What’s lacking from the NHS Lengthy Time period Workforce Plan

Again within the days of the Healthcare Fee’s annual well being test, insurance policies and procedures had been central to high quality. It definitely felt like that when the psychological well being medical governance crew I used to be in spent hours guaranteeing follow adopted coverage. I additionally learnt the worth of employees involvement in coverage and its affect on retention. So, once I noticed the inclusion of this usually missed side of retention in an proof synthesis, I needed to learn on.

As a part of the Well being Basis funded Effectivity Analysis programme, researchers from the College of Sheffield reviewed literature from 2004-2020 (Lengthy, et al, 2023) to discover employees retention in psychological well being providers. By likelihood, I learn this synthesis inside the identical week because the NHS Lengthy Time period Workforce Plan (NHSE, 2023).  I questioned if the authors of the Plan had learn this evaluation and concluded they hadn’t. The synthesis underlined what was lacking from the Plan.

I wondered if the authors of the NHS Long Term Workforce Plan had read this synthesis on retention. I decided they hadn’t.

I questioned if the authors of the NHS Lengthy Time period Workforce Plan had learn this synthesis on retention. I made a decision they hadn’t.


The researchers carried out a realist synthesis. A way aiming to develop theories explaining why interventions work (or don’t), how they work and in what contexts. The researchers undertook the evaluation in 3 ‘hybrid’ phases (Rycroft-Malone, et al 2012), combining conventional evaluation strategies with folks’s views, together with:

  1. Exploratory scoping of literature alongside workshops, from which they developed preliminary theories;
  2. Searches and information extraction;
  3. Evaluation of knowledge, refining theories and growth of a logic mannequin.

Three key components of richness, relevance and rigour had been thought-about. Numerous stakeholders, together with employees and repair customers, helped take a look at and refine the theories.


The primary part of the evaluation generated 6 preliminary theories on efficient retention for additional exploration. The formal search within the second part generated information that was used to determine key elements and points towards every concept. Evaluation of the info confirmed that themes from throughout the 6 theories interconnected and overlapped. Consequently, in part three the crew built-in and refined the 6 theories into 3 key drivers, which represented an entire techniques perspective on efficient retention, beginning with organisational tradition and consisting of:

  • Workload and high quality of care
    • If employees expertise excessive workload,
    • then they’ll really feel they must ship decrease high quality care to handle time calls for;
  • Workers funding
    • If organisations spend money on coaching, growth and supervision,
    • then employees will really feel extra assured to ship increased high quality care;
  • Workers enter
    • If employees form the event of insurance policies and follow,
    • then they’ll really feel valued and supported to work autonomously.

Evaluation indicated that these drivers all affect on wellbeing, sense of connectedness to an organisation and in the end job satisfaction. To point out the relationships between these theories the crew created an overarching logic mannequin.

Figure 1 The logic model of factors affecting the retention of mental health staff

Determine 1 The logic mannequin of things affecting the retention of psychological well being employees. View full-sized determine.

What’s helpful about this evaluation, isn’t solely that it enhances our understanding of retention, nevertheless it generates an entire techniques perspective. A perspective sadly lacking from the Lengthy-Time period Workforce Plan.

The 3 key drivers of effective staff retention: workload & quality of care, investment and involvement, stem from organisational culture and demand a whole systems perspective.

The three key drivers of efficient employees retention: workload & high quality of care, funding and involvement, stem from organisational tradition and demand an entire techniques perspective.


The Workforce Plan picks up a few of the elements recognized by the evaluation, for instance coaching. Nonetheless, the main focus is on rising numbers of employees. The significance of investing in folks emphasised within the evaluation is much less obvious. The Plan acknowledges the numerous workload points for psychological well being settings, however fails to acknowledge the interconnectedness with high quality of care. The third issue for profitable retention: employees enter in coverage growth, doesn’t even get a point out. The closest the Plan will get is a bit entitled ‘we’ve got a voice that counts’.

The authors of the Plan appear to have missed the important thing level this evaluation underlines, merely recruiting extra employees is unlikely to resolve the problems. We have to preserve them. This central level is greatest summed up in realist phrases:

  • If workforce planning enabled an entire techniques method to tackling retention,
  • Then high quality of care would improve and employees job satisfaction enhance,
  • Resulting in…. extra employees staying.
Simply recruiting more staff is unlikely to solve the issues. We need to keep them.

Merely recruiting extra employees is unlikely to resolve the problems. We have to preserve them.

Strengths and limitations

The true energy of this evaluation isn’t merely what it tells us about retention in psychological well being providers, however what it gives us as a case examine for different UK well being settings. It could not ‘show’ one thing, however we are able to study one thing (Flyvbjerg, 2006). Because the NHS Workforce Plan acknowledges, psychological well being providers have increased turnover and extra vacancies than different employees teams. Workers face specific points from the character of care, akin to monitoring threat of suicide and expertise reportedly increased emotional exhaustion than colleagues in emergency settings (O’Connor, et al, 2018). Furthermore, despite the fact that the majority of the reviewed research had been from inpatient settings, the involvement of numerous employees and repair customers in creating the theories helps to make sure that the findings have wider applicability.

One of many primary limitations acknowledged by the researchers is their give attention to “interpretation fairly than guaranteeing probably the most complete identification of data” (Lengthy et al, 2023). Which means the evaluation could not have picked up all potential sources. The emphasis on the necessity to interpret could have additionally contributed to a seeming lack of emphasis on appraisal, not less than within the article. The researchers state that “Judgements on examine high quality had been deferred till later phases of research”. Sadly, no additional particulars are supplied within the article on how examine high quality was judged and the reader is left questioning what affect deferring had on the conclusions that had been reached.

The real strength of this review is not simply what it tells us about retention in mental health services, but what it offers us as a case study that may not ‘prove’ something, but where we can learn something.

The true energy of this evaluation isn’t merely what it tells us about retention in psychological well being providers, however what it gives us as a case examine that will not ‘show’ one thing, however the place we are able to study one thing.

Implications for follow

This synthesis generates implications for a number of teams. Firstly, for coverage makers, highlighting the have to retain, not merely recruit employees. Additionally, for retention to be approached utilizing a entire system perspective that tackles the interconnecting points. The interconnectedness of the elements affecting retention is equally vital for service suppliers. The evaluation underlines the necessity to begin with organisational tradition and make use of methods that recognise:

  • The interconnectedness of workload and high quality of care
  • The necessity to spend money on coaching and growth
  • The significance of employees autonomy by way of involvement in how high quality care is articulated and practised (usually forgotten).

Lastly, this evaluation gives an implication for funders of well being and social care analysis, particularly these working within the panorama of advanced interventions. If we’re to play a job in bettering the proof base, lowering uncertainties and bettering care (HRA, 2023), then we have to help syntheses of the proof that assist us perceive not simply what works, but additionally how.

The implications are not only for service providers, or policy makers, but also research funders who should support syntheses that help us understand what works and how.

The implications will not be just for service suppliers, or coverage makers, but additionally analysis funders who ought to help syntheses that assist us perceive what works and the way.

Assertion of pursuits

Justine Karpusheff is Assistant Director of Analysis at The Well being Basis. The Well being Basis funded this examine as a part of the Effectivity Analysis Programme.


Major paper

Lengthy J, Ohlsen S, Senek M, Sales space A, Which S, Wooden E. (2023) Realist synthesis of things affecting retention of employees in UK grownup psychological well being providers.  BMJ Open, 13(5) 2023. Obtainable at: https://bmjopen.bmj.com/content material/13/5/e070953#DC1

Different references

NHSE (2023) NHS Lengthy-term workforce plan. June 2023. Obtainable at: https://www.england.nhs.uk/wp-content/uploads/2023/06/nhs-long-term-workforce-plan-v1.2.pdf

Rycroft-Malone J, McCormack B, Hutchinson A M. et al (2012) Realist synthesis: illustrating the strategy for implementation analysis. Implementation Science, 7(33) 2012. Obtainable at:  https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-7-33

Flyvbjerg B. (2006) 5 Misunderstandings about case-study analysis. Qualitative Inquiry, 12(2) 2006. [abstract]

O’Connor Okay, Muller Neff D, Pitman S. (2018) Burnout in psychological well being professionals: a scientific evaluation and meta-analysis of prevalence and determinants. European Psychiatry, 53. Obtainable at: https://www.cambridge.org/core/journals/european-psychiatry/article/burnout-in-mental-health-professionals-a-systematic-review-and-metaanalysis-of-prevalence-and-determinants/8DE6B29F7AD65E2442726CA8D1F7F876

Well being Analysis Authority (2023) UK Coverage Framework for Well being and Social Care. Obtainable at: https://www.hra.nhs.uk/planning-and-improving-research/policies-standards-legislation/uk-policy-framework-health-social-care-research/uk-policy-framework-health-and-social-care-research/

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