NHS staff shortages put long-term vision for primary and community care at risk

A new report by the Health Foundation highlights that NHS staff numbers are failing to keep pace with demand and that there is ongoing deterioration in workforce numbers in critical areas such as primary and community care, nursing and mental health.

Read the executive summary of the report

Moving care out of hospitals and closer to people's homes has been identified as a continued priority in The NHS Long Term Plan, but the research published today identifies worrying trends in the workforce needed to support this. While the number of hospital-based doctors has continued to grow, the number of GPs has fallen by 1.6% – 450 full time equivalent (FTE) staff – over the year in September 2018, moving further away from the government's pledge to find 5,000 extra GPs by 2020. 

Similarly, numbers of nurses and health visitors working in community health services have continued their long-term decline, falling by 1.2% (540 FTE staff) in July 2018 compared to a year before. 

And while The NHS Long Term Plan set out ambitions to improve mental health care, numbers in mental health nursing have increased by less than half a percent (170 FTE), while psychiatrists have seen the smallest percentage increase (0.6% or 50 FTE staff) amongst doctors. Learning disabilities, another priority area, saw numbers of specialist nurses fall by 3.7% (120 FTE) over the same period. 

The report notes that the number of overall NHS staff saw a modest increase of 1.8% (18,570 FTE) against a backdrop of more than 100,000 vacancies reported by trusts in England. Nursing numbers grew by just 0.5% (1,300 FTE) and there are now over 41,000 nursing vacancies – more than 1 in ten nursing posts.

Another worrying trend is a lack of improvement in staff retention which has worsened since 2011/12 with work life balance increasingly reported as a factor for people leaving the NHS. The analysis found that the issue of retention was most stark in community trusts where on average, 1 in 5 staff left their role over the course of 2017/18. 

Despite a clear and ongoing need to recruit health professionals from overseas to help staff the NHS, recruitment from within the EU has fallen significantly. We also warn that there remains no 'joined-up' policy approach to international recruitment and that the government's approach to immigration risks further undermining efforts to fill critical gaps by exacerbating shortages of certain key health professionals. 

Anita Charlesworth, Director of Research and Economics at the Health Foundation said:
'Providing more care outside of hospitals is central to the NHS Long Term Plan but the health service faces an uphill struggle. If it can't recruit and retain more health care professionals in primary, mental health and community care, this will continue to be an unrealised aspiration. There is unfortunately no sign that the long-term downward trend for key staff groups, most notably GPs, will be reversed. 

'So much now hinges on the forthcoming workforce implementation plan. But to bring an end to chronic workforce shortages for good, action must go beyond specific policy measures and address the underlying major fault lines in the current approach, particularly the lack of alignment between staffing and funding, and the damaging impact of wider government policy.  

'International recruitment remains vital but it is being constrained by migration policies and the uncertainties of Brexit. We urgently need a coherent strategy that involves government health departments, the Home Office, regulators and employers, and which is embedded in overall national health workforce planning.'

Our extensive analysis of workforce trends, profiles and pressure points also reveals that:

• In contrast to the falling numbers of GPs, other direct care staff working in general practice (such as dispensers, pharmacists, phlebotomists and health care assistants) rose by 5.5% (12,250 FTE) pointing to a change in the mix of staff working in general practice.
• 2018 is the second year in a row that applications and acceptances onto nursing degrees in England fell, almost certainly impacted by changes to the nursing bursary, combined with a dip in the population of 18-year olds. 
• The number of students from England starting nursing degree courses in 2018 dropped to its lowest level (20,250) since 2013, a fall of 8.1% since 2016, the last year when new nursing students were eligible for NHS bursary funding. This contrasts with increases last year in new nursing students in Wales (5.5%) and Scotland (4.4%), which both reached all-time highs. 
• The issue of fewer people starting nursing degrees is compounded by the student attrition rate. A survey of UK universities, in partnership with Nursing Standard magazine, found that 1 in 4 (24%) of those due to complete a nursing degree in 2017 had left the course or hadn’t graduated within the expected timeframe. 

Read the full report

Media contact

Simon Perry
External Affairs Manager
simon.perry@health.org.uk
0207 257 2093