Urgent action needed to address nurse shortages and create sustainable general practice

A joint report from three leading health charities says urgent action is needed to avoid a vicious cycle of growing nurse shortages and declining quality of care.

The Health Foundation, The King’s Fund and Nuffield Trust report, Closing the gap – key areas for action on the health and care workforce says an investment of an extra £900 million per year by 2023-24 to create a sustainable model for general practice and help to eliminate nursing shortages.

The report says that, based on current trends, in 10 years’ time the NHS will have a shortfall of 108,000 full time equivalent nurses. Half of this gap could be bridged by increasing the number of nurses joining the NHS from training. This would require 5,000 more nurses to start training each year by 2021, reducing the drop out rate during training by a third, and encouraging more nurses to join the NHS once they qualify.

To achieve this, the report recommends that the Government significantly increases the financial support to nursing students, with cost of living grants of around £5,200 a year on top of the means-tested loan system. The report also calls for the costs of tuition fees to be covered, to triple the number of nurses training as postgraduates.

‘This is essential to address the financial problems trainee nurses face while studying that deter students from starting a nursing degree and are a factor in the high drop out rate during training. The availability and quality of clinical placements is another key priority for reform,’ the report states.

From a starting point of 57,420 applicants for nurse training, only 17,670 eventually qualify, of whom only 2,470 (14%) enter primary care, or residential care settings.

The report points out that national efforts to increase the number of GPs need to continue, but the ‘stark reality’ is that even with a major effort on increasing the number of GPs in training, the number of doctors in general practice will fall substantially short of demand. The NHS in England currently has 2,500 fewer full time equivalent GPs that it needs, and the gap is projected to increases to 7,000 if current trends continue.

‘The only way forward is to make substantial progress towards a new model of general practice with an expanded multidisciplinary team drawing on the skills of other healthcare professionals. The new GP contract and the NHS long-term plan support this shift, but the key issue is the speed, consistency and quality of implementation across the NHS.’

The charities say that the workforce implementation plan to be published later this year presents a ‘pivotal opportunity’ to address workforce shortages.

Commenting, RCGP chair Professor Helen Stokes-Lampard said: ‘We must not give up. We are extremely grateful to the hard work, skill and dedication of members of the wider practice team – they are pivotal in supporting us to deliver care to over a million patients every day – but they are not GPs and must never be seen as direct substitutes or used to “fill the gaps” long-term where numbers of GPs are insufficient. The forthcoming NHS workforce strategy does need to include plans to expand the multi-disciplinary team in general practice. Taking steps to reduce workload to make working in general practice more sustainable would be a sensible place to start.’