NHS Staffing Crisis – Where do we go from here?

England and Wales

It is no secret that the NHS staff supply is in crisis. Official figures show that in March 2022, 105,855 health services posts were unfilled in England. According to health service vacancies published by NHS Digital the shortages include 38,972 nurses.[1]. A lack of staff increases workload per employee and, thereby, increases risk to patients. A 2021 survey by NHS Employers states that only 27% of NHS staff felt that there were enough employees for them all to do their job properly, and 34% feel ‘burnt out’ ‘often or always’ from their job[2]. So, what is being done to combat the workforce emergency?

In June 2022, Sajid Javid, former Health and Social Care Secretary, stated that 2022 will see a published digital health and care plan, an update of the NHS Long Term Plan after COVID, and the Health Education England’s workforce framework followed by the publishing the NHS’s first 15-year workforce strategy[3]. The NHS resource budget will increase to over £160 billion in 2024 to 2025, which will include £5.9 billion of capital investment to support diagnostics, technology, and elective recovery[4]. Sajid Javid also referred to the potential for reform partnerships, which would decrease waiting lists through bringing together specialist, acute, mental health and community providers in an NHS collaborative[5].

In addition to future-facing proposals, the staffing crisis has already been aided somewhat by recently introduced roles. Clinical pharmacists are increasingly working within general practices, carrying out regular structured medication reviews for patients with ongoing health problems. Since the NHS England Clinical Pharmacists in General Practice Programme commenced in 2015, over 1000 full time equivalent pharmacists are working across the country in this role, which has been reported to improve patient safety, outcomes, and value through a person-centred approach[6]. The NHS Long Term Plan commits to further increasing the number of clinical pharmacists working in primary care[7]. In May 2022, the General Pharmaceutical Council (‘GPhC’) changed the entry requirements for an accredited independent prescribing course to require applicants to demonstrate that they have followed certain conditions and illustrate their readiness, rather than having to wait until they have been on the GPhC’s register for two years[8]. Further, in June 2022, Amanda Pritchard, NHS England’s Chief Executive announced a pilot programme in which pharmacists can assess and directly refer patients for a hospital check-up when they have potential signs of cancer to drive earlier diagnosis[9]. Though not as new as clinical pharmacists’ role, other allied healthcare professionals (‘AHP’), including midwives and nurses who have completed an accredited prescribing course and registered their qualification with their regulatory body, are now also able to prescribe[10]. Each of these changes provides patients with earlier and faster access to healthcare through creating more efficient and different qualification routes or sharing workloads between different healthcare professionals taking some of the toll off GP prescribers.

Under chapter four of the NHS Long Term Plan, funding was guaranteed for an expansion of clinical placements of up to 25% from 2019/20 and up to 50% from 2020/21[11]. Additionally, Health Education England has pledged £15 million to fund clinical placements across nursing, midwifery and AHPs in 2021/22[12]. The Conversative government’s manifesto pledge to increase full-time equivalent number of nurses in the NHS by 50,000 by March 2024 appears to be on track. Since September 2019, the full-time equivalent number of nurses working in the NHS has risen by more than 26,000[13]. There has been an expansion of routes to qualification in nursing and other disciplines, including apprenticeships, nursing associates, online qualifications, and ‘earn and learn’ support, all with a new post-qualification employment guarantee[14]. July 2022 has seen the approval of a new Medical Doctor Degree Apprenticeship, anticipated to commence in September 2023[15]. However, England’s Chief Nursing Officer, Ruth May, has noted that, despite the increasing number of nurses, there are still substantial shortages[16]. It is hoped that the 2022 update of the NHS Long Term Plan will further increase opportunity for prospective nurses and AHPs, continuing to combat the workforce shortages.

Another notable practice aimed at decreasing NHS pressure is the significant increase in online GP appointments within the past 3 years. GP practices and hospital outpatients provide around 400 million face-to-face appointments annually. The NHS Long Term Plan states that from 2019 to 2024, every patient will have the right to online GP consultations. It is predicted that this will avoid up to a third of outpatient appointments, saving 30 million trips to the hospital, and saving the NHS over £1 billion a year in averted expenditure[17].

Notwithstanding the above, it is clear that although initiatives have been introduced to tackle the fiscal and workload related pressure on the NHS, it is still not enough. A Health and Social Care Committee report published on 25 July 2022 reports that the Government has shown a reluctance to act decisively, as the 15-year workforce plan has not yet been published and will be a ‘framework’ with no numbers, which could potentially follow in yet another report later in 2022. The report states that the demand on the health and social care sector continues to grow with 475,000 jobs needed in health and 490,000 jobs needed in social care by the early part of the next decade[18]. Trusts remain pressurised as their lack of staff amplifies the backlog of patients and delays. It remains to be seen whether the proposed future plans, including the revision of the NHS Long Term Plan and the creation of the NHS and HEE’s 15-year workforce strategy, will make any real difference to the struggling NHS.

If you are a health care provider and require advice and assistance, please contact us. We are monitoring developments regularly and our team are on-hand to assist with your queries.

Co-authored by Heather Flaherty, Solicitor Apprentice at CMS

[1] NHS Vacancy Statistics England April 2015 – March 2022 Experimental Statistics - NHS Digital

[2] NHS Staff Survey 2021 National results briefing (nhsstaffsurveys.com)

[3] Health and Social Care Secretary sets out vision for year ahead - GOV.UK (www.gov.uk)

[4] Health and Social Care Levy to raise billions for NHS and social care - GOV.UK (www.gov.uk)

[5] Sajid Javid – 2022 Speech at the NHS ConfedExpo – UKPOL.CO.UK

[6] NHS England » Clinical pharmacists

[7] nhs-long-term-plan-june-2019.pdf (longtermplan.nhs.uk)

[8] Changes to the requirements for entry to independent prescribing courses | General Pharmaceutical Council (pharmacyregulation.org)

[9] NHS England » High street pharmacies spot cancers in new NHS early diagnosis drive

[10] Non-medical prescribing | Advice guides | Royal College of Nursing (rcn.org.uk)

[11] NHS Long Term Plan » Overview and summary

[12] Expansion of clinical placements gets a £15m boost from HEE | Health Education England

[13] Government over halfway to delivering 50,000 more nurses by 2024 - GOV.UK (www.gov.uk)

[14] Career paths for HCAs | Royal College of Nursing (rcn.org.uk)

[15] New Medical Doctor Degree Apprenticeship launched, delivering a more representative workforce for local communities | Health Education England (hee.nhs.uk)

[16] England’s CNO says 50,000 more NHS nurses ‘no longer enough’ | Nursing Times

[17] NHS Long Term Plan » Overview and summary

[18] Workforce: recruitment, training and retention in health and social care - Health and Social Care Committee (parliament.uk)