Not enough GPs and nurses to meet demand, say think-tanks

The NHS is unable to train enough GPs and nurses to meet demand and the situation is at crisis point, leading health experts have warned.

The King’s Fund, Nuffield Trust and Health Foundation said the Government would miss its target to recruit 5,000 more GPs by 2020 and the only way to cope with the growing workload was to put more pharmacists and physiotherapists into GP practices.

Thousands more nurses are also needed and immediate measures must be brought in to relieve financial pressure on trainees and to support overseas recruitment, they said.

Without decisive action, nurse shortages will double to 70,000 and GP shortages in England will almost triple to 7,000 by 2023/24.

In their new report, Closing The Gap, the organisations call for a £5,200-a-year grant for trainee nurses.

But they warn that, even with grants, an expansion of postgraduate training, bringing 5,000 more students on to nursing courses each year and action to stop nurses leaving, “the nursing gap cannot be entirely filled domestically by 2023/24”.

Therefore, an extra 5,000 nurses a year must also be recruited from abroad, they said.

Richard Murray, chief executive of the King’s Fund, said: “Patients are facing longer delays for NHS treatment as services struggle to recruit and retain enough staff.

“Without radical action to expand the NHS workforce, there is a very real risk that some of the extra funding pledged by the Government will go unspent, waiting lists will continue to grow and important improvements to services like mental health and general practice will fail.”

He said GP numbers were dropping and the service must look to other professionals to take on some of the work.

“We can’t GP our way out of the problem,” he said. “There’s no way … that by training more GPs or by trying to do something on retention, that that on its own will create enough GPs.”

NHS England has already pledged to make pharmacists and phsyiotherapists routine members of the general practice team – a move welcomed by the three organisations.

Mr Murray said GPs from overseas “just won’t come in the numbers needed” because the NHS is often not attractive enough in terms of pay or lifestyle.

To plug the workforce gap, 6,000 more physiotherapists and 3,000 more pharmacists are therfore needed in GP surgeries, he said.

He added: “Around 20% of patients that see GPs are there for issues… such as back pain. This is exactly what physiotherapists are trained for.

“First-contact physiotherapy has been piloted across England and has been successful.

“You can’t with all of them obviously – many patients may have things that still need a GP – but there’s a significant workload there (for physiotherapists).

“For pharmacists, there’s a lot of work that GPs do that is repeat prescribing, repeat dispensing, medications reviews.”

He said using a wider range of staff could relieve pressure on GPs, making it easier for patients to book appointments and meaning receptionists act less as “gatekeepers”.

He said: “Part of the pressure on receptionists is trying to manage extremely scarce GP time.”

Anita Charlesworth, director of research and economics at the Health Foundation, said the situation on nursing was “dire” but the Government could “radically transform” it.

And she said that, while it was true that staff numbers are increasing year on year, “you have to run to stand still in the NHS”.

She added: “Demand is not stationary. Demand is growing because the population increases and ages, and we get an increasing burden of chronic disease.

“For example, on nurses, the number per head of population has declined.”

Candace Imison, director of workforce strategy at the Nuffield Trust, called for more to be done to retain existing staff, saying: “We’ve noticed that our leaking bucket in workforce is leaking quite dramatically more.

“In the last six years, the number of nurses leaving has grown by 25% and one in nine staff left the NHS in 2017/18.

“We crucially need to do something to hold on to the staff we’ve got.”

Mr Murray added: “On general practice, it’s not that it’s not keeping up with the population, the number of GPs is going down.

“The more it goes down, the more they get overworked and the more of them leave.

“So we really need to turn it around if we think that general practice will continue in its current form.”

Professor Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “We agree with the writers of this report that the GP workforce faces significant challenges but we disagree that these are insurmountable.

“We must not, under any circumstances, give up on our aims and endeavours to build the GP workforce – achieving these is vital for the future of the NHS, and patient care.

“The NHS long-term plan has aspirations that will benefit patients, but it will need the right workforce to deliver it, and that includes at least 5,000 more family doctors.

“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.”

In the report, the King’s Fund, Nuffield Trust and Health Foundation said their proposals must be backed by a £900 million increase in the annual budget for the training and developing of NHS workers by 2023/24.

Barriers to international health staff coming to the UK must also be removed, and all healthcare professionals should be added to the shortage occupation list.

They also called for action to properly fund social care and to ensure a flow of overseas staff into social care after Brexit.

A Department of Health and Social Care spokeswoman said: “Across the NHS there are tens of thousands more doctors and nurses on our wards since 2010 and thanks to their dedication, thousands of patients get excellent, safe care every day.

“We’re supporting our workforce by putting general practice at the forefront of our long-term plan for the NHS, in addition to funding towards up to 20,000 more staff working in GP practices – helping to free up GPs to spend more time with the patients who need them.

“We’re also making funding available to increase university training places for nurses by 25%, exploring how flexible working can better support existing staff and the upcoming workforce implementation plan will set out how we can ensure the NHS has the staff it needs for future years.”