Creative solutions to London's NHS workforce challenges needed, says The King's Fund

The NHS in London must cash in on the capital's reputation as a leader in health care training and one of the world's most exciting, dynamic and culturally diverse cities if it is to tackle shortages in its workforce, says a report from The King's Fund published today.

In Capital Health? Creative solutions to London's NHS workforce challenges urges the NHS in London to accept that high staff turnover, many mobile health workers, from overseas and other parts of the UK, and heavier use of temporary staff than the rest of the UK are characteristics of the capital's health care workforce that cannot be prevented.

It argues that the NHS should not only focus on preventing these trends, but also think creatively about how to manage them. For example, London has some of the best health care training and career opportunities in the world and offers a gateway to an exciting life in a dynamic city, but it needs a co-ordinated marketing campaign to publicise these opportunities and to counter the view that living and working in the capital is a predominately negative experience.

In Capital Health? examines the latest statistics on London's NHS workforce in order to pinpoint the dynamics that employers can use to develop more imaginative solutions to staff shortages. It brings together input from health professionals, human resource managers and NHS workforce planning chiefs across London and it draws on case studies of creative solutions which NHS employers in London are already putting into practice.

As well as a concerted marketing campaign to attract staff from elsewhere, the report says London must invest more in growing its own health care workforce, making links with urban regeneration initiatives to develop NHS employment opportunities for local people. For example, London could create new entry points to health care training, tailored for local populations. The high numbers of foreign health workers already living London as refugees could be targeted and brought in through refresher training and clinical attachments in NHS trusts.

Report author Belinda Finlayson said:

'NHS staff shortages are a recognised problem, and there are many national initiatives looking at family friendly working, career paths and pay to tackle them. But we have to look at workforce dynamics in specific labour markets to see where we can be more creative. In London, this means encouraging job growth rather than forcing staff to move to develop their careers. It means supporting career structures and rotation schemes that exploit high turnover in a way that meets service, as well as staff, needs and it means using temporary staff more effectively.

'Even seemingly intractable problems, such as the shortage of affordable housing in the capital, can be countered through initiatives such as the provision of subsidised accommodation or through joint ventures with housing associations.'

The King's Fund chief executive, Rabbi Julia Neuberger, added:

'As expected, detailed analysis of London's NHS workforce dynamics reveal the highest vacancy and turnover levels in the country. But it also shows we have the most ethnically diverse workforce, as well as a generally younger workforce. The scale of the challenge facing the NHS workforce in London is huge, but so too are its resources and capacity. It is not a wholly negative picture by any means and there are many examples of good practice taking place throughout the capital.'

Notes to editors: 

In Capital Health? Creative solutions to London's NHS workforce challenges, by James Buchan, Belinda Finlayson and Pippa Gough, is available from The King's Fund publications on 020 7307 2591.

For a review copy, case studies, or for further information, please contact Daniel Reynolds in the public affairs office on 020 7307 2581 or 07831 554927.

Case studies:

  • The Guy's, King's and St Thomas' (GKT) School of Medicine is attracting more students from the local community who are from low income and under-represented ethnic minority backgrounds, but who may not have the necessary academic grades. They have been doing this by realising that traditional medical schools require levels of academic achievement that are unlikely to be achieved by students from deprived communities. GKT works with local schools and colleges to encourage students to apply. To be eligible, students must be nominated by their school, their projected A-level results must be lower than those of students admitted to the conventional course and they must live or study in one of the ten inner London boroughs covered by the programme.
  • The work of the London deanery in preparing refugee doctors, who find it difficult to compete with UK-trained doctors, for a career in the health service. The refugee doctors are trained to develop interview skills, improve their language skills for consultations, and understand general practice and hospital medicine in the UK through clinical attachments. Of the 29 refugee doctors that originally took part in the programme, 17 are now working as Senior House Officers.
  • A successful international recruitment campaign by University College London Hospitals which has seen nurses from the Philippines arrive, initially, on two-year contracts. UCLH offers the nurses accommodation and helps them to integrate into the London community, for example by opening bank accounts from them. UCLH has successfully recruited nursing staff from the Philippines on four occasions. The trust reports a very high retention of the nurses it has recruited from overseas. On the last recruitment trip, 73 nurses were offered jobs, 68 actually travelled to the UK and all are still working at the trust.

Key London workforce facts:

  • The NHS in London already employs more than 142,000 people, representing approximately one in six of all staff in the NHS workforce nationally;
  • Qualified nursing and midwifery staff are the biggest group, with almost 50,000 being employed; there are also 20,000 qualified allied health professionals and other qualified scientific, therapeutic and technical staff, and 40,000 administrative and estates staff;
  • A BMA survey found that only a fifth of the students who graduated from London medical schools in 1995 were still living in London in 2002. Most of the remainder were living in central or southern England;
  • Twenty-eight per cent of London nurses on the register of the Nursing and Midwifery Council were from overseas in 2002, compared with around eight per cent for the UK as a whole;
  • In 2001-02, the NHS spent more than £220 million on agency nurses in London, a figure that has doubled over the last four years and now represents 40 per cent of the total for England.
  • Hospitals in central London face nursing staff turnover levels of up to 38 per cent each year;
  • The vacancy rate for the allied health professions in London is 8.3 per cent. It is 4.1 per cent for doctors and dentists;
  • In some parts of London, one in four family doctors are due to retire in the next few years;
  • In April 2003, 54 per cent of the 849 doctors on the BMA/Refugee Council database of refugee doctors were based in London.