The NHS in England directly employs 1.8 million people (equivalent to 1.6 million full-time staff), with employee costs accounting for around three-quarters of NHS providers’ expenditure. The NHS is the country’s biggest employer and the largest employer in Europe, as well as being one of the largest employers globally by headcount. Currently, around one in 17 workers across England work for the NHS. This is set to rise as the demand and need for health care changes with the changing population.
Here we lay out the facts – in so far as the existing data allows – on the size and structure of the current NHS workforce. We highlight the changes seen over the past decade, recruitment and retention issues, and outline some of the workforce pressures that lie ahead.
Please note that the latest data in this workforce explainer reflect staffing levels as of December 2025 and represent a snapshot in time. More up-to-date information can be found in our staffing tracker, which is regularly refreshed alongside key staffing and training targets for the health service.
In this explainer, when describing who makes up the NHS workforce, as well as recruitment and retention, we use headcount numbers. When describing how the NHS workforce has changed over time, we use full-time equivalent numbers to provide a more accurate picture of trends in staffing capacity. Where full-time equivalent calculations are used, this is specified in the text.
Who makes up the NHS workforce?
The NHS workforce includes those directly employed by the NHS, as well as the large number of people working in primary care services, dentistry, community pharmacy, and a range of other services that help to provide health care services to the population. For the purposes of this workforce explainer, we look exclusively at those working in hospital and community care services and primary care services.
The vast majority of NHS staff – 1.5 million people – work in ‘hospital and community services’ as direct employees of NHS trusts, providing ambulance, mental health and community and hospital services. In addition, approximately 200,000 people work in general practice (149,000 full-time equivalents) and 32,000 people work in primary care networks (groups of GP practices, who share staff and resources to deliver a wider range of services than core general practice).
Across NHS hospital, community and general practice settings, there are 216,000 doctors in total, and around 467,000 nurses and midwives. These two groups – while large – constitute around two-fifths (38%) of the total workforce. This highlights the multidisciplinary nature of the NHS, with its reliance on others such as health care scientists, physiotherapists, occupational therapists, as well as support to clinical staff (such as health care assistants) and infrastructure support staff (such as administrative staff).
These figures focus on staff directly employed by NHS organisations, including general practice, but do not represent all staff who contribute to the NHS. In addition to NHS employers, there will also be staff who deliver NHS services but are employed in non-NHS organisations. The NHS may also indirectly employ staff, for example, through paying a company to provide particular services such as laundry, catering and cleaning.
How has the NHS workforce changed over time?
The number of NHS staff in England has increased substantially, with over 350,000 (35%) more full-time equivalent staff working in hospital and community health services in December 2025 compared to 10 years prior. However, the increase has varied considerably between staff group and setting. In particular, the relative increase in doctors in hospital and community services (47%) has far outstripped that of nurses (31%).
There have been substantial increases in general practice, with the total number of staff increasing by 48% over the same period. This has largely been driven by a number of clinical roles (such as pharmacists, physiotherapists and occupational therapists) funded by primary care networks through the Additional Roles Reimbursement Scheme (ARRS) to support GPs to deliver more integrated primary care services. The picture across other staff groups in primary care, including GPs and nurses, is more mixed.
There has been a 35% increase in hospital and community health services staff and a 48% increase in general practice staff since 2015
ChartHospital and community health services
Doctors
Doctors had the second highest percentage increase (47%) from 2015 to 2025 across hospital and community health staff groups, with an increase of 49,000 full-time equivalent doctors. Most specialty groups saw increases over this period. Emergency medicine saw the largest increase, with the number of doctors almost doubling (a 5,600 increase). General medicine, the largest specialty group accounting for approximately 30% of HCHS doctors, increased by over 60% (17,000). Both clinical oncology and radiology saw increases of over 50% (600 and 2,200 respectively). Only public health medicine saw a decrease over the past decade, with the number of doctors decreasing by almost 40% (a decrease of over 500).
Nurses and health visitors
There were 88,000 more full-time equivalent nurses and health visitors working in hospital and community health care services in 2025 compared to 2015 – an increase of 31%. During this time, there was a pledge to increase the nursing workforce by 50,000 by 2024, which was met. However, this increase has not been consistent across the different branches of nursing, which is shown in the chart below. For example, the number of children’s nurses increased by 41% in the decade to December 2025, while the number of learning disability nurses fell by 10%.
The numbers of learning disability nurses fell in the decade to December 2025, while numbers in other areas of nursing have increased
ChartDespite numerous ambitions over the past decade to shift care out of hospitals and into the community, the most recent one being set out in the 10 Year Health Plan, the NHS community nursing workforce has not kept pace. In particular, health visitors in community health and school nurses have both fallen by 45% (4,600) and 29% (800) respectively since 2015. Over the same time period, the number of district nurses and community matrons has decreased by 13% (700), while the number of other community health nurses has increased by 28% (7,800).
Health visitors, school nurses and district nurses and community matron numbers have all fallen over the past decade
ChartOn top of this changing mix of nurses and health visitors, our previous work on district nursing highlights the variation in the number of district nurses across local geographies in a way that does not match patient need. The work also highlights the changing mix of seniority and pay within district nurses, and highlights that many nurses are working at a higher level than would be typical for their current pay band.
Want to know more? See our report District nursing: Understanding the decline and mapping the future.
Clinical support staff
The clinical support workforce are front-line staff who are typically not registered professionals, but deliver a large proportion of hands-on patient care. Support worker roles were identified by the 2023 NHS Long Term Workforce Plan as a key way to increase routes into the clinical workforce. Although a new workforce plan is expected soon, support workers are expected to continue to play a vital role. Numbers of full-time equivalent staff in this group have risen from 301,000 in 2015 to 405,000 in 2025 – an increase of 35%. Our previous research looks specifically at mental health support staff, where we found that the same promise of good working conditions and training and development to all NHS staff was often not afforded to support staff.
Want to know more? We examined the profile of mental health clinical support staff and discussed how issues around recruitment and retention can be improved in our report Untapped? Understanding the mental health clinical support workforce
Scientific, therapeutic & technical staff
The wider professionally qualified clinical and scientific workforce account for a large proportion of hospital and community staff, with around 182,200 full-time equivalents in December 2025. Scientific, therapeutic and technical staff include allied health professionals (such as physiotherapists, radiographers and orthoptics), health care scientists as well as other staff groups (such as dental and pharmacy). Overall, this group has increased by 42% since 2015 (54,000).
The allied health professional group has grown by 52% (32,400) – although the trend has been inconsistent between professions within the group. The chart below shows that, while the number of radiographers has increased by 48%, the number of orthoptics/optics staff (those who deal with eye problems) has decreased by 12%.
Scientific, therapeutic and technical staff increased by 42% between December 2015 and 2025
ChartMental health staff
Around 160,000 full-time equivalent staff are substantively employed by the English NHS to care for people who need mental health services. The largest group of clinicians within this group – registered mental health nurses – have seen a 29% (11,800) increase in their numbers over the past decade.
Want to know more?
We looked at participation and progression in psychology careers and included recommendations for enhancing awareness of different roles and professions that psychology graduates can especially contribute to: The right track: Participation and progression in psychology career paths. We looked at how inaccurate perceptions and lack of clarity on the roles within mental health services can be a barrier to increasing the size of this workforce in Laying foundations: Attitudes and access to mental health nurse education, with key metrics updated and new insights on mental health nurses in our 2023 paper In train? Progress on mental health nurse education
Ambulance staff
Year-on-year increases saw full-time equivalent ambulance staff numbers rise from 18,000 in December 2015 to 22,800 in December 2025. The number of paramedics, the largest ambulance staff group, increased by 50% between December 2015 and December 2025 from 12,100 to 18,100.
Retaining ambulance staff has been a persistent challenge. Difficult working conditions, poor relationships with colleagues and crises in service performance are among the reasons why they report some of the lowest levels of satisfaction in the NHS staff survey.
Want to know more? We describe the staffing trends and working experiences of ambulance staff in more detail here: Feeling blue: the experiences of ambulance staff
General practice
Over the past decade there has been little change to the total number of full-time equivalent fully qualified GPs working in England, which totalled 28,800 in December 2025. This is despite there being two successive targets (one in 2015 and a second in 2019) set with the intention of boosting the number of fully qualified GPs.
While the number of fully qualified GPs has remained steady, the mix of GPs has shifted. In 2015, GP partners made up two-thirds (68%) of the GP workforce. However, by 2025, fewer than half (46%) of the GP workforce were GP partners. The number of GPs in training has doubled over the last decade from 5,100 in 2015 to over 10,800 in 2025. However, previous research has shown that historical increases in GP training places have not always delivered more GPs and it is estimated that, on average, nearly two training posts are required to get one fully qualified, full-time equivalent GP.
There have been significant shifts in the general practice labour market in recent years. The number of newly qualified GPs has been increasing while the number of available jobs has fallen. Temporary changes have been made to the ARRS, enabling primary care networks to employ recently qualified GPs. This was expanded to any qualified GP in the 2026/27 GP contract.
Practices in more deprived areas of England have fewer GPs per 10,000 patients than those in less deprived areas. England also now appears to have the lowest level of GP staffing of any of the four UK countries. Bedfordshire, Luton and Milton Keynes ICB have the highest average number of patients per GP in England, and across the UK, with an average of 2,220 patients per GP. In comparison, the areas with the highest average number of patients per GP across Scotland and Northern Ireland are Lanarkshire Health Board with an average of 1,817 patients per GP and Western Health and Social Care Trust with an average of 1,728 patients per GP. Hywel Dda University Health Board in Wales have the highest average number of patients per GP in Wales at an average of 1,618 patients per GP.
There is significant variation in the average number of patients per GP across the UK with England having the highest average number of patients per GP
ChartThe number of full-time equivalent nurses working in general practice has hovered around the 23,000 mark for the past few years, and has slowly been decreasing from a high of 24,000 in 2019. This equates to just under 17,000 full-time posts in 2025, as a large proportion of nurses work part time.
While both GP and nurse numbers have remained steady, the number of other clinical staff providing direct patient care – including pharmacists, social prescribing link workers, and care coordinators – has almost doubled. The number of full-time equivalent staff grew by 33,100 between September 2015 and September 2025. The majority of this increase has been funded through primary care networks rather than directly by practices. This has dramatically changed the balance of professions within general practice. A decade ago there were three GPs for each member of other clinical staff providing direct patient care. By 2025 there was more than one other clinical staff member providing direct patient care for each GP.
Large increases in other staff providing direct patient care has been driven by funding through primary care networks
ChartWant to know more? We wrote about the welcome increase in general practice staff but the potential mismatch between demand and clinical capacity in More staff in general practice, but is the emerging mix of roles what’s needed? We explored how recruitment and retention premia are used in Placed at a premium? The use of recruitment and retention pay supplements to address staffing shortfalls. We also explored why some GPs are struggling to find work here: Why does England have unemployed GPs when patients can’t get GP appointments?
What is it like to work in the NHS?
Staff satisfaction
The experience of working in the NHS has a huge impact on workforce wellbeing and productivity, as well as the likelihood of staff remaining in the system. The 2025 staff survey showed a decrease in staff motivation, with fewer staff looking forward to going to work and fewer staff feeling enthusiastic about their jobs compared to previous years.
Staff experiences have varied over time and there are notable differences in experiences across staff age groups, with younger staff members less satisfied with pay and more likely to experience work-related stress. There are also visible differences in job satisfaction across age groups, with those in older age groups reporting higher levels of satisfaction.
Diversity
Over one-quarter (29%) of NHS staff report being of Asian, Black or another minority ethnicity, compared to 19% of all working-age adults in the UK. However, these proportions vary considerably by staff group. For example, while 42% of nursing staff report being of a minority ethnicity, only 6% of ambulance staff do.
Staff who report being from ethnic minorities as a whole remain less well represented at senior levels, have worse day-to-day work experiences – including being more likely to experience harassment, bullying or abuse from either colleagues or others – and face more challenges in progressing their careers. In particular, Black and minority ethnic staff are 38% less likely to be appointed from shortlisting compared to White staff. Black and minority ethnic staff are also less likely to access additional training that is not mandatory compared to their White colleagues. There have been some improvements over time, notably falling disparities in the likelihood of entering formal disciplinary processes (which has been subject to a national target).
Black and minority ethnic staff are less likely to be appointed from shortlisting and more likely to enter a formal disciplinary process compared to their White peers
ChartWant to know more? Our 2021 report looked at how the NHS performs on attracting, recruiting and retaining a diverse workforce, including across the range of protected characteristics, such as age, gender, disability, religion and sexual orientation: Attracting, supporting and retaining a diverse NHS workforce. We also explored generational differences in the experience and satisfaction of staff working in the NHS in: What does the NHS staff survey tell us about the changing behaviours and motivation of health care staff?
Recruitment and retention of the NHS workforce
Domestic supply
A key factor contributing to the shortfalls in the NHS workforce has been a failure to train sufficient numbers of staff. The chart below shows the number of UK joiners within different staff groups at Band 5, a proxy for the number of UK-trained graduates who are joining the NHS within these staff groups. While midwives and ambulance staff have seen increases over time, there has been little change to the number of UK-trained nurses joining Band 5 posts since 2016. This is likely driven by a large decline in the number of students starting nursing.
In the 2025/26 academic year, there were 21,000 placed applicants onto nursing courses, approximately 4,800 (18%) fewer relative to the peak of 25,800 in 2021/22. Alongside a lower number of people starting nursing courses at university, there is a high proportion of university students not completing their nursing course or not becoming NHS nurses after graduation. One estimate suggested that for every five university nursing places, only three full-time equivalent nurses eventually join the NHS.
There has been little change in UK nationals joining the NHS as nurses, while the number joining as midwives and ambulance staff has increased significantly
Chart
There are also substantial issues in the domestic training pipeline. Historically, most medical students have graduated and gone on to join the NHS, but thereafter there appear to be significant retention issues. We estimated that fewer than three in five doctors (56%) in ‘core training’ remained (even in a different role) in NHS hospital and community services in England eight years later, with 24% of this attrition seen in the first two years. And, while the data on the GP training pipeline is limited, previous research has shown that the attrition rate is high.
Want to know more? We set out the scale of the leaks in the training pipeline and put forward a 10-point plan to fix it, including a policy proposal to gradually write off clinicians' student debt over 10 years, in Waste not, want not: Strategies to improve the supply of clinical staff to the NHS
International recruitment
When the domestic supply of staff is insufficient to meet demand, the health service relies on international recruitment to fill gaps. Approximately 40% of nurses and midwives joining the professional register in the year to March 2025 trained outside the UK. Since the Brexit referendum, the proportion of international recruits joining from the EU/EEA has dropped substantially across a range of specialties. Higher levels of international recruitment have often been driven by national targets and support in response to unforeseen additional demand for staff (such as following the Francis Inquiry and safe staffing guidelines, and more recently due to the Covid-19 pandemic). In an attempt to improve retention of UK-trained doctors, the Medical Training (Prioritisation) Bill received royal assent in early 2026. This Bill sets out a new process for the allocation of medical training places in the UK that prioritises UK-trained doctors.
Since the Brexit referendum the number of internationally (non-EU/EEA) trained nurses and midwives has increased substantially, while the number of EU trained nurses and midwives has declined
Chart
Want to know more? Our briefing analyses the benefits, pitfalls and ethical concerns surrounding the use of overseas recruitment to address shortfalls in nursing staff numbers: Return on investment of overseas nurse recruitment: lessons for the NHS
Retaining existing staff
As well as recruiting new staff, it is also vital to keep the existing workforce. The proportion of professionally qualified clinical staff leaving the NHS was 9.4% in the year to December 2025. This is the lowest level it has been in a decade and there is evidence linking lower staff turnover to improvements in patient care.
The proportion of professionally qualified clinical staff leaving the NHS in England is the lowest it has been in a decade
Chart
Despite pay being the main point of dispute during the strikes seen in recent years, a multitude of reasons drive NHS staff to leave their roles, with stress and understaffing coming out ahead of pay.
Want to know more?
We produced a briefing on the high levels of leavers in 2022: Peak leaving? A spotlight on nurse leaver rates in the UK
We also produced a stocktake about what is known and not known about the numbers of staff leaving NHS (and social care roles), and the reasons given for moving on: The long goodbye? Exploring rates of staff leaving the NHS and social care
We have also looked at the issues facing NHS staff (and surgeons in particular) with parental or caring responsibilities: Future proof: The impact of parental and caring responsibilities on surgical careers
Our 11-point plan to improve the pay review process, which has implications for retention and recruitment, is here: Basis of negotiation: recommendations to improve the NHS pay review process
How do staffing levels in the NHS compare to other countries?
Comparisons with other countries must be treated with caution due to differences in, for example, geographies, service design and data. While it appears the UK as a whole has relatively more staff compared to other developed nations, different countries have different levels of skill mix, with the UK (particularly England) employing more support staff per head compared with other countries. The UK has relatively fewer doctors per capita working in hospitals compared to some of its European peers, including Germany and France, but there are more doctors when compared to the OECD average. Another measure looking at the total number of doctors providing direct patient care in all settings suggests that the UK ranks poorly relative to peer nations.
Further discussion about how England compares internationally is available in our international comparison report, which highlighted the NHS as having higher bed occupancy rates, lower numbers of key staff and lower levels of capital investment compared to other high-income countries.
Is there a shortfall of staff in the NHS?
There has been remarkable growth in the NHS workforce over the past decade. There have been significant recruitment efforts contributing to this increase, such as the 50,000 nurses programme, and expanded training pipelines by increasing the number of medical school places.
However, defining a staffing shortfall is tricky. While data shows that there were just over 100,000 vacancies (6.7%) between October and December 2025 – with this being one of the lowest relative vacancy rates since 2018 – this does not tell the full story. Many of these vacancies will be filled by temporary (agency or ‘bank’) staff from day to day, and there are causes of shorter-term rota gaps, such as sickness absences. But such data is not regularly published, meaning that we have little understanding of the true shortfall in the NHS.
More recently, vacancy rates may be historically lower because NHS trusts are under pressure to balance their budgets and reduce deficits. Since staff pay is their largest cost, reducing the number of advertised posts – which, in turn, will reduce the growth in the number of employed staff – is an inevitable consequence.
That said, there are still some trends that are a cause for concern.
Not all staff groups have increased. While there have been substantial increases overall in the NHS workforce over the past decade, this has varied across staff groups. In particular, there have been worrying declines in public health consultants, health visitors, school nurses, district nurses and community matrons. This is particularly concerning in the context of shifting more care into the community.
Retention of staff remains an issue. There have been promising declines in the leaver rates of professionally qualified clinical staff over the past decade. However, the staff survey results show declining motivation and engagement, neither of which are promising signs for future retention of staff. Furthermore, NHS staff are also earning less in real terms than they did 15 years ago. Ongoing (and proposed) strike action among resident doctors and consultants highlights the discontent within these groups.
Reliance on international recruitment. Over the past decade, the NHS has relied on international recruitment of clinicians to fill gaps in the workforce. In 2025, almost 40% of nurses and midwives joining the professional register had trained internationally. To build a sustainable workforce, more needs to be done on training and retention of locally trained medical professionals. The newly established Medical Training Prioritisation Act is a step in this direction and will ensure that, when it comes to allocating training spaces, UK-trained doctors will be prioritised. The 10 Year Health Plan states that the NHS will reduce its reliance on international recruitment by reducing the number of international joiners to less than 10% of all joiners by 2035. However, this is a highly ambitious target given the current reliance on international recruitment.
All of these challenges are occurring against a backdrop of a growing and ageing population. People are living longer with more complex health needs, which has implications for the future number of clinicians required to provide high-quality care. Furthermore, the NHS does not operate in a vacuum. It is one player – albeit a very large one – in a wider ecosystem of organisations that provide care and look after the health of the nation. Failures in other parts of the system, such as a lack of appropriate social care or insufficient funding in public health, will have implications for the NHS, as well as its workforce.
What is the outlook for the future?
The 10 Year Health Plan for England recognises the centrality of the workforce to delivering future reforms. The plan sets out three major shifts: from hospital to community, from analogue to digital and from sickness to prevention. A new NHS long-term workforce plan, expected shortly, will need to support these shifts.
Both the shift to the community and a shift to prevention will require strengthening the primary and community care workforce. While there have been encouraging increases in GP trainees and in direct patient care roles funded via ARRS, this is offset by worrying declines in public health consultants, health visitors, school nurses, district nurses and community matrons. The upcoming plan will not only need to address the overall staffing levels, but also the mix of skills, training and career development that support high-quality community and preventative care. For example, while the NHS has expanded non-medical prescribing, training and support for new prescribers in community settings is more limited, which will undermine efforts to shift services to the community.
Digital capability is expected to become a core skill for NHS staff. Realising the benefits of new technologies will require sustained investment in training. To date, much of the focus on the shift to digital has been around increasing productivity. The preoccupation with digital and productivity risks undermining other benefits, in particular staff experience, wellbeing and professional development, which all have implications for retaining staff.
The NHS’s ability to deliver care is wholly reliant on its staff. Workforce challenges often cannot be quickly resolved. When clinical professionals leave, replacing their expertise takes years. The workforce plan will need to get the fundamentals right, for example with a grounded approach to modelling the expected future workforce, backed by sufficient funding. It will also need to address the domestic training pipeline, improve retention and the implementation and use of technology. But perhaps most importantly, the workforce plan should put staff wellbeing at its centre, both during training and throughout NHS careers.
Want to know more?
Doing right when you are wrong: perspectives on workforce planning in the NHS in uncertain times
We explored the key considerations around regulation of advanced practitioners here: Independent report on the regulation of advanced practice in nursing and midwifery
Suggested citation
Nuffield Trust, "The NHS workforce in numbers" This explainer was first published in 2017 and has been updated regularly.