In the NHS, there is a concerted plan to create innovative opportunities to increase access to roles through the use of apprenticeships and balancing them with more traditional academic routes of entry in some professional groups (such as medicine). The expansion of apprenticeships has been highlighted as a means of not only addressing key workforce shortages, but also widening opportunities for people from all backgrounds, making the NHS more accessible, diverse, inclusive and representative of the community it serves.

Following National Apprenticeship Week this year and our celebration of our own internal legal apprenticeship scheme, now in its fifth year, our experts look at the law and rules that apply to the NHS apprenticeship schemes, the common issues that arise and set out practical tips for success.

The current position in the NHS

The June 2023 NHS Long Term Workforce Plan sets out the strategy and commitments to address existing and future workforce challenges by focusing on three key priority areas of training, retention and reformation:

• apprenticeship ambitions feature heavily in the plan including aims to triple apprenticeship training for all clinical staff by 2031/32 from 7% to 22%
• increasing training places for nursing associates (NAs) to 10,500 by 2031/32. By 2036/37, there will be over 64,000 nursing associates working in the NHS, compared to 4,600 today
• introducing medical degree apprenticeships, with pilots running in 2024/25, so that by 2031/32, 2,000 medical students will train via this route.

The NHS apprenticeship route offers school leavers the opportunity to become doctors and nurses outside the traditional university graduate route, making careers in medicine more accessible. It is estimated that up to 1:10 doctors and 1:3 nurses in the NHS could be trained through the apprenticeship route by 2031/32.

There are many success stories from NHS employers that have embraced the apprenticeship pathway as a means of addressing issues such as recruitment difficulties, high turnover rates and agency spending, for example:-

• the nursing apprenticeship pathway (see case study - CUH NHS FT, case study - UHS NHS FT and From support worker to dream career: Emily's journey) 
• the ambulance sector has also done great work with the paramedic apprenticeship pathway (see First paramedics on ‘trailblazing’ apprenticeship graduate and enter NHS workforce (cumbria.ac.uk) and Apprenticeship scheme success | Yorkshire Ambulance Service (yas.nhs.uk)).

Medical Doctor degree apprenticeship

Health Education England (HEE) (now NHS England) confirmed funding for a new five-year Medical Doctor degree apprenticeship with the first pilot scheme due to open for applications in Spring 2024 to start in September 2024.

However, these plans have met with some resistance. The British Medical Association (BMA) and Hospital Consultants and Specialists Association (HCSA) voiced “deep unease” about the changes. The concerns raised include; that apprenticeship programmes like these should not be at the expense of a graduate profession; whether they will be viable in practice; and, how successful they will actually be in plugging the resources gaps.

The government’s response was that standards will not be lowered. This is because apprentice doctors will be subject to the same rigorous requirements as doctors with traditional training; apprentices will have to complete all academic elements of medical training (including a medical degree and the Medical Licensing Assessment) and meet all requirements set out by the General Medical Council for entry onto the Medical Register. 

Apprenticeship Levy

The apprenticeship levy is a tax on employers with an annual pay bill of over £3 million and is paid at a rate of 0.5% on the total annual pay bill. Employers can access their levy funds to spend on training and assessing their apprentices and can even transfer up to 25% of their unused levy funds to a business of their choice. It should be noted that employers cannot recover any of the levy they have paid from their apprentices – even if the apprentice does not complete the training or their employment ends.

What is an apprenticeship?

An apprenticeship is:

• a work-based training programme that combines paid employment and training leading to a nationally-recognised qualification
• available for anyone aged over 16 years.

NHS apprenticeships offer routes into more than 350 NHS careers and are available at several levels from GCSE up to a Master’s degree. NHS apprenticeships can be offered for a wide range of roles including administration, health care workers, nursing and ambulance services, radiography and healthcare science.

Flexi-job apprenticeships was launched in 2022 to support short term and flexible working arrangements. The government is currently running pilot schemes for flexi-job apprenticeships, however, employers must have applied to be on the register by 31 May 2023 in order to take up this option. It allows an agency to employ the apprentice directly for the duration of their apprenticeship and arranges placements with the host business. Alternatively, the apprentice can secure multiple short term employment contracts directly with the business that support apprenticeships. The training provider supports the apprentice to take their learning and progress as they move between employers.

The benefits of apprenticeships

Promoting and encouraging apprenticeships will be an important way to align with the work plan strategy to train, retain and reform, and meet recruitment and retention challenges in a way that is:

• Cost effective and provides a high return on investment. The employer can focus on and upskill areas where there are gaps in recruitment and retention and develop careers across core parts of the organisation. Employers can access government funds and grants to help cover the costs of apprenticeships allowing costs savings whilst upskilling the workforce.
• Productive. Apprenticeships are designed with input from the NHS to evolve with the needs of the workforce and the healthcare services being provided.
• Flexible. Apprenticeships are not aimed at a particular group or career level – the programmes designed are for every level which helps drive skills development across the organisation.
• Innovative. They provide a new way to expand, reshape, develop and upskill the workforce by injecting new perspectives into a work culture to create a rounded, balanced and more successful workforce.
• Inclusive. Apprenticeships boost social mobility, reaching people from diverse backgrounds to open up opportunities for all and diversifying the workforce.

The law

Apprentices are employees and will have the same rights as employees including:

• minimum hourly rate of pay
• holiday and sick pay
• protection from unlawful discrimination  and whistleblowing
• statutory maternity, paternity adoption share parental pay
• protection from unfair dismissal (although this right depends on having two years’ continuous service and the end of the apprenticeship after its term expires will not be a redundancy where there is an ongoing requirement for the work).

However, apprentices are excluded from the protection offered by the Fixed-Term Employees (Prevention of Less Favourable Treatment) Regulations 2002.

Agreements and managing apprenticeships

Apprenticeship agreements usually involve a three-party agreement between the employer, education provider and employee.

Employers should ensure the apprenticeship agreements cover the required conditions, employment rights and obligations and be specific to the role and organisation needs.

As a minimum, a valid apprenticeship agreement under the apprenticeship standards regime must be in writing and include the following information:

• the basic terms of employment required by section 1 Employment Rights Act 1996
• provide for the apprentice to receive training to assist in achieving the approved apprenticeship standard in the work done under the agreement
• provide start and end dates for the apprenticeship
• length of the practical period (which must be at least 12 months)
• The apprenticeship standard and level they are working towards
• the time to be spent on off-the-job training.

It is possible for the agreement to include a conditional offer and/or acceptance of a role after the completion of the apprenticeship. However, employers will need to be clear what those conditions are, how they will be met and the implications of any failure to meet them.

As stated above, employers cannot recover any of the levy they have paid from their apprentices, so a repayment clause cannot be included in the agreement (even to cover circumstances where the apprentice does not complete the training or their employment ends).

There are various types of apprenticeships in place (depending on when they were entered into) and legally compliant and clear apprenticeship agreements will be crucial to the success of the programme and to resolving any disputes that may arise.

Promoting apprenticeships and their benefits will be key to running successful apprenticeship programmes. Managers will need training, support and the tools to effectively manage apprenticeships as many apprentices are likely to come straight out of education with limited work experience or are looking for a career change, in order to adapt and integrate in the business.

Summary

For NHS employers struggling to recruit and retain staff, apprenticeship schemes provide an interesting recruitment tool. The public sector equality duty requires NHS employers to give due regard to the need to advance equality of opportunity and the use of apprenticeships can go some way to improving diversity (as evidenced by the statistics and case study in the 2022 NHS Apprenticeship Levy Study (published on 1 February 2023). NHS England’s NHS Long Term Workforce Plan expects NHS employers to move away from the usual reliance on traditional routes to qualification for medics and clinicians in a move to boost staff numbers. Increasing the size of the workforce to deal with demand and doing so in a way which looks to address some of the issues all employers face around diversity, means that apprenticeships are likely to grow in popularity.

For those wanting to educate their teams on the use of apprenticeships, further information can be found at:

• NHS apprenticeships | NHS Health Careers
• What apprenticeships are and how to use them | NHS Employers
• The value of apprenticeships in the NHS | NHS Employers
• Apprenticeship FAQs | NHS Employers
• NHS doctor apprenticeships: Everything you need to know - The Education Hub (blog.gov.uk)
• Flexi-job apprenticeships - GOV.UK (www.gov.uk)
• Pay Apprenticeship Levy - GOV.UK (www.gov.uk).

How Capsticks can help

Capsticks supports NHS organisations and other employers in delivering successful apprenticeship programmes (through drafting agreements, policies, etc., and delivering training to employees at all levels). We also support NHS organisations and other employers to deal with any issues or complaints that may arise (by conducting investigations, supporting decision makers and HR, and defending any employment tribunal claims).

If you would like access to advice, training or need further guidance on apprenticeships (either generally or in relation to a specific case), please contact Raj Chahal and Sian Bond.