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'Critical pressures' in NHS workforce put Five Year Forward View in danger

Delivery of the Five Year Forward View is in danger due to shortages and “critical pressures” in the NHS workforce, The King’s Fund has warned.

In a new report, the health policy think tank argues that there are major disconnects between strategic goals and workforce trends.

A key aim of the forward view strategy is to deliver more care in the community but this appears to be at odds with the slow rate of increase in the number of GPs, which has been dramatically outstripped by increases in the medical workforce in secondary care.

Pressures on primary care have been well documented recently with fewer training posts being filled and more GPs planning to retire early, resulting in a growing shortfall in the number of GPs.

A recent study by the BMA found that a third of GPs are considering retirement in the next five years due to excessive workloads, and another 30% are considering going part time. In January NHS England announced a new £10m plan to incentivised newly trained doctors to become GPs, deter early retirement and kick start the general practice expansion of the workforce.

Additionally, whilst the number of health visitors has increased by nearly a quarter over the past five years, the number of senior district nurses has fallen by 30% and there are now 16% fewer community matrons.

The King’s Fund found that the greater strategic priority given to mental health has not translated into staff numbers on the ground. Their figures show the number of inpatient nurses has fallen sharply by 15% over the past five years, resulting in a significant rise in the use of agency staff and a two thirds increase in requests for temporary mental health nurses since the beginning of 2013-14.

The report also finds that, overall, the information needed to guide workforce planning locally and nationally has not kept pace with the growing number 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.

It underlines the increasing reliance on agency staff among NHS organisations. The Fund’s analysis of recent figures provided by NHS Professionals shows requests for temporary hours more than doubled between April 2012 and January 2015.

The authors argue that the reported use of temporary staff on this scale represents a “substantial financial burden” for the NHS at a time when budgets are stretched to breaking point and risks reducing quality of care.

Rachael Addicott, senior research fellow at The King’s Fund and the report’s lead author, said: “The workforce is a key asset for the NHS and is pivotal in meeting the health needs of current and future patients. We need the right people in the right place, able to adapt their skills to changing demographics and work together to support new models of care. However the trends we are seeing are moving in the opposite direction, with an increasing over-reliance on temporary staff and a ‘black hole’ in the data needed to make effective workforce plans.

“Staff working for the NHS in 2015 will essentially be the workforce of 2020, so it’s crucial we have the right information to plan locally and nationally for retention and retraining as well as recruitment. National bodies will have to demonstrate leadership on this issue and local leaders should better coordinate efforts in their communities and regions to meet current need and build the future workforce.” 

The report calls for a clear plan for the NHS workforce to support the ambitions set out in the Five Year Forward View. It says this should focus on:

• Improved data – a lack of national data particularly for temporary staff and the independent sector makes long-term planning very difficult
• Better national leadership – stronger, more strategic leadership from national bodies involved in training and developing the workforce of the future
• Greater collaboration – across local and regional levels to deal with short to medium term workforce pressures in a more joined-up and systematic way
• Improved consistency between local and national levels – better co-ordination is needed between bodies responsible for training staff to meet national ambitions and the expectations of local organisations employing staff
• Robust assessment of supply and demand – there is currently inadequate national-level assessment of supply and demand for most areas of the workforce

Responding to the report, Saffron Cordery, director of policy and strategy at NHS Providers, said: “The report’s focus on workforce planning experience within mental health, general practice and community nursing is key.

“As generalist roles develop in response to the increasing proportion of patients and service users with multiple needs, and the movement between specialisms, for example, emergency care and general practice or health and social care, NHS providers will have to adapt to more care delivered in the community and to the increasing use of new roles such as physicians assistants.

“We will continue to work with the national bodies to understand the nature of workforce pressures and what can be done to address them. We also look forward to contributing on behalf of our members to the issues raised in this report through the new Workforce Advisory Board chaired by Health Education England to ensure that NHS staff are fully supported in both the short and the long term.”

Danny Mortimer, chief executive of the NHS Employers organisation, called the report a “useful addition to current thinking on planning the NHS workforce”. 

“It’s important that any future policies support the ability of local NHS organisations to deploy staff in the best way to support high quality and efficient patient care,” he added. “This will allow them to build on the examples of innovation we see across the NHS.”

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