It is clear that there are a relatively high number of unfilled staff positions in the NHS. According to the latest quarterly report from NHS Improvement, there are currently about 1.1 million whole-time equivalent (WTE) staff employed by the NHS in England and about 100,000 vacancies (around 9% of the total staff). This compares to a current UK average overall vacancy rate of 2.8%. Recruitment seems to be a particular problem in the more affluent regions of the country, where finding affordable housing is difficult, with London being the worst area for unfilled vacancies. Of course, some NHS vacancies are filled on a temporary basis by bank and agency staff, but there is little doubt that the overall situation is challenging.
The vacancy rate is particularly high for nursing staff, being over 10% in England and about 4-5% in Scotland. There seems to be a perfect storm caused by many nurses choosing to leave the profession before retirement, inadequate numbers being trained, and the uncertainties caused by Brexit making it harder to recruit from other EU countries.
Although the number of nurses qualifying by completing degree courses has generally increased over the years, it has not kept pace with demand. The removal of bursaries for nursing students has been blamed for a recent slight decrease in the numbers starting nursing degrees. The recently introduced nursing degree apprenticeship allows trainee nurses to qualify ‘on-the-job’, thus giving more options with regard to qualification.
Although a politically contentious point, it has been suggested that the overall level of nurses’ pay should be higher in order to attract more to the profession and retain existing staff. Nurses pay, along with that of other NHS staff, has fallen in real terms since 2010. Although in some areas, such as A&E, workplace stress may be a more important factor than pay for those who choose to leave the profession.
Although the situation with doctor vacancies is not in general as bad as for nurses, there is a particular problem with GPs. Although the government is planning to fill the gap, a 2017 editorial in the BMJ suggests that the numbers being currently trained will prove to be inadequate. The shortage of GPs is particular acute in some rural areas and the less fashionable small towns. A £20,000 ‘golden hello’ has been announced to attract GPs to areas where shortages are particularly bad.
Although some action is being taken to address the problem, the number of unfilled vacancies is unlikely to be fully resolved without spending more money on pay, training, and support for existing staff – so the problem of unfilled vacancies needs to be seen in the context of overall NHS funding, which seems likely to struggle to keep pace with demand under present conditions.