NHS Staffing Shortfalls 'Threaten Long-Term Plan'

Peter Russell

February 12, 2019

NHS staff numbers in England have failed to keep pace with demand, according to a report by an independent health charity.

In its third annual review of staffing levels, the Health Foundation highlighted specific problems in primary and community care, nursing, and mental health.

It said the analysis for 2018, which largely confirmed trends seen in the previous 2 years, would have important repercussions for the success or failure of the Government's much vaunted long-term plan for the health service.

However, the Department of Health and Social Care (DHSC) said the figures in the analysis were out of date and accused the Health Foundation of making "misleading" claims.

GP Numbers Falling

The report, A critical moment: NHS staffing trends, retention and attrition said there were 18,567 more NHS staff in July 2018 compared with a year before – an increase of 1.8%. However, the increase should be seen against a backdrop of more than 100,000 vacancies reported by trusts, a figure expected to rise in the future.

Among the main findings:

  • Growth among clinical staff was "patchy", ranging from 3% or more for ambulance staff, hospital and community doctors, and technical staff, to less than 1% for midwives

  • The number of full-time GPs fell by 1.6%, despite the Government's pledge to find 5000 extra GPs by 2020

  • The number of registered nurses and health visitors grew by just under 0.5%, with underlying shortages evident from the more than 41,000 registered nursing posts reported vacant

Staff Numbers and the Long-Term Plan

The reduction in GP numbers, and sluggish growth among the number of mental health nurses and psychiatrists, threatened to undermine key elements of the long-term plan to move care out of hospitals and into the community, and to improve mental health care.

Although the Government had pledged to increase the number of trainee nurses, the report found that 2018 was the second year in a row in which the number of applications and acceptances for pre-registration nursing degrees in England fell. It said the problem was compounded by the high number of student nurses (24%) either not graduating on time or leaving the course.

Another "worrying" trend identified in the analysis was a lack of improvement in staff retention which had worsened since 2011-12, with problems achieving a work-life balance increasingly reported as a factor for people leaving the NHS.

"Providing more care outside of hospitals is central to the NHS long-term plan but the health service faces an uphill struggle," said Anita Charlesworth, director of research and economics at the Health Foundation. "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."

Maintaining overall staffing levels depended on the success of international recruitment, the report said, "but it is currently being constrained by broader migration policies and by 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," said Anita Charlesworth.

Commenting on the findings, Prof Helen Stokes-Lampard, chair of the Royal College of GPs, said: "This report further highlights the dire straits that the general practice workforce is currently in – and hammers home just how much we need to see every effort taken to increase the numbers of family doctors working in the NHS."

'Situation Improving' DHSC

The DHSC responded with the latest full-time equivalent staff statistics for the 12 months from October 2017 to October 2018. These were:

  • An increase of 0.9% for nurses and health visitors

  • A 1.3% increase in mental health nurses

  • A 2.6% increase for doctors in psychiatry

However, it acknowledged that, excluding locums, registrars and retainers, there were 400 fewer GPs in September 2018 than in September 2017.

There had also been a 2.5% decrease in the number of learning disability nurses.

A DHSC spokesperson said: "Latest statistics from October 2018 actually show record numbers of dedicated NHS staff – including 2564 more health visitors, 473 more mental health nurses, and 233 more psychiatrists – working tirelessly to make sure patients get excellent, safe care compared to the same time last year. 

"Last year, a record number of doctors were recruited into GP training and the new 5 year contract for general practice will see an extra 20,000 more staff working in GP practices – backed by an extra £4.5 billion more a year for primary and community care by 2023-24 through the long-term plan."

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