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.
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.
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.