The UK National Health Service employs around 1.5 million people in England alone and trains approximately 286,000 more at any given time. When the pandemic disrupted clinical placements, cancelled training, and pushed half its educators to the edge of burnout, it exposed how fragile that system was. What the NHS built in response — and what it is still trying to resolve — offers a clear-eyed view of what large-scale L&D design looks like when it is tested in the hardest possible conditions.
The National Health Service in England employs approximately 1.5 million people and trains around 286,000 more at any given time, according to figures cited in the NHS Long Term Workforce Plan published in June 2023. Before the pandemic, it already had over 100,000 vacancies and a structural dependency on international recruitment to fill gaps that domestic training pipelines could not cover. Then COVID-19 removed the conditions training depended on: clinical placements were cancelled, surgical lists were reduced, trainees were redeployed to frontline critical care work, and the educators responsible for training were simultaneously managing an emergency of unprecedented scale.[1]
The training deficit that accumulated during this period was concrete and documented. A 2023 study on surgical training published in PubMed noted that the initial COVID-19 pandemic wave resulted in the mass redeployment of trainees to support critical care and medical services, alongside almost complete cancellation of elective services. The training deficit was then compounded through subsequent pandemic waves. The paper, examining High Volume Low Complexity theatre list pilots designed to recover training, noted trainees' concern that further waves were anticipated and that returning to operating was essential to both service delivery and the surgical training pipeline.[2]
NHS England's own Educator Workforce Strategy, published in 2023, captured the broader systemic impact on the people responsible for delivering training: the GMC National Training Survey 2022, completed by over 18,000 educators, found that 52 percent of trainers were at a moderate or high risk of burnout. Alongside this, 55 percent of educators reported being unable to use all the training time allocated to them, due to conflicting clinical workload pressures — a figure that had been rising since 2021. The campaign hashtag #NoTrainingTodayNoSurgeonsTomorrow, referenced in the Educator Workforce Strategy, captured the logical consequence: if the people responsible for training are themselves overloaded and undersupported, the pipeline of future clinicians is simply not being filled.[3]
The policy response to these accumulated pressures arrived in two significant documents. The NHS Long Term Workforce Plan, published on 30 June 2023, was described as the first-ever long-term plan of its kind for the NHS. It set out a 15-year framework built around three priorities: train, retain, and reform. The government committed more than £2.4 billion in additional investment for education and training over the next five years, on top of existing budgets already rising to a record £6.1 billion over two years. The plan's modelling identified a potential staffing shortfall of between 260,000 and 360,000 by 2036/37 without action, and set out ambitious targets including doubling medical school places to 15,000 by 2031/32 and increasing nursing training places by 92 percent to nearly 38,000.[4]
The Long Term Workforce Plan is primarily discussed in terms of numbers: places, headcount, growth percentages. But the more interesting L&D design changes concern the routes through which training happens and the infrastructure that supports it, both of which shifted meaningfully in response to what the pandemic exposed.
One of the most structurally significant changes in the Long Term Workforce Plan is the deliberate expansion of apprenticeship routes into clinical roles that previously required traditional undergraduate pathways. The plan commits to delivering 22 percent of training for clinical staff through apprenticeship routes by 2031/32. It is piloting medical degree apprenticeships from 2024/25, with 200 places funded in the first cohort and an ambition of 2,000 medical students training via this route by 2031/32.[5]
For nursing associates — a role that did not exist at scale before the pandemic pressures reshaped workforce planning — the plan sets a target of 10,500 training places per year by 2031/32, rising to 64,000 nursing associates working in the NHS by 2036/37 compared to approximately 4,600 in 2023. This is not a marginal expansion. It is the creation of an entirely new workforce tier, built on a training model that keeps candidates employed and earning while they qualify, which directly addresses one of the structural barriers to domestic recruitment that the pandemic brought into focus: the cost of full-time study.[4]
The logic is a direct response to the fragility the pandemic exposed. A training system that depends heavily on removing candidates from the workforce for three to five years to put them through full-time university programmes cannot respond quickly to demand. A parallel system of earn-while-you-learn routes creates a more resilient pipeline, because candidates are already embedded in clinical settings as they train.
The NHS Educator Workforce Strategy, published alongside the Long Term Workforce Plan in 2023, represents something the system had not formally attempted before: treating the people responsible for training as a distinct workforce group with their own development needs, career pathways, and protection requirements. It acknowledges directly that in many professions there is currently no clear job planning that makes the educator contribution identifiable and transparent — meaning the time educators spend on training is not formally protected in job plans, which is why 55 percent were unable to use their allocated training time.[3]
Alongside this, in June 2022 NHS England published the first NHS-wide Patient Safety Syllabus, applying to all NHS employees. This was specifically designed so that all staff receive enhanced patient safety training through a common framework, covering systems thinking and human factors. Levels 1 and 2 are available on the eLearning for Healthcare hub. The significance for L&D is practical: it represents the NHS building a universal baseline for safety learning that is standardised across all roles and settings, rather than leaving it to local interpretation.[6]
The National Education and Training Survey (NETS), which tracks learner and placement provider experience annually, has become a key mechanism for identifying gaps and holding the system accountable. By 2024, 95 percent of learners knew how to raise concerns in their organisation, up from 65 percent in 2022 — a meaningful improvement in psychological safety in training environments.[6]
In July 2025, the NHS published a 10 Year Health Plan that explicitly rejected the staffing projections in its own 2023 workforce plan, calling those projections "fiction" and stating that fewer NHS staff will be needed by 2035 than previously planned.
This is a significant policy reversal. The 2023 Long Term Workforce Plan was built around a projected shortfall of up to 360,000 staff by 2036/37 and set ambitious targets to double medical school places and near-double nursing training. The 2025 plan, analysed by the King's Fund and the Health Foundation, argues instead that the shift toward community-based care, digital technology, and AI-enabled workflows means the NHS will need a differently skilled workforce rather than a larger one.[7]
The 10 Year Health Plan commits to completely reforming mandatory training by April 2026, introducing new skills escalators that give all staff a trajectory for career progression with increasing autonomy, and promising personalised development plans and career coaching for all NHS staff by 2035. It also pledges to end agency staffing in the NHS by the end of this parliament in 2029. For training designers, the pivot is instructive: the NHS is moving from a model built around producing more of the same roles to one built around producing differently skilled people capable of working differently.[8]
The Long Term Workforce Plan has been criticised for its long delivery horizon and its dependence on future spending decisions. The criticisms are largely accurate. But they should not obscure the design choices that represent genuine advances on what came before.
The turnover data also shows a meaningful improvement that the plan's retention focus contributed to. NHS England reported that 10.1 percent of hospital and community health service staff left in the twelve months to September 2024, down from 12.5 percent in the twelve months to September 2022, according to Health Foundation analysis. That four-year trajectory is not dramatic, but it represents tens of thousands of people who were retained in roles rather than replaced. In an organisation where replacement typically requires multi-year training, retention is the fastest available lever for effective workforce capacity — and the plan recognised this explicitly, aiming to reduce the annual leaver rate from 9.1 percent in 2022 to between 7.4 and 8.2 percent over fifteen years.[9]
The NHS's own planning documents are notably candid about what is not yet working. Combined with independent analysis from the King's Fund, Health Foundation, and GMC, the unresolved gaps are specific enough to be instructive for any large organisation attempting training reform at scale.
The most acute fragility is the educator pipeline. The GMC National Training Survey 2024 found that more than half of NHS trainers still felt their work was emotionally exhausting — a figure broadly consistent with 2022. Around 29 percent of trainers reported difficulties using allocated time to train alongside their clinical commitments. Around 31 percent in secondary care said rota gaps were not being dealt with effectively.[10] The Educator Workforce Strategy was designed to address this, but the gap between publishing a strategy and protecting educator time in actual job plans — across 1.5 million employees in hundreds of organisations — is substantial. The Health Foundation noted in 2023 that the Long Term Workforce Plan's commitments would hinge on how effectively the Educator Workforce Strategy was implemented in practice.[11]
The second fragility is simulation access. Simulation-based learning is the mechanism the NHS has identified for training more people with fewer clinical placements, reducing the dependency on patients being present for training to happen. The National Education and Training Survey consistently tracks learner access to simulation and immersive learning opportunities. The 2025 NETS results showed 38 percent of learners could access simulation — up from 33 percent in 2022, but still meaning that nearly two in three NHS learners in training cannot access the technology the training expansion strategy depends on.[6] This is an infrastructure gap, not a pedagogical one.
The third fragility is the social care parallel. The King's Fund's analysis of the Long Term Workforce Plan noted that social care in England had approximately 152,000 vacancies at the time of the plan's publication in 2023 — and that without a companion plan for that sector, the NHS plan's ambitions were at risk, since workforce pressure in social care directly affects hospital patient flow and therefore clinical capacity for training.[12] The 2025 10 Year Health Plan restated the problem without resolving it. The interdependency between health and social care workforce capacity remains the most structurally underaddressed issue in the NHS training system.
The NHS is not a model that other organisations can copy. Its scale, regulatory environment, and clinical specificity are unique. But the strategic problems it has encountered — and the design choices it has made in response — translate directly to any organisation attempting to rebuild or restructure training at significant scale.
The NHS Long Term Workforce Plan was built around ambitious growth in training numbers. The Educator Workforce Strategy existed because the people responsible for delivering that training were burning out faster than they could be replaced. The two plans needed to be designed together; they were published together but remain at risk of being implemented independently. The practical lesson for large organisations is direct: any training expansion plan that increases volume without identifying where the additional educator capacity will come from is building on an unstated assumption. For a hospital trust that trains 50 more clinical staff, that training must be delivered by someone who also has a patient load. For a large corporate organisation rolling out a capability programme to 20,000 employees, the manager who delivers the coaching conversation is also managing a team, a project, and a performance cycle. Protecting educator time is not a welfare consideration; it is the primary delivery constraint. The #NoTrainingTodayNoSurgeonsTomorrow campaign named this clearly: the same logic applies to any function where the people doing the training are also the people running the business. Identifying who will train, protecting their capacity to do it, and measuring their experience is not a secondary implementation task. It is the core design problem.[3]
One of the clearest lessons from the NHS pandemic experience is that a training architecture built around one delivery model — in this case, full-time undergraduate study requiring removal from the workforce — collapses completely when that model is disrupted. Clinical placements could not happen during the acute pandemic phase. A training system designed around those placements as its only route had no fallback. The NHS's post-pandemic investment in apprenticeship routes, nursing associate pathways, and simulation-based learning is not just a capacity expansion strategy. It is a diversification strategy that reduces the concentration risk in its training architecture. For L&D professionals in GCC and Southeast Asian markets, where large infrastructure and giga-projects are creating sudden, massive demand for skills that take years to develop through traditional routes, this lesson has direct application. Designing training programmes that can run in parallel — some classroom-based, some work-embedded, some digital and asynchronous — creates a system that can continue functioning when any single route is unavailable. The 2025 NHS 10 Year Health Plan's explicit pivot toward skills escalators, earn-while-you-learn pathways, and AI-enabled learning tools reflects the same recognition: the training format cannot be allowed to become the training constraint.[4][8]
Baugment works with organisations designing large-scale training architecture: mapping trainer capacity, building diversified delivery routes, and designing programmes that hold together under operational pressure rather than collapsing when a single component is disrupted. Whether you are in healthcare, infrastructure, or any complex sector where L&D sits alongside demanding operational workloads, we help you design systems that can actually be sustained.
