NHS nursing apprenticeships – breaking down barriers to nursing careers?

It is National Apprenticeship Week – an opportunity to reflect on how both individuals and employers can use apprenticeship schemes to address skills gaps and make use of alternative routes to training and qualifications.

The NHS is a major employer of apprentices. In 2023/24, around 20,000 people started an apprenticeship in the NHS, equivalent to 1 in 4 (29%) of the new apprenticeships across the public sector. The NHS Long Term Workforce Plan, published in 2023, projected a major expansion in the use of apprenticeships, with an aim to increase the share of nurses trained through apprenticeships from 9% in 2022/23 to 28% in 2030/31. 

Along with improving recruitment and retention, a major rationale for expanding apprenticeships was widening access to clinical training to those from a broader range of backgrounds and to people living in underserved areas.   

Looking ahead to the refreshed NHS Long Term Workforce Plan due in the summer, this blog considers how intake to the registered nurse degree apprenticeship programme, which was introduced in 2017, compares with the main undergraduate route.   

Comparing the demographics of nursing apprentices with undergraduate nurses

Nursing apprentices are more likely than undergraduate nurses to be aged 25 years and older, but less likely to come from an ethnic minority background. Figure 1 compares the demographic characteristics of nursing apprentices with those of nursing undergraduates between 2018/19 and 2023/24. 

Both routes into nursing are heavily female dominated. More than 4 in 5 nursing apprentices are aged 25 years and older, compared with under half of nursing undergraduates. This in part reflects NHS trusts offering and promoting nursing apprenticeships to their own employees, such as health care assistants, who already have work experience and therefore tend to be older. 

Just under 1 in 5 nursing apprentices come from an ethnic minority background, compared with just under 2 in 5 nursing undergraduates. This could partially be explained by the geographical distribution of apprenticeship and undergraduate opportunities, as described in the following section.

Regional distribution of nursing undergraduates and nursing apprentices

A key rationale for expanding apprenticeships in the 2023 Long Term Workforce Plan was to widen access to opportunities for those living in underserved areas. The definition of an underserved area is not made clear in terms of size or organizational structure (that is, a region or integrated care board). It is also not clear whether these areas are just underserved by the existing local NHS care provision and clinical workforce (including registered nurses), or also by more limited access to existing training routes into that workforce.

Here, we focus on comparing regional distribution of nursing undergraduates with nursing apprenticeships. While this alone cannot tell us whether apprenticeships are concentrated in ‘underserved’ areas, it does illustrate how the provision of apprenticeships is different from the main undergraduate route into registered nursing. 

Figure 2 shows the regional distribution of nursing undergraduates and nursing apprentices in England in 2023/24. Regions are ordered according to their share of undergraduates. The three regions with the lowest share of nurse undergraduates – the South West, East and South East – have higher shares of nursing apprentices. For example, in the South West, the share of nursing apprenticeships (15%) is more than double the share of nursing undergraduates (6%). This could reflect either a higher demand for apprenticeships when there are fewer local undergraduate places or a greater willingness of employers, in partnership with universities, to offer apprenticeships. Nursing graduates often choose to stay near where they studied, which can make it harder to recruit in regions with lower levels of nursing undergraduates.  

The opposite pattern is present in London and the North West, which have low shares of apprentices (less than 10% each) relative to their share of undergraduates. Again, this may be because there is less demand from potential nurse apprentices or because providing apprenticeships is less attractive for employers.

The Midlands and North East and Yorkshire present more of a mixed picture, perhaps reflecting the presence of both large urban areas with universities offering nursing degrees and more rural localities with less access to undergraduate training. 

Almost 9 in 10 (88%) nurse apprentices remain in their home region, and any movement is mostly to adjacent regions (for example, from the South East to London). This is consistent with the average nursing apprentice being older, which often means less geographically mobile. A potential benefit of apprenticeships stated by NHS employers is they help attract and recruit future nurses from their local communities.

Together, the geographic distribution of nurse apprentices and the tendency of nurse apprentices to stay close to home in part explain the lower ethnic minority representation seen in Figure 1. London and the North West, which are among the more ethnically diverse regions of England, have a relatively low share of England’s apprentices, while shares are higher in less diverse regions, like the South West. 

Ensuring apprenticeships work for all

Evidence from the first 5 years of the NHS nursing apprenticeship programme suggests that it expanded opportunities for potential nurses aged 25 years and older, and for those who wish to train close to home. For trusts, this suggests apprenticeships could offer an important alternative pipeline of nurses, particularly in regions where the existing supply of local graduate nurses is relatively low.

If the government is committed to breaking down barriers to an NHS nursing career, apprenticeships appear to provide one route to doing so. However, it should consider how to ensure that groups who have so far participated less in nursing apprenticeships – for example, non-white candidates – do not miss out. The future success of the nurse apprenticeship programme in producing registered nurses will also depend on aligning government ambitions with the financial constraints and capacity of NHS employers and universities to offer apprenticeships.