Taking stock: is the government meeting its commitments to increase NHS staff numbers?

The government’s 2019 manifesto included ambitious targets to increase the numbers of nurses and GPs in the NHS. Lucina Rolewicz takes a look at performance against these targets since the 2019 election and outlines some of the broader challenges in staffing health services.

Blog post

Published: 29/10/2021

In 2019, this government set some ambitious goals for the NHS workforce, recognising the long-standing staffing shortages. Covid-19 has subsequently shifted these goalposts, with the need for additional staff to help clear waiting lists and take pressure off existing staff more prominent than ever – increasing the level of scrutiny typically afforded for government ambitions.

In this blog, we take stock of performance against two of the headline commitments in the government’s 2019 manifesto: on the number of nurses in the health service, and then on the number of GPs. Drawing on our NHS staffing tracker, we cast a light on progress against workforce targets at large.

Is the NHS on course to have 50,000 more nurses by 2025?

As with many similar commitments, there are limited details available to explain how the government proposes to measure or monitor its flagship ambition to recruit 50,000 more nurses by 2025 – a target that was reaffirmed in this week’s Spending Review. For instance, it is unclear whether the 50,000 target refers to full-time equivalents or simply a count of the number of nurses.

In any case, as of June this year the number of full-time equivalent nurses based in hospital and community health settings had increased by 14,158 since December 2019. Noting the potential effect of seasonality when comparing data between different months, on the face of it this appears to be the right level of growth needed to achieve the 50,000 target. However, we would caution against complacency.

First, there is no precedent for such a sustained increase in the number of nurses since records began – an annual increase of 10,000 more nurses has only been achieved four times in 62 years (see chart). The closest increase to 50,000 more nurses over five years was between 2000 and 2005 (an increase of 46,500), which corresponded to a major investment in and expansion of NHS staff.

Annual change in number of nurses 29/10/2021

Chart

Note:  

Gaps represent changes to the data collection. Includes hospital / community nurses and health visitors but excludes nurses in general practice. Data are for full-time equivalents. All data points show staffing levels as at September each year, with the exception of 2021, which represents the number of staff in June.

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Second, the picture is more varied when looking within specific types of nursing. In particular, the number of learning disability nurses has fallen by 4.1% since December 2019.

Third, there have been atypical recruitment and retention practices during the pandemic, where students/trainees and recently retired NHS staff have been asked to rally together to face the multiple waves of Covid-19 that have swamped the health service. But Covid-19 has posed some unique challenges, namely heightened burnout of existing staff, as well as an increasingly competitive global market for nurses.

Is progress being made against the ambition to have 6,000 more GPs by 2025?

The government also committed to increasing the number of GPs by 6,000 by 2025. As alluded to above, ambitions for staffing are undermined by a lack of understanding of what is supposed to be measured – making it more challenging to hold the government to account. While the headcount of GPs has risen by 1,385 (as at June this year) since the 2019 general election, the number of full-time, fully qualified GPs has actually decreased by 105. At the time of writing, we would have expected an increase of over 1,700 more full-time, fully qualified GPs over this period for the government to be on track to meet its commitment.

Looking at the historic trend in GP numbers, similarly to nursing there have only been a few instances where the annual increase in GPs has been greater than 1,200 (which is the average yearly increase needed to reach the target of 6,000 more GPs over five years). While these large increases may appear encouraging (see chart), this long-term trend is based on a headcount of all staff. In recent years, only around one in four (24%) GPs work full-time (down from one in three in 2015). Trends that do not account for this must therefore be treated with caution.

Annual change in number of GPs since 1962 29/10/2021

Chart

Note:  

Gaps represent changes to the data collection. All GPs are counted, including locums and trainees, and represent a headcount. All data points show staffing levels as at September each year, with the exception of 2021, which represents the number of staff in June. This data point therefore does not represent an annual change, and comparisons made between different months may be affected by seasonal trends.

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What is happening with the wider workforce?

The NHS is made up of a wide range of staff working across a broad range of services and settings. Overall, since September 2000, the number of staff employed in hospital and community settings has increased by 37%, and in general practice by 60%.

Despite staff increases, there are some clear challenges. The reasons why hospital and community services staff are resigning have shifted. A greater proportion of staff now cite work-life balance or further education or training. In general practice, although there has been a surge in the number of allied health professionals and administrative staff, fewer GPs are working full-time, and more are opting for early retirement.

When health care workers leave professions altogether, they are not easily or quickly replaced – least not when relying solely on domestic supply. Our research concluded that international recruitment would have to be a major contributor to the nursing workforce if the goals on increasing nurse numbers are to be met in the short and medium term. We also noted that one-fifth (21%) of joiners to the NHS in 2020 were not UK nationals, which shows they contribute significantly to achieving the staffing ambitions.

It is also important to note that national trends can mask substantial local differences in staffing levels. For example, our analysis of GP numbers shows large differences in much of London and the South East compared to other regions in England. Higher numbers of patients per one GP are evident in areas such as Thurrock (2,373 patients per GP) compared with the North West, where the Wirral has only 1,318 patients per GP.  

We are also identifying trends that are emerging in relation to Brexit and the pandemic. While on the face of it, staff increases are encouraging, they don’t always tell the full story. Recruiting new staff is one challenge, but retaining existing staff and making the NHS an appealing place to work is now more crucial than ever, as the NHS begins to recover from the repercussions of Covid-19.

Suggested citation

Rolewicz L (2021) “Taking stock: is the government meeting its commitments to increase NHS staff numbers?”, Nuffield Trust comment.

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NHS staffing tracker 02/11/2020

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Monitoring and analysis of key workforce targets and trends.

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