HOW THE ENGLISH GOVERNMENT CAN START TO ADDRESS STAFF SHORTAGES IN THE NHS

Eisha Aqil

Aneurin Bevan, the ‘architect of the [NHS]’ (Anon., n.d.) famously stated that “the NHS will last as long as there’s folk with faith left to fight for it” (White, 2017). Inarguably, among the individual who have fought hardest for the NHS to survive are the doctors and nurses within it. However, the number of healthcare professionals (HCPs) in the nation is clearly low, with England only having 2.9 doctors per 1000 people—far from the OECD EU nation average of 3.7 (Anon., 2024a). As such, it is vital that the government address the shortage of doctors and nurses in the NHS by considering the key reasons for the shortage, including lack of HCPs in the workforce, low incentives to work in the NHS, and the attractiveness of overseas opportunities. Then relevant changes can be suggested to tackle the shortage.

Firstly, a reason for the shortage of doctors and nurses in the NHS is simply a lack of HCPs available in the country’s workforce. As of December 2023, there were 110,781 vacancies in secondary care in England; of these, 8,758 vacancies were medical and 34,709 were for nursing. Furthermore, 13% of secondary care doctors and 18% of general practitioners (GPs) will reach minimum retirement age within the next decade. This could mean a loss of over 25,000 doctors through retirement alone (Anon., 2024a), which exacerbates the issue of staff shortages. The high vacancies can be partly attributed to the inaccessibility of healthcare professions in the country. Even though UK medical school applications have increased over time, with 9480 more applications from 2017 to 2021 (Anon., 2021), the overall offer rate has stayed consistently low. As such, a dwindling number of doctors entering the workforce faced with a growing population (Anon., 2020) can explain the NHS shortage. Nevertheless, there is much that can be done to increase the doctors and nurses in the country. Firstly, medical and nursing schools must increase the number of British students they train each year. Ensuring enough British medics will reduce the impact on the NHS of foreign doctors moving back home. The high demand for schools can be met by establishing new programs or expanding current ones so that more trained HCPs enter the NHS. Moreover, the government should devote more funding for bursaries and scholarships to increase the incentive for British students of pursuing a medical/nursing career. This is especially relevant for the field of general practice: in February 2020 the government committed funding to recruit an additional 6,000 GPs by 2024. Yet, as of January 2024, there has only been a 2,690 increase since 2019 (Anon., 2024b). The government should offer support for GP training programs across the country and incentivise medical students to pursue a career in primary care, as it serves as the foundation of the NHS. Additionally, the multi-disciplinary team’s significance must be acknowledged by the government. Expanding training for nurses and allied HCPs is vital to relieve the work burden on doctors and allow for more comprehensive health provision overall to minimise the impact of shortages. Also, the country should prevent international HCPs from moving abroad and attract internationally trained staff to work in the NHS. In 2023, roughly 14% of hospital and community staff are recorded as having non-British nationality (Anon., 2023a). The goal should be to increase this number to support the workforce. This could be done by improving working conditions (which will be elaborated on further into the essay) or expediting the immigration processes for internationally trained doctors/nurses so less strain is put on medical education institutes in the country. However, the aforementioned strategies are focused on supplyside policy, so will take time to have an impact on the NHS shortages. Yet over time, the problem will decrease as the government puts more effort into implementing these solutions. Therefore, increasing the number of doctors and nurses in the country’s workforce will help to address the shortage in the NHS.

Another factor contributing to the shortage of doctors and nurses in the NHS is the lack of incentive for existing HCPs to work in the NHS. Deterrents include long working hours, low wages, increased stress, and a subsequent decrease in retirement ages, all contributing to a workforce deficiency. Poor pay and working conditions were the top reasons for junior doctors wanting to quit the NHS in a 2022 survey. 85% cited their current level of pay, and 83% deteriorating working conditions (Anon., 2022). Concerningly, these issues have already prompted 31% of HCPs to seek jobs outside the NHS, intensifying fears around staff shortages (Anon., 2024c). Moreover, the lack of employees means that existing staff must work overtime to keep the NHS running: in 2022, 43% of NHS staff worked up to 5 hours of unpaid overtime in an average week (Yang, 2023). Additionally, HCPs are retiring earlier: the number of doctors taking early retirement from the NHS has more than trebled from 2008 to 2021 (Moberly, 2021). This indicates that the working conditions for doctors and nurses are poor, prompting them to leave the NHS, which is a key reason for a shortage of HCPs. To address this, the demands of the doctors and nurses ought to be met by increasing their wages to compensate for their tedious work. The government should ensure competitiveness of NHS salaries among similar public sector jobs. For example, the starting salary for qualified teachers is now £30,000 while the graduate starting salary in the NHS is £28,407 (Anon., 2024d). The factor of long hours will largely be addressed by increasing the doctors and nurses available for hire (as discussed previously), since workloads would be distributed evenly among greater numbers. Bettering staff work-life balance by adhering to the 37.5-hour work-week description will further improve conditions by making hours manageable. Likewise, government investment in technology can alleviate the burden on HCPs. By streamlining administrative tasks, doctors and nurses can focus on patients, potentially improving job satisfaction and reducing burnout. Moreover, the mental burden on HCPs of working in the NHS must be recognised by institutions as declining wellbeing contributes to staff turnover and early retirement. This can be done by implementing staff mental health initiatives, such as counselling services, and destigmatising wellbeing support within the NHS. Therefore, improving conditions in the NHS will attract/retain existing doctors and nurses, so will help to address the shortage.

With an aforementioned reason for the shortage of HCPs being transfers abroad, it is important to assess the appeal of foreign healthcare systems and push the NHS to adapt accordingly, in order to maintain staff. In 2022, 33% of junior doctors planned to work abroad within the next year, with Australia being the popular destination (42%) (Anon., 2022). One reason British doctors are drawn there is the improved working environment. The Australian healthcare system values a healthy worklife balance with less bureaucracy, allowing doctors to work efficiently with lower burnout (Anon., 2023b); doctors there generally work fewer hours than they do in the UK and receive overtime pay (Anon., 2022). Financial incentives are also significant in attracting British doctors to Australia, with salaries of doctors there being higher (Anon., 2023b). Therefore, in seeing the success of Australian healthcare and the pull it has on British HCPs, the NHS should aim to replicate these conditions. Yet, this comparison poses the question of whether the British system should move towards privatisation, as Australia has more private options alongside public systems as compared to the universal government-run NHS. This would allow for better pay and conditions for doctors and nurses, thus attracting more and reducing the shortage. However, according to Goodair (2022), “when for-profit provision increases, the quality-of-care declines”. The increase in outsourcing to for-profit providers by NHS commissioners since 2013 raises concerns about the quality of care. Despite the belief that marketisation enhances efficiency, outsourcing was associated with higher mortality rates, potentially due to worsened care quality (Goodair & Reeves, 2022). The findings challenge the notion that privatisation would improve the NHS. Thus, working towards an Australian model of mixed provision would prevent the drawbacks of both extremes and help to address the NHS shortage.

In conclusion, the shortage of doctors and nurses in the NHS is a significant problem for the government and must be addressed urgently if the service is to continue caring for patients effectively. By implementing the strategies suggested in this essay, there would be an increased number of HCPs available in the workforce, with incentive to work for the NHS as opposed to alternatives abroad. Though it will take time for these suggestions to affect the employee deficit, the faster the government moves to address this issue will directly determine how quickly it can be resolved, allowing the shortage of doctors and nurses in the NHS to be addressed.

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