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Primary and community care staff shortages could undermine long term plan, think tank warns

by Valeria Fiore
12 February 2019

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The NHS’s aim to keep people out of hospital by investing at community level could remain an ‘unrealised aspiration’ due to workforce shortages, a leading think tank has warned.

A report by the Health Foundation, published today, found that there is an ‘ongoing deterioration’ in the number of staff employed in primary and community care, nursing and mental health.

The Health Foundation is challenging the NHS’s ability to prioritise primary and community care – which received £4.5bn per year by 2023/24 as part of the long term plan– without proper alignment between staff and funding.

Health Foundation director of research and economics Anita Charlesworth said: ‘Providing more care outside of hospitals is central to the NHS long term plan but the health service faces an uphill struggle.

‘If it can’t recruit and retain more health care professionals in primary, mental health and community care, this will continue to be an unrealised aspiration. There is unfortunately no sign that the long-term downward trend for key staff groups, most notably GPs, will be reversed.’

However, a Department of Health and Social Care spokesperson said the Health Foundation’s findings are ‘misleading’ as they haven’t referred to the most recent figures.

They said: ‘Latest statistics from October 2018 actually show record numbers of dedicated NHS staff – including 2,564 more health visitors, 473 more mental health nurses and 233 more psychiatrists- working tirelessly to make sure patients get excellent, safe care compared to the same time last year.’

‘Chronic workforce shortages’

While the number of hospital-based doctors has continued to grow, the number of GPs fell by 450 full time equivalent (FTE) between September 2017 and September 2018, the report said.

The level of nurses and health visitors employed in the community has also declined, down by a combined 540 FTE staff in July 2018 compared with the year before.

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The number of mental health nurses saw a meagre increase between July 2017 and July 2018, up by 170 new FTE joiners, while there has been a drop in nurses who work specifically with people with learning disabilities – down by 120 FTE in the same period.

Both areas – mental health and learning disabilities – were acknowledged as priorities in the long term plan.

There are now over 41,000 nursing vacancies in the NHS, a number that could grow to over 50,000 post-Brexit, as the Cavendish Coalition – which comprises six health and social care bodies – previously warned in a report published last year.

The Health Foundation also found that despite the number of GPs falling, ‘other direct care staff working in general practice – such as dispensers, pharmacists, phlebotomists and healthcare assistants’ – was up by 12,250 FTE as of the end of September 2018.

International recruitment

The UK continues to heavily rely on international healthcare staff and 28% of UK-based doctors were trained internationally, according to data published by the Office for Economic Co-operation and Development (OECD).

However, despite the need to recruit from abroad, the report found that the level of hires from the EU has fallen considerably.

The report said: ‘Uncertainty about the status of EU nationals after Brexit, changes to immigration policies, and the impact of changed language testing requirements for international nurses have led to a reduction in the inflow of health professionals from the EU and a shift in focus to the recruitment of non-EU nurses.’

Ms Charlesworth added that international recruitment ‘is being constrained by migration policies and the uncertainties of Brexit’.

She said that a coherent strategy, involving ‘government health departments, the Home Office, regulators and employers’ is urgently needed.

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