The NHS workforce is the primary driver of future health costs. Given the substantial changes in population demographics and health care needs, the workforce needs to be fit for purpose. That means responding to immediate needs and financial pressures while adapting to deliver the future care models outlined in the NHS five year forward view. Getting the right balance requires a robust understanding of the nature of workforce pressures locally and nationally and what can be done to address them in the short and the long term.
Using national statistics, key publications and insights gained from interviews with expert stakeholders, this paper describes what is happening in the NHS workforce now in three key areas: mental health, general practice and community nursing. This analysis is presented alongside data that highlights providers’ reliance on agency staff. It looks at how workforce issues have been addressed across the system so far, explores the main challenges, and makes recommendations to improve workforce planning.
Key findings
There are major disconnects between strategic goals and workforce trends.
The greater strategic priority given to mental health has not translated into staff numbers on the ground.
The rate of increase in the number of GPs has been dramatically outstripped by increases in the medical workforce in secondary care – a trend at odds with the ambition to deliver more care in the community.
Despite long-standing ambitions to raise the level and range of community services provided, it is difficult to see any increases among key staff groups. Any such increases have been limited to areas with specific national targets.
The information needed to guide workforce planning locally and nationally has not kept pace with the growing plurality of providers delivering NHS-commissioned services. There are large data gaps on primary and community care, use of agency and bank staff, vacancy rates, and independent and voluntary sector providers.
Policy implications
Recent reforms have put Health Education England firmly in control of training the workforce of the future. But there needs to be a more joined-up approach to workforce planning today, with a national strategy that covers all NHS-commissioned services. This will avoid the current piecemeal approach to addressing workforce pressures.
Building a national workforce strategy will require changes at national level to support providers as they develop strategies locally and across health systems, whether in relation to return-to-practice campaigns, international recruitment, making key professional careers more attractive to trainees, or other measures.
Ensuring greater consistency between national strategy and the available workforce will also involve tackling questions of affordability. With pay overwhelmingly the biggest element of NHS costs, it is not credible for the recent trend of low real-terms growth to sustain any rapid increase in the NHS workforce.
These considerations are vital in order for providers and the wider NHS to develop a workforce that is adaptable and able to deliver the new care models outlined in the NHS five year forward view.
A major cause of the unequal growth between sectors is the model of funding. Whilst primary care is paid on a population basis for a year of care no matter how many times an individual attends, secondary care is paid for activity. This sets up "supply driven" care where there is increased health activity but not necessarily improved health outcomes for populations. The current system allows for secondary care workforce growth but constrains primary care workforce growth. As needs and demands increase in primary care an underfunded and under supplied workforce is struggling to keep pace. Meanwhile, those with little or no experience of the sector shout from the sidelines that primary care must "work differently". Thanks for that, very helpful, but we already know. It's like shouting "swim harder" at the drowning man.
So much is said that the problem is cost of agency nursing yet most hospitals are only now making their staff work bank holidays and weekends and agency weekday which is much less cost
the truth is that agency nurses will always be needed so why not give the hospital managers no room to come up with silly reasons why their staff are not covering the costly shifts Also instead of a very expensive quango that does nil all put that money into hospital budgets
Money is paid to GPs with no questions asked even if the GP is not a good GP or to those who seem to always be taking yet another holiday!
Maybe what is needed is a complete rethink of how the master plan will work going forward 10 years We know the top managers will say there is a plan and GPs who moan will say "not enough money" yet where else can you make a great salary even when you are a new GP?
The NHS is a wonderful organisation but is neither a business nor a charity
Comments
the truth is that agency nurses will always be needed so why not give the hospital managers no room to come up with silly reasons why their staff are not covering the costly shifts Also instead of a very expensive quango that does nil all put that money into hospital budgets
Money is paid to GPs with no questions asked even if the GP is not a good GP or to those who seem to always be taking yet another holiday!
Maybe what is needed is a complete rethink of how the master plan will work going forward 10 years We know the top managers will say there is a plan and GPs who moan will say "not enough money" yet where else can you make a great salary even when you are a new GP?
The NHS is a wonderful organisation but is neither a business nor a charity
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