10 Warner M, Zaranko B. Implications of the NHS workforce plan: IFS Report, 2023. https://ifs.org.uk/publications/implications-nhs-workforce-plan 11 NHS England. General practice workforce, 31 December 2023. 2024. https://digital.nhs.uk/data- and-information/publications/statistical/general-and-personal-medical-services/31-december- 2023 12 Fraser C, Beech J, Mendelsohn E. General practice tracker. Health Foundation https://www.health.org.uk/news-and-comment/charts-and-infographics/general-practice-tracker 13 Twigg DE, Kutzer Y, Jacob E, Seaman K. A quantitative systematic review of the association between nurse skill mix and nursing-sensitive patient outcomes in the acute care setting. J Adv Nurs 2019;75:-23. doi: 10.1111/jan.14194 pmid: 31483509

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