NHS staff shortages – addressing the challenge

Staffing shortages within the NHS and wider healthcare market continue to be a key challenge across the UK. The media and executive reports highlight a worsening position with little light at the end of the tunnel however there are strategies and solutions that can be adopted to help alleviate some of the pressures of achieving successful outcomes.

It is well documented that the NHS has key worker vacancies across GP, nursing and key allied healthcare worker job roles. Current figures suggest more than 30,000 extra nurses are needed and almost 3,000 GPs1. In March a report was issued by three leading think tanks which predicted that in the next five years nurse shortages will double and GP gaps nearly treble, unless action is taken. The Nuffield Trust, Health Foundation and King’s Fund say on current trends this will rise to nearly 70,000 nurses and more than 7,000 GPs within five years. Report co-author Anita Charlesworth said: “The workforce is the make-or-break issue for the health service. Unless staffing shortages are substantially reduced, the recent NHS Long Term Plan can only be a wish list.” 1

The NHS Long Term plan, which was published in January, outlines its strategy to improve patient care over the next ten years and aims to address the problem by increasing the NHS workforce by training and recruiting more professionals. This will include thousands more clinical placements for undergraduate nurses, hundreds more medical school places, and more routes into the NHS such as apprenticeships, as well as efforts to support improvements in retention.

However, the NHS Long Term plan is just that – long term – and in the meantime many healthcare providers have staffing challenges to address today. Faced with this situation it can be difficult to embed the overall workforce aspirations of an organisation and to build a strategy that will deliver operationally. However, there are some key actions that providers can take to help mitigate some immediate risks and drive a pro-active approach to addressing market challenges.

International recruitment

With the current political uncertainty regarding the UK’s membership of the EU, healthcare providers may have concern over any changes to immigration status. The Home Secretary has extended the minimum salary exemption for overseas nurses wanting to work in the UK up to the next review period in January 2021 to allay concerns. And the government has recently announced that health and social care workers with professional qualifications from EU institutions can continue to practise in the UK after an exit from the European Union. Employment contracts will not need to be changed if the UK leaves without a deal and staff will not have to reapply for their current positions.

Gary Snart is Director of Total Workforce Solutions at HealthTrust Europe (HTE) which operates as a healthcare solutions partner for the NHS and commercial health and care providers, working as a bridge between suppliers and providers. On the topic of international retention and recruitment he advises: “Keeping an open dialogue with existing members of staff who are from the European Union and the Europe Economic Area is paramount. Anyone currently living in the UK who is an EU/EEA citizen has the right to apply for the EU Settlement Scheme by 30 June 20212 in order to  stay in the UK; it is in the interest of providers to offer support and guidance for staff who have applied for this or are required to do so.”

For each staff group that is a recruitment challenge setting up international recruitment projects is a sensible step to take. Gary advises on deciding on a realistic cohort of new recruits that can be on-boarded effectively each month and integrated into an organisation with an excellent experience. He adds: “This will serve to develop word of mouth recruitment between international peers, generating a regular new headcount to improve continuity of care locally and reduce pressure areas such as controlling agency spend.”

Pastoral care offered to new recruits and employees can help organisations retain staff members. Simple steps such as finding out if they are happy at work and feel reassured that there will be a role for them whatever the future holds for the UK can help. Setting up and encouraging social groups and events can help overseas staff feel more secure in their role.  Managers can also ask employees if they need help and guidance to feel settled, such as setting up a British bank account, and if they are in regular contact with family back home.

Manage staffing agencies

There has been criticism in the media of the use of agency staff due to the cost of this route, however most providers use agency staff to some extent. It remains important to engage with agencies to manage requirements effectively. Whilst agency staff do have an important role to play, organisations have to balance the financial cost of agency compared to that of permanent or staff bank workers.

On the topic of how to save money on agency spend Gary believes that there are several tactics and mechanisms that can save healthcare providers money and develop a level of partnership with suppliers that have a shared interest in changing existing market pressures. He said: “It is advisable to approach staffing agencies in an organised and pre-agreed manner, if alternative options are not available it is always advisable not to leave staff requests until the last minute (24-72hrs prior) as time constraints could force providers to agree less favourable terms.”

“If an agency must be used it its desirable to take control from the beginning, using a framework like those provided by HealthTrust Europe that is patient-centred and clinically-led, driving quality, safety, service, and price. Healthcare solutions partners such as HealthTrust Europe provide expertise and guidance as a trusted adviser to healthcare partners, operating independent of the market to develop agreements that work for all parties in the short and long term.”

Gary also advises that healthcare providers use solutions providers to them keep up-to-date on market intelligence on NHSI rate caps and market positions. This can provide them with key data enhancements such as intelligence on local, regional & national average rate data per specialism, grade/band and shift, and which suppliers to contact to get the best fill or adherence to cap in any rota gap sent out to agency.

Workforce Planning Technology

Creative use of IT software can help improve recruitment processes, from planning to vacancy release to executive reporting. Developing something as simple as a database of healthcare workers who are available on a flexible basis could help Trusts and other providers avoid using expensive agency staff and to put more control in-house to enhance collaboration in areas such as bank. Rather than contacting a staffing agency as soon as staff shortages are identified an up-to-date database of known workers can identify available workers to fill vacancies and subsequently help to keep salary costs down.

A lot of time and money is spent by organisations merely scheduling their staff, however technology can help improve workforce planning. Rostering software can produce optimal rosters/rotas that meet safe staffing levels, quickly and easily. They can help managers oversee flexible shift patterns, provide a real time view of staff on duty and the skills available within the workforce to drive performance and control costs. Using e-rostering services can help forecasting and subsequent planning for staffing shortfalls and will display visibility of purchasing. As well as enhancing care quality and safety for patients, rostering IT can increase productivity and improve staff morale.

Steve Barrow, Deputy Director of Finance at Warrington and Halton Hospitals NHS Foundation Trust worked with HealthTrust Europe to embed a collaborative agency project for healthcare staffing with regional colleagues from across the sustainability and transformation partnership (STP). A successful project led through procurement teams put in place a new approach to challenge the agency market and expenditure. Steve said: “The Trust adopted a robust yet transparent stance with the agencies that has led to improved administrative processes and procedures and reduced the rates towards the agency caps introduced by NHS Improvement.”

In summary, Gary said: “As a trusted partner for the NHS and commercial health and care providers HealthTrust Europe is aware that providers need to be focused on tactics and strategies that make a difference to staffing shortages today but with their mind on their future plans.

“This could be through them saving money on agency to free up funds for wider workforce projects, integrating new technology or developing the pipeline for the next generation of healthcare staff coming into the UK.

“These actions can enhance the purchasing power of providers to enable further savings to be delivered in the future, freeing up funds to be spent on providing high quality care and services for their patients.”


1 https://www.bbc.co.uk/news/health-47616491

3 https://www.gov.uk/settled-status-eu-citizens-families