Staffing matters; funding counts examines the profile and features of the NHS workforce in England, including; health labour market trends; relevant international data and comparisons from other countries; and a series of specific ‘pressure points’ (see below).

Download Staffing matters; funding counts.

General practice and nursing workforces in particular are examined in detail – two key components that have been the subject of much recent policy analysis and media scrutiny – as areas that continue to need a strong policy focus. There is also a supplement giving more detailed information about the profile and recent trends of the workforce of the NHS in England.

Key findings

  • Mismatches between funding and staffing levels, along with repeated reorganisation, have led to a ‘boom and bust’ approach to the NHS front line.
  • The less costly, reactive and short-term solutions – being used by national and local leaders to tackle current problems – are quick fixes, and will only put a sticking plaster on deep-seated and systemic problems for the NHS.
  • Effective use of temporary staff and international recruitment will help to buy time while a more long-term, sustainable approach is introduced.
  • Investment in current staff should not be downplayed by an over-emphasis on new roles; some new roles are necessary but will not have a major impact unless there is significantly more central support for scale up.

Ultimately, the report concludes that the greatest threats to the delivery of the NHS’s Five year forward view are funding constraints and workforce shortages. Policymakers need to look at how targeted and aligned policies covering the effective use of temporary staff, retention of existing employees and international recruitment can be used to address current shortages in staffing and skills in order to buy time, while a more long-term sustainable approach is introduced.

Pressure points

During the research to inform the report, six particular pressure points were identified for the workforce of the NHS in England. They were chosen based on feedback from a stakeholder roundtable, held in October 2015, and analysis of recent policy reports.

The pressure points are:


Professor Clive Smee

A very sad commentary on the state of workforce planning in the English NHS. I fear this is what happens when Ministers prefer "bull shitting " (to quote Tim Hartford) about statistics to finding out what is actually going on. It will end in tears.

Mary Hawking

Taking the budget for HEE outside the NHS, then reducing it considerably doesn't help the development of the future workforce - or encourage any form of realistic planning: the long-term view is sadly absent in the NHS.

As far as GPs and practices goes, it is interesting that the effects of increasing workload accompanied by decreasing practice income don't seem to have been taken into account in looking at the long-term future for general practice.
A GP partner's income depends on the formula ((practice income - practice expenditure)/partnership share): increasing the staffing level might improve the ability to manage the ever-increasing workload - but unless the practice income can be increased in line with the increased expenditure (practice expenditure includes staff, add-on costs and indemnity cover for them as well as GP principals), only at the expense of further decrease in the GPs incomes.
Removing incentives for retention of GPs seems to have been policy for a good many years: seniority has been removed, the retainer scheme was abolished (and now is being re-instated), there has been no investment in GP premises for well over 10 years - and GPs are obliged to make provision for their own premises - and the new system for approving rent means that the practice will only find out whether they will receive full reimbursement *after* they have signed the lease!

Wouldn't it help if workforce planning included addressing some of the problems being heaped on the existing workforce?
Making the job attractive once more might help with both retention and recruitment.
But that would mean joined-up planning across HEE, NHS England and DH - and the structures, especially since the Health & Social Care Act 2012 might have been designed to ensure that there is noone responsible for the service as a whole..

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