The NHS Long Term Plan’s central aim of providing more care out of hospitals “will continue to be an unrealised aspiration” if it can’t recruit and retain more health care professionals in primary, mental health and community care, the Health Foundation has warned. It found in its latest report that primary and community care staffing in the NHS in England is failing to keep pace with demand, with a drop in full-time equivalent (FTE) numbers of GPs over the past year, as well as in nurses and health visitors working in community health services.
In A critical moment: NHS staffing trends, retention and attrition, the independent charity reported a modest 1.8% overall growth in the number of FTE staff, with 18,567 more staff in July 2018 compared with a year before; roughly half of this growth was among professionally qualified clinical staff. In contrast, the FTE number of GPs (excluding locums and trainees) fell by 1.6% in the year to September 2018.
“Despite substantial rises in activity pressures”, the Health Foundation said, the FTE number of registered nurses and health visitors employed in the NHS in England barely grew, by just under 0.5% (1,300 FTE), between July 2017 and July 2018. The number working in community health services “continued its long-term decline”, falling by 1.2% (538 FTE); a drop in the number of health visitors negated a small rise in the number of other nurses working in community services. And the numbers in mental health nursing – another priority area – increased by less than 0.5% (172 FTE) over the year to July 2018.
The charity noted that the staff mix in general practice is changing – over the past year, the number of nurses and other direct patient care staff working in general practice has been expanding, and there has been a small but notable increase in the number of general-practice-based pharmacists and advanced practice nurses.
It said: “Moving care from hospitals into primary and community health services has long been a policy goal and the NHS Long Term Plan continues to reflect this ambition. However, turning it into a reality on the front line remains elusive. Although the overall number of nurses employed in the NHS has increased slightly, there are particular problems in key priority areas such as primary care and learning disabilities.”
The report identified further problems such as declining numbers of applications and acceptances for pre-registration nursing degrees in England; international recruitment being constrained by broader migration policies and by the uncertainties of Brexit; and no improvement in NHS staff retention over the past year. It said there is an urgent need to reduce the high rates of vacancies and staff turnover that we currently see, and added: “These issues are most stark in community trusts, where on average one in five staff left their role over the course of 2017/18.”
The Health Foundation warned that if the existing workforce shortages and deficits continue, they will severely hinder progress in the NHS Long Term Plan. It criticised the lack of a coherent policy that takes into account both funding and staffing, which it said has undermined any long-term consistency in the NHS’s approach to workforce policy and planning.
It said that for the ‘national’ element in the overall workforce policy and planning system to be truly national, and fully effective, it must:
- take account of the national labour market (not just NHS employment)
- align planning and policy across different occupations and sectors
- focus more on productivity and investment in the current workforce rather than on new roles (unless there is significantly more central support for scaling up)
- achieve a more efficient balance of skill mix
- enable local workforce planning to be conducted within a supportive overall framework
- recognise that national workforce policy and planning cannot be effective unless the relationship between staffing and funding is at the forefront of the approach.
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.”
Professor Helen Stokes-Lampard, chair of the Royal College of GPs, commented: “It is really positive to see that strides are being made to increase the numbers of other members of the practice team, some more than others, and it remains concerning to see a continued decline in practice nurse numbers.”
She added: “It takes at least ten years to train a GP and the level of skill it takes to deliver truly holistic care to patients, and manage immense amounts of risk, cannot be substituted. We want to see efforts to continue to increase numbers of all members of the practice team. But we also need to see efforts re-doubled to recruit and retain more GPs, who will lead these teams.”