The three think tanks look at the challenges facing the health and care workforce and offer a series of recommendations on how to meet them

policy digest

26 / 03 / 2019

Closing the gap: Key areas for action on the health and care workforce
Health Foundation, The King’s Fund & Nuffield Trust, March 2019

The three health and care think tanks have produced a follow up report to their previous report on the challenges facing the NHS Workforce. This report says that it seeks to move from setting out the key challenges to developing solutions. It makes recommendations in five main areas 

  • Workforce Supply (education and training)
  • Making the NHS a better place to work
  • Pay and Reward
  • Workforce Redesign
  • Workforce Supply (international recruitment)

Workforce Supply (Education and Training)

The report reiterates the scale of the workforce challenges facing the NHS. In particular it highlights that current initiatives are unlikely to close the gap between the available workforce and the need for staff to deliver services and that this gap is a significant obstacle to using the extra resources allocated to the NHS to transform services. It especially highlights the gap in nursing staff and in GP numbers. It estimates that without additional action there will be a gap of 40 000 nurses by 2023 and "On current trends, in 10 years’ time the NHS will have a shortfall of 108,000 fulltime equivalent nurses. It also argues that the Government will not achieve its objective of increasing GP numbers.

It calls for a more ambitious target than the 5% nurse vacancy rate target set by NHS Improvement for 2028. It says that with a mix of measures it could be possible to match supply and demand from 2028/29. Half of the increases would come from increasing supply and half from improved retention. 

It calls for restoration of financial support for nurses in training with a new £5200 cost of living grant and payment of tuition feeds for NHS clinical staff. It highlights the risk to nurse supply from the switch from bursaries to loans. It also calls for action to reduce attrition rates in training. 

It also calls for a restoration of cuts made to Continuing Professional Development funding in the NHS, for a fairer allocation of support for clinical placements and improvements to the Apprenticeship levy. These changes could need up to 900m additional investment in education and training budgets. 

Making the NHS a Better Place to work

The report refers to the need to make the NHS a better Place to Work and in particular to offer a more flexible and less stressful workplace. In particular it suggests a new “compact” with staff could be a useful way forward setting out what staff can expect from employment. It calls for this idea to be taken forward by employers and staff side representatives. It calls for national NHS bodies to implement the recommendations of previous reports on compassionate and inclusive leadership. 

Pay and Reward

The report notes the recent NHS Pay Agreement and calls for a commitment to ensure NHS staff do not fall behind other groups in the economy in future. It calls for a more targeted use of incentives within the pay system. It emphasises the need to address gender and race equality issues in the NHS. It calls for urgent action on pension changes which may be creating incentives for staff to leave and to have a system that retains staff nearing retirement age. 

Workforce Redesign

The report calls for more innovative action to support workforce redesign. Focussing on the need to implement new workforce models in primary care, It supports the expansion of pharmacy, therapy and paramedic roles arguing that there is a good case to recruit 3000 more pharmacists and 6000 physiotherapists to free up GP from tasks that others can do more effectively. It also argues that there could be better use of clerical staff and of technology in primary care. 
It says there needs to be more support for local organisations to take the lead in workforce redesign and be supported to develop local solutions. It says new roles should be evidence based.

Workforce supply (International Recruitment) 

The report argues that in the short-term international recruitment is the only way the NHS can plug the growing workforce gaps. To achieve this, it calls for a nationally supported coordinated programme with an initial target of 5000 additional nurses by 2020.


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