A critical moment NHS staffing trends, retention and attrition

February 2019

James Buchan
Ian Seccombe
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Key points

  • Analysis of the NHS staff profile and trends in England in 2018 largely confirms the trends identified in our previous reports, showing an ongoing deterioration for some key staff groups.
  • The past year has seen modest growth of 1.8% in the total number of full-time equivalent (FTE) staff. However, this is against a backdrop of more than 100,000 vacancies reported in total by trusts, including more than 41,000 vacant nursing posts. 
  • Staffing in some key areas is a problem. The number of GPs is falling, as is the number of nurses and health visitors working in community and mental health services.
  • The government has committed to increasing the number of nurses in training, however, in the past year the number of applications and acceptances for pre-registration nursing degrees in England both fell. 
  • Staff retention has worsened since 2011/12 and our analysis shows there has been no improvement over the past year. 
  • International recruitment will remain vital to achieving the overall staffing numbers needed, but it is currently being constrained by broader migration policies and by the uncertainties of Brexit. 

This is our third annual report analysing the staff profile and trends in the NHS workforce in England. It is intended to be read as an annual update, examining changes in the overall profile of NHS staffing in 2018.

As well as assessing the implications of trends in NHS staffing, this report also focuses in more detail on two critical ‘pressure points’ – the retention and attrition of NHS staff in general, and then student nurse attrition.

It is being published at a critical moment. The NHS Long Term Plan, published in January 2019, sets out an ambitious programme of service-delivery expansion and change. It recognises that the NHS workforce can be the enabler of its objectives. However, if the existing workforce shortages continue, they will severely hinder progress. 

This report sets out recommendations for improving these worrying trends. It then concludes with a brief assessment of ‘where next’ in terms of health workforce policy and planning in England, in the context of ongoing reforms of the NHS.

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