FICM evidence submission to the 10 Year Workforce Plan

The Faculty of Intensive Care Medicine has made a submission to the government’s call for evidence to inform development of the 10 Year Workforce Plan. The below is an edited version of the submission, minus some additional documentary components, presented for the information of members and the public. 

Some of the evidence referenced in this submission is drawn from draft or pre-publication materials currently being finalised by the Faculty, including our most recent Consultant Census and the forthcoming version 3 of Guidelines for the Provision of Intensive Care Services (GPICS), which has been circulated for pre-publication consultation. Where used, such references are clearly indicated and reflect the most up-to-date insights available to the Faculty at the time of submission.
 

Section 1: The 3 Shifts

1.1. Digital Initiatives Improving Patient Care

FICM supports the development of robust digital infrastructure to enable more effective clinical communication, remote support, and equitable access to specialist care — particularly for small and remote critical care units. The Faculty has advocated for:

• Remote access to digital patient records, imaging, and decision-making tools is essential to support effective ‘hub and spoke’ models of care, particularly for small and remote units. This need was highlighted by the Small and Specialist Units Advisory Group (SSUAG), a committee of the FICM (see SSUAG FICM Critical Eye, Winter 2024 article).
• Phase 1 of NHSE’s digitalisation survey in critical care services, with Phase 2 to identify infrastructure needs (see SSUAG FICM Critical Eye, Winter 2024 article).
• Remote clinical advice networks (e.g., neuro-critical care, ventilatory weaning) to support complex decision-making in smaller units.
• AI-enabled tools such as Clinical Decision Support (CDS) and Ambient Voice Technology (AVT), which can reduce administrative burden and enhance care — though implementation must be cautious and clinician-led (AI in Critical Care, FICM Critical Eye, Summer 2025).
• A call for basic IT systems that work, with interoperability between platforms and access to remote digital solutions, a foundational requirement for any digital shift.

These initiatives aim to improve patient outcomes by enabling timely, expert input regardless of geography, and to support staff in isolated settings. However, digital transformation must be underpinned by infrastructure investment and workforce training.

1.2. Shift from Hospital-Based to Community Care

While critical care is inherently hospital-based, FICM recognises the importance of models that enable earlier discharge, repatriation, and continuity of care closer to home. The Faculty supports:

• Strengthening transfer and repatriation pathways: Transfer and repatriation policies that enable patients to return to local units once stabilised help reduce pressure on tertiary centres (see SSUAG FICM Critical Eye, Winter 2024 article). To ensure these pathways are effective, they must be underpinned by fully commissioned and appropriately staffed services, including critical care transfer teams and receiving units with adequate capacity.
• Enhanced Care Units (Level 1/1+) to bridge the gap between ward and ICU care, supporting earlier discharge and reducing hospital length of stay.
• Realistic Medicine and escalation planning to ensure appropriate use of ICU resources and avoid unnecessary admissions.

These models support continuity of care in the community and align with broader NHS ambitions to reduce hospital dependency.

1.3. Preventative Care Services

Although prevention is not traditionally within the remit of intensive care, FICM supports initiatives that reduce the need for ICU admission through early intervention and patient empowerment:

• Martha’s Rule, which empowers patients and families to escalate concerns early, potentially preventing deterioration and ICU admission.
• Early escalation pathways in urgent care and perioperative settings, which can prevent critical illness through timely intervention.
• Recognition of geographical inequalities in access to critical care, as highlighted in the CMO’s report on coastal health and the MTR diagnostic review; prevention must include equitable access to timely care.
• Vaccination programmes for COVID-19 and influenza, which reduce the burden of respiratory illness and ICU admissions. FICM has supported national efforts to promote vaccination uptake through research, education, and clinical leadership.
• Rehabilitation following critical illness, which is essential to prevent long-term physical, psychological, and cognitive complications. NICE guidelines (CG83 and QS158) recommend structured rehabilitation pathways from ICU through to community care.
• FICM’s Life After Critical Illness (LACI) programme provides best practice guidance for developing follow-up services, addressing inequalities in access to rehabilitation and supporting recovery across physical, psychological, and social domains.

1.4. Critical Professions, Roles and Skills

Successful implementation of the 3 shifts depends on a multidisciplinary workforce with the right skills, support, and infrastructure. This includes:

• Consultants in Intensive Care Medicine (ICM) leading care and decision-making, as mandated by GPICS v3 (GPICS v3 is currently in the final stages of development and is expected to be published by the end of 2025). Data referenced here is based on draft content reviewed by the Faculty.
• The non-consultant medical workforce, including Intensivists in Training (IiTs), SAS Doctors, and Locally Employed Doctors (LEDs), as well as Advanced Critical Care Practitioners (ACCPs).
• Critical Care Pharmacists are essential to safe ICU care. GPICS requires 7-day pharmacy cover, but most units fall short. The FICM Critical Care Pharmacist Toolkit outlines a national shortfall and a tiered development framework to address this.
• Other MDT roles: including dietitians, physiotherapists, occupational therapists, and psychologists, are also under-resourced in many units.
• Digital literacy and access to remote consultation tools are increasingly essential.
• Regional Advisors and Faculty Tutors play a key role in workforce planning and training.
   

1.5. Barriers and Solutions

Barriers

• Workforce shortages, particularly in small and remote units.
• Inadequate infrastructure, including lack of isolation facilities, which impacts infection control and causes moral distress among staff.
• Digital fragmentation and lack of interoperability.
• Recruitment challenges due to geography, lifestyle, and lack of exposure to smaller units during training.
• Shortfalls in MDT staffing, especially pharmacy, dietetics, and psychology.

Solutions

• Increase ICM NTNs and distribute them to rural and high-need areas.
• Promote ICM as a career path in smaller units through exposure during training and flexible job planning.
• Develop digital infrastructure to support remote working and advice.
• Implement the Critical Care Pharmacist Career Pathway Toolkit to upskill and credential pharmacists.
• Support flexible job planning, incentives, and retention strategies to attract consultants to underserved areas.
• Recognise and support the full workforce, including SAS doctors and LEDs working in critical care, ACCPs and Critical Care Pharmacists, in workforce planning.

Section 2: Modelling Assumptions

2.1. Workforce Modelling Assumptions in ICM

FICM’s workforce modelling is based on several key assumptions:

• Service redesign (e.g. centralisation of specialist services, expansion of Enhanced Care Units) will reduce acute admissions to smaller ICUs, impacting skill maintenance and recruitment.
• Digital transformation and remote support will allow more flexible deployment of staff but requires investment in infrastructure and training.
• Multidisciplinary team (MDT) staffing must meet GPICS standards, including 7-day pharmacy, dietetics, physiotherapy, and psychology, most units currently fall short.
• Consultant-led care remains essential, with GPICS v3 (pending publication) reinforcing the need for ICM consultants to lead care 7 days a week.
• Attrition from training must be factored into workforce forecasting. Between August 2012 and August 2024, 190 doctors left the ICM CCT programme, resulting in an average attrition rate of 10.38%.
• Long-term workforce intentions are strong. Preliminary findings from our most recent Consultant Census indicate that 84% of Intensivists in Training (IiTs) intend to practice ICM long term, a trend consistent across other doctor groups.

Evidence

• SSUAG report highlights the impact of centralisation on small units and the need for digital and network support to maintain viability (see SSUAG FICM Critical Eye, Winter 2024 article).
• GPICS v2.1 sets out minimum staffing standards, with v3 expected to strengthen these further.
• The FICM Critical Care Pharmacist Toolkit outlines the national shortfall in trained pharmacists and the tiered development framework needed to meet standards.
• FICM Annual Recruitment Report 2024 confirms the 10.38% attrition rate from the ICM CCT programme.
   

2.2. Impact on Workforce Supply and Demand

Consultant Workforce

• 44% of consultants are contemplating reducing their programmed activities, with implications for rota sustainability.
• On-call frequency varies widely, with many consultants working more frequently than 1:8, raising concerns about wellbeing and retention.
• The census also suggests that newly appointed and younger consultants are less likely to want to work >10 PAs, which is currently common practice. This shift is closely linked to the increasing uptake of Less Than Full Time (LTFT) training among Intensivists in Training (IiTs) and will further exacerbate existing workforce shortfalls unless job planning and recruitment strategies are adapted accordingly.
• Concerns persist among single and dual/triple ICM CCT holders from medical backgrounds regarding employment opportunities. As highlighted in the Critical Eye Winter 2025 article by Dr Zoe Brummell and colleagues, employers must recognise the value of intensivists from all training routes, including those with backgrounds in internal medicine and emergency medicine, and ensure equitable access to consultant posts.

Training Pathways

• The FICM 2024 Annual Recruitment Report and workforce evidence show:
  • There has been a noticeable increase in the proportion of doctors completing training with a single ICM CCT between 2023 (20) and 2024 (41).
  • A growing proportion of residents entering from medical and emergency medicine backgrounds, not just anaesthesia.
  • ~30% of Intensivists in Training (IiTs) are training less than full time (LTFT), which extends time to CCT and affects workforce planning.

Non-Consultant Workforce

• The ICM workforce includes IiTs, SAS doctors, LEDs, ACCPs and Critical Care Pharmacists, all of whom contribute to service delivery but are often excluded from formal workforce modelling.
• The Portfolio Pathway is increasingly used, with 18 successful applications in 2024, offering an alternative route to specialist registration for ICM.

Regional Variation

• FICM’s 2025 Regional Advisor survey shows significant shortfalls in consultant numbers in regions such as East of England (-33), East Midlands (-19), and South Yorkshire (-17).
• Fill rates for training posts vary from 72% to 100%, with some regions consistently under-recruiting.
   

2.3. Implications for Future Planning

To meet the ambitions of the 10-Year Health Plan, workforce modelling must:

• Include the full MDT, not just consultants.
• Account for LTFT training, dual/triple ICM CCT pathways, and Portfolio Pathway entrants.
• Target regional investment, especially in underserved and remote areas.
• Integrate infrastructure and digital readiness into workforce planning, staffing cannot be separated from the environments in which staff work.
• Factor in attrition rates and long-term workforce intentions to ensure realistic forecasting and sustainable service delivery.

Section 3: Productivity Gains from Wider 10-Year Health Plan Implementation

3.1. Digital Initiatives Increasing Productivity or Reducing Demand

Evidence-backed examples

• AI-enabled documentation tools (e.g. Ambient Voice Technology) can reduce administrative burden and free up clinician time for direct patient care. NHS England guidance highlights AVT’s potential, but also the need for robust governance (see AI in Critical Care article – FICM Critical Eye Summer 2025).
• Clinical Decision Support (CDS) systems embedded in Electronic Health Records (EHRs) can analyse data streams and provide real-time prompts, improving decision-making efficiency (see AI in Critical Care article – FICM Critical Eye Summer 2025).
• Remote access to digital records and imaging enables timely decision-making and reduces duplication, especially in hub-and-spoke models (see SSUAG FICM Critical Eye, Winter 2024 article).
• Digital infrastructure is essential for enabling remote clinical advice networks, which reduce unnecessary transfers and support local care delivery (see SSUAG FICM Critical Eye, Winter 2024 article).
   

3.2. Addressing Training Gaps to Support the 3 Shifts

Evidence-backed actions supporting education reform, retention, and workforce modernisation 

• Upskilling the MDT for modern care models: The FICM Critical Care Pharmacist Career Pathway Toolkit provides a tiered framework (Tiers 1–5) to develop pharmacists from basic medicines reconciliation to consultant-level practice. This supports the shift to digital, community-based, and preventative care by ensuring safe medication management across diverse settings.
• Embedding MDT training into core standards: GPICS v2.1 and the forthcoming v3 highlight the need for structured training and support for wider MDT roles, including dietetics, physiotherapy, and psychology, where provision is currently limited. Addressing these gaps is essential to expand training capacity and modernise the workforce model.
• Aligning Recruitment Practices with Workforce Diversification: The FICM 2024 Annual Recruitment Report highlights an increasing uptake of dual and triple CCT pathways, with an increasing number of Intensivists in Training (IiTs) entering from medical and emergency medicine backgrounds. This diversification enhances flexible workforce deployment across settings. However, despite this trend, concerns remain about employment opportunities for doctors from medical specialties. Bridging gaps in employer understanding is essential to fully realise the productivity benefits of a diverse ICM workforce.
• Recognising LTFT as a long-term workforce model: An increasing number of doctors are training Less Than Full Time (LTFT), a trend that is likely to continue into consultant practice. While exact figures are not yet published, FICM acknowledges this shift and plans future reporting. Supporting LTFT pathways is essential not only for retentionbut also for modernising workforce models to reflect evolving expectations around work–life balance and sustainable careers. 
   

3.3. NHS Role in Local Communities

FICM recognises the NHS’s vital role in supporting patients and communities beyond the acute phase of illness. This includes:

Retention of Services in Small and Remote Units

• Retaining services in small and remote units supports local economies, sustains other hospital services, and reduces health inequalities.
• FICM’s Small and Specialist Units Advisory Group (SSUAG) highlights that these units serve populations with higher deprivation, multimorbidity, and poor housing, and are essential to maintaining access to care in geographically isolated areas.

Repatriation Pathways and Local Recovery

• Repatriation pathways allow patients to return to local units once stabilised, improving recovery and reducing travel burden for families.
• These pathways also help maintain patient throughput in smaller units, supporting staff skill retention and service viability.

Digital Access and Remote Support

• Remote access to digital records and imaging enables timely decision-making and supports care closer to home.
• Digital infrastructure is essential for enabling remote clinical advice networks, reducing unnecessary transfers and supporting community-based models.

Vaccination Programmes

• The NHS England Autumn/Winter Flu and COVID-19 Vaccination Programme targets high-risk groups and aims to reduce hospital admissions, support NHS resilience, and ease winter pressures.
• FICM supports these efforts through clinical leadership, education, and advocacy, recognising the role of intensivists in promoting vaccination uptake among patients and staff.

Rehabilitation Following Critical Illness

• Survivors of critical illness often experience long-term physical, psychological, and cognitive impairments. Despite this, there has historically been no nationally established approach to post-ICU rehabilitation.
• FICM’s Life After Critical Illness (LACI) programme provides best practice guidance for developing and commissioning follow-up services. It includes service model archetypes, eligibility criteria, toolkits, business case development, and governance frameworks.
• NICE guidelines (CG83 and QS158) recommend structured rehabilitation pathways from ICU through to ward and community care, with goals set and reviewed at key transition points.
• NHS England’s  Intermediate Care Framework supports rehabilitation and reablement following hospital discharge, aiming to reduce readmissions and improve independence.

3.4. Managing Changing Expectations and Patient Participation

Evidence-backed examples

• Martha’s Rule empowers patients and families to escalate concerns, improving safety and responsiveness.
• Digital tools for escalation planning and shared decision-making support Realistic Medicine principles and reduce unnecessary ICU admissions.
• AI-enabled CDS systems can support personalised care planning but must be implemented with safeguards to avoid bias and ensure equity (see AI in Critical Care, FICM Critical Eye, Summer 2025).

Section 4: Culture and Values

4.1. Policy Interventions Improving Workforce and Patient Outcomes

Evidence-backed examples

• GPICS standards (v2.1 and draft v3) require consultant-led care 7 days a week, appropriate MDT staffing, and access to training, all of which support staff wellbeing and patient safety.
• Preliminary findings from our most recent Consultant Census indicate that 44% of consultants are contemplating reducing their programmed activities, often due to workload pressures and unsustainable rotas. This highlights the need for job planning reforms and retention strategies.
• The Critical Eye NHS Jobs analysis article found that many consultant posts do not meet AoMRC or FICM recommendations for SPA time, transparency, or flexibility, contributing to recruitment challenges and dissatisfaction.
• Flexible training pathways, including LTFT and Portfolio Pathway routes, support retention and career progression, especially for those with caring responsibilities or non-traditional backgrounds.
   

4.2. Embedding Core Values into Leadership and Service Delivery

Embedding inclusive values into leadership and service delivery requires recognising the full breadth of ICM training backgrounds. As highlighted in the Critical Eye NHS Jobs analysis article, doctors with single or dual/triple CCTs from medical routes often face barriers to employment. Employers must ensure fair access to consultant posts for all qualified intensivists, regardless of training route.

Evidence-backed approaches

• FICM promotes Realistic Medicine principles, including shared decision-making, escalation planning, and patient-centred care, aligning clinical leadership with ethical values.
• The Critical Care Pharmacist Toolkit outlines a tiered development model that supports leadership, education, and research roles for pharmacists, embedding professional values across the MDT.
• FICM’s ICM Regional Advisors and Faculty Tutors play a vital role in mentoring, ensuring the quality of training, and promoting standards, and upholding professional standards across intensive care medicine. As key educators within the system, they should be appropriately supported and allocated sufficient time within their job plans to carry out these responsibilities effectively.

Embedding a culture of prevention and recovery in critical care also includes:

• Supporting vaccination advocacy as part of public health leadership, recognising the role of intensivists in promoting COVID-19 and influenza vaccination to reduce ICU demand and protect vulnerable populations.
• Promoting rehabilitation as a core value, with FICM’s LACI programme and NICE guidelines (CG83 and QS158) providing frameworks for equitable, patient-centred recovery services.
• Recognising the moral distress caused by inadequate infrastructure (e.g. lack of isolation facilities), which impacts staff wellbeing and patient safety, a cultural issue that must be addressed alongside staffing.
   

4.3. Listening to Staff Feedback and Acting on It

Evidence-backed systems

• The FICM Consultant Census and CCT Holder Surveys provide structured feedback on job satisfaction, career intentions, and barriers to retention, informing Faculty policy and advocacy.
• The SSUAG report reflects feedback from small and remote units, highlighting the need for equitable transfer services, digital support, and recognition of staffing challenges (see SSUAG FICM Critical Eye, Winter 2024 article).
• FICM’s inclusion of SAS doctors, LEDs, Portfolio Pathway doctors, ACCPs and Critical Care Pharmacists in its membership and workforce planning reflects a commitment to listening to and representing under-recognised groups.