Workforce gaps are result of reorganisations and “quick fixes,” Health Foundation says

BMJ 2016; 354 doi: (Published 18 July 2016) Cite this as: BMJ 2016;354:i3980
  1. Matthew Limb
  1. BMJ Careers

The NHS workforce in England has swung from boom to bust because of repeated reorganisations and a reliance on “quick fixes” to solve deep systemic problems, independent healthcare charity the Health Foundation has said.

A study by the charity has concluded that “mismatches” between funding and staffing levels and top down system reforms have undermined any long term consistency in workforce planning. At the same time lower cost “quick fixes” have placed a “sticking plaster” on deep seated systemic difficulties, the study found. The Health Foundation has called for a more coherent, sustainable approach to tackling funding constraints and staff shortages. It said that these constraints and shortages posed the “greatest threats” to the delivery of the NHS Five Year Forward View.

The authors said that “more targeted and aligned” policies were needed regarding retention, temporary staff use, and international recruitment to tackle current and future skills shortages in the short term. They concluded, “This will buy time for more effective and sustained responses to skills shortages and staffing to be implemented.”

The report, entitled Staffing Matters; Funding Counts, examined trends and features of the NHS workforce in England and specific “pressure points.”1 These pressure points included the recruitment and retention of GPs, international recruitment to fill vacancies, and the use of temporary and agency workers.

The Health Foundation said that attempts to recruit from abroad and cap temporary staffing costs showed that national and local leaders were trying to use “less costly, reactive, and short term solutions” to tackle staff shortages. Few “top-down” NHS system reforms have given detailed consideration to workforce implications, and national policy changes have focused on saving money, it said.

The report noted that the health service’s workforce problems owed more to “poor strategic coordination and conflicting political, funding, and planning objectives and cycles,” than to technical shortcomings in planning. This “recurring theme of mismatches between staffing and funding” must be tackled, it said.

The authors commented that national policy and planning must consider the needs of the health system workforce “holistically” and have a full understanding of labour market dynamics. They wrote, “In simple terms, it is not just about training more workers.”

The analysis showed how rising GP practice workload has outstripped more modest growth in staffing over the past few years. The GP workforce rose by 4.75% and the practice nurse workforce by 2.85% between 2010-11 and 2014-15.

However, the report said that GP workload increased “hugely both in volume and complexity” over the period. It noted that additional GPs or more GP hours were only part of the answer to problems with recruitment, retention, and distribution, and further thought should be given to achieving a more equitable distribution of current GP services.

The authors wrote, “There is a need for a broader and more comprehensive policy focus, where the real driver is improved access to primary care and productivity, and where the staffing element of the ‘solution’ takes account of the need to enable effective team-working.”

Workforce data also showed that the UK has one of the highest levels of reliance on internationally trained health professionals of any country represented in the Organisation for Economic Co-operation and Development. About one in three doctors and one in eight nurses in the UK were trained in another country, figures from 2013 have shown.

The report said that a more integrated, nationally led approach was needed, focused on achieving overall healthcare workforce sustainability. “Domestic” policies, including adapting the current workforce and improving regional recruitment, retention, distribution, and productivity, “must be aligned with policies aimed at making any international recruitment efficient,” the report noted.


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