Finding solutions to the developing NHS workforce crisis

The NHS is currently facing a workforce crisis. One in 12 posts (8%) are now vacant around England. This is partly a reflection of a growing global shortage of healthcare workers, but has its own particular causes: failure to train and retain enough home grown health professionals; inability to recruit sufficient numbers from abroad; trainee departures to work overseas, to other occupations and to locum agencies; as well as early retirement of senior staff driven by rota gaps, overwork, burnout and damaging pension rules. An aging population and the social impact of years of austerity have also exacerbated the crisis.

Despite promises of 5000 extra GPs, there are fewer GPs per patient for the first time since the 1960s, 40 000 nurse vacancies, and 10% of specialty medical and 32% of psychiatry training posts unfilled. The result is a vicious cycle of low morale and disillusionment driving doctors and nurses out of the NHS and deterring others from joining, which puts yet more unsustainable pressure on those who choose to stay.

The scale of the problem has finally begun to hit home with government, and an interim workforce plan has made some suggestions. But new staff and new roles will take years to materialise, and the NHS has a huge task ahead if it is even to retain its current staff. A referendum on the offer of a new contract that provides an 8.2% pay rise over four years and improved working conditions for junior doctors is being held between the 14th and 25th of June.

Other recommendations for more motivated and safer hospital doctors include the return of ‘the firm’. The firm is a shorthand for many of the things that the best employers have always known: that for people to flourish in their work they need nurture, support, community and a sense of belonging, and the assurance that your leader knows who you are and will support you when things go wrong.

The reduced working hours and early retirement of experienced senior doctors is largely a reflection of the pension taper, which has resulted in massive tax liabilities for higher earning consultants and GPs as a result of the NHS’s inflexible pension system. It is not at all clear that the proposed 50:50 solution will ease the problem, since the generous pension arrangements have been a major motivation for doctors to continue working within the NHS.

Are things really this bad? What are your experiences and suggestions? Do add a comment to this blog.

Comments (15) Add yours ↓
  1. Greg Shaw Consultant urologist

    The pension issue is simply scandalous adding financial stress to an increasingly litigious and unsupported environment can only push good practitioners towards reduced hours and early retirement and deter good young people from medical careers.

    It’s difficult to believe that the effects were not predictable by those planning the pension changes (I think George Osborne was chancellor at the time).

    The increased stress on doctors has profound consequences. For example, suicide rates are rising steadily:

    The government’s disregard for the well-being of our professionals is underlined by the dearth of support for those who are struggling to cope with the stress of work.

    In the absence of adequate support the onus is on us to be attentive to the well-being of our colleagues and provide support where needed.

    June 20, 2019 Reply
  2. David Nicholl Dr

    Sad to say, I think things are this bad, in my own department I’ve had one colleague retire and return and another Italian colleague leave. Although the latter move was not directly due to Brexit, 14% of neurologists in the UK are originally from a EC country, so Brexit is a factor. I have spent a year trying unsuccessfully to fill 2 Consultant posts unsuccessfully due to the staffing crisis, I have never known it to be this difficult to recruit. We successfully appointed a Consultant locum from oversea via Skype, but over 4 months later, we have yet to get him registered with the GMC due to the byzantine level of red tape (I’m not sure even the GMC understand all the hoops they make doctors jump through). All of this means, with increasing numbers of patients, workload and waiting times have gone up, as have complaints.

    June 21, 2019 Reply
    • David Nicholl Dr

      …jeepers, the GMC have approved our locum, took over 4 months to prove that yes his English was good enough. Clearly it was Trends in Men’s Health what won it 😀

      June 22, 2019 Reply
  3. Peter Duffy Consultant urological surgeon, Isle of Man

    Thanks for bringing this subject to our attention Roger.
    As you say, new trainees and recruits will take years to materialise and therefore the retention and motivation of existing staff is crucial. Unfortunately, the NHS is extremely poor at this.
    I’d have been delighted to have dedicated my last 7 years to completing my lifetime ambition to serve the NHS in NW England but was forced out over the sheer amount of abuse of my terms and conditions that was going on. It matters not whether you accept the NHS’s explanation for my constructive unfair dismissal (an “accident”, and a co-incidence that it immediately followed my whistle-blowing to the CQC) or my closest colleagues’ explanation, namely that this was a plausibly-deniable career assassination. Either way, the NHS makes little or no effort to invest in or support its workforce and it seems that the more committed and dedicated the individual, the greater the risks and abuses they face.
    I’m afraid that I don’t have any easy solutions, but a good place to start would be leadership from the top. Within days of pledging to stand with NHS whistle-blowers, Matt Hancock’s office was writing to me on his behalf to refuse any help or support. Says it all really.

    June 21, 2019 Reply
  4. Roger Kirby Professor of Urology

    The long-running dispute over pay and working conditions for junior doctors in England was set to end after a British Medical Association (BMA) ballot overwhelmingly endorsed the terms of a deal.
    A total of 9449 junior doctors, or 82% of those who voted, backed improvements to the 2016 contract which would see a pay rise and improvements to wellbeing and safety.
    This may go some way to resolve the crisis of recruitment and retention of junior doctors in the NHS.

    June 26, 2019 Reply
  5. Roger Kirby Professor of Urology

    The number of doctors taking early retirement has tripled in the past decade, NHS figures show.

    From 2007-08 to 2018-19 the number of GPs and hospital doctors in England and Wales taking voluntary early retirement or retiring because of ill health rose from 386 to 1186. The average retirement age fell over this period, from 61 in 2007-08 to 59 in 2018-19.

    Overall, the number of doctors retiring over the period rose by 7%, from 2359 to 2527.

    June 29, 2019 Reply
  6. Roger Kirby Professor of Urology

    An interesting BBC programme re junior doctors and workforce issues, worth listening to:

    July 4, 2019 Reply
  7. Roger Kirby Professor of Urology

    Waiting lists for operations are soaring as growing numbers of senior doctors turn down extra shifts over changes to pensions.

    Hospital trust chief executives say a dramatic increase in the number of consultants declining extra work in recent weeks has had an impact on patient care.

    The changes in pension taxation mean picking up extra shifts are no longer worth their while for doctors.

    One NHS trust reported that a senior anaesthetist at their hospital, who had worked 27 Saturdays the previous year to help reduce a backlog of operations, had informed them they would no longer work any weekends.

    July 8, 2019 Reply
  8. Roger Kirby Professor of Urology

    The number of junior doctors reporting their role leaves them feeling burnt out has continued to rise, according to a damning annual report on the state of medical training in the UK.
    A quarter of doctors in training said that their job leaves them burnt out to a high or very high degree – up from 23.9 per cent in 2018, the General Medical Council’s (GMC) national training survey found.
    Despite some improvements in training, the stark findings from more than 75,000 doctors in training and their trainers show how much work is still to do to address the pressures on junior medical staff.
    More than a third said their daily workload was heavy and just 44 per cent said they had access to free rest facilities when working on call out at nights.
    Junior doctors’ conditions have been under the spotlight since the Department of Health and Social Care – then led by prime ministerial hopeful Jeremy Hunt – caused England-wide strikes by enforcing a contract that sought to cut payments for weekend and evening work.

    July 8, 2019 Reply
  9. Roger Kirby Professor of Urology

    A recent report on NzHS staffing has some blunt conclusions about the consequences of scrapping the state-funded bursaries in England and making the training of nurses subject to tuition fees.
    The theory was that the policy would encourage universities to expand places for nursing degrees.
    But the report says “in parts of the country, some university intakes have been reduced significantly over the past two years”.
    It goes on to point out that “applications for nursing and midwifery courses have fallen since the education funding reforms, with a 31% decrease between 2016 and 2018 … the 50% decrease in applicants for learning disability nursing since 2016 is particularly concerning”

    July 8, 2019 Reply
  10. Roger Kirby Professor of Urology

    England’s A&E departments have recorded their worst June performance since current records began, with just 86.4% of patients seen within four hours.

    Performance was down 4.4% on the same month last year, when 90.8% of patients were seen within four hours, despite a negligible increase in attendances of just 0.7%.

    In June, a total of 2,108,000 people attended an emergency department, up from 2,094,000 in June 2018.

    The NHS England target of seeing 95% of patients within four hours has not been hit since July 2015.

    A spokesperson for NHS England said staff shortages were a factor.

    July 11, 2019 Reply
  11. Roger Kirby Professor of Urology

    The NHS is facing a “year-round crisis” as summer waiting times soar to record levels. The number of patients forced to wait more than six months for treatment has hit an all-time high while A&E has had its worst June on record, official figures show.
    Health service performance figures for May show 245,079 people spent more than 26 weeks on the waiting list, with experts warning many will be “in pain and distress”.
    A heatwave last summer led to unprecedented pressures for the NHS, which sapped time to prepare for winter. There are signs that this summer could be even worse.
    The proportion of patients waiting more than four hours to be seen in A&E last month more closely resembled the run-up to Christmas than the start of summer, and was the worst June performance on record.
    Just 86.4 per cent of patients were seen within four hours, down from 90.8 per cent 12 months ago. In June, a total of 2,108,000 people attended an emergency department, up from 2,094,000 in June 2018.
    These intense pressures at work must surely be an important factor in the current NHS workforce crisis.

    July 12, 2019 Reply
  12. Christian Brown Urologist

    It is exactly as you state Roger and a major concern. I have seen waiting times for routine (non 2 week wait) referrals go up exponentially as our work force at all levels seems to reduce when we all feel we need more doctors. We are constantly being told to work differently, more remotely even virtually – but without people the NHS will further fail, even with innovative working schedules. It is the most basic of principles – look after the staff and they with thrive and work hard, failure to do this results in negativity and loss of good will.

    July 12, 2019 Reply
  13. Roger Kirby Professor of Urology

    Thanks Christian – Stella Vig, a leading surgeon, said recently that thereis no such thing as an NHS winter crisis anymore, arguing an “all-year round crisis” is a far more accurate description.

    A lack of investment and failure to fill staffing gaps had, she said, created the “predictable perfect storm” leaving the health service stretched even in summer months.

    She went on to grimly predict that the waiting list for treatment could hit five million by Christmas.

    July 13, 2019 Reply
  14. Roger Kirby Professor of Urology

    Jeremy Hunt, now often congratulating himself over his record as Secretary of State for health in his bid to be prime minister, took over responsibility for the NHS in 2012. By the time he left the post 6 years later, patient experience and staff morale had both taken a dramatic turn for the worse across many key indicators. Winter crises deepened, with official figures showing 2017, 2018 and 2019 were successively “worst on record”. The British Medical Association (BMA) reported that by 2018 “the “winter crisis” has truly been replaced by a year-round crisis”. NHS rules say 95% of patients visiting A&E should be seen within a maximum of four hours. When Hunt took over the performance was just below target – 94.9%. Performance worsened steadily during his tenure and was 84% by the time he left, with the target having been missed every winter since 2013/4, and every single month since July 2015. That meant three times more patients waiting over four hours to be seen in A&E when Hunt left office than when he took over. I’m not so sure that congratulations are in order!

    July 13, 2019 Reply

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