NHS England has said the health service will need more registered nurses by 2020 and has announced a series of reforms to try to increase numbers.
The national body has also set out ambitions to boost key clinical workforce numbers as part of its new delivery plan, published today and titled Next Steps on the NHS Five Year Forward View.
The move confirms comments made earlier this month by NHS England chief executive Simon Stevens that the health service will need “more registered nurses, not fewer” in future.
The new plan places an emphasis on boosting the number of registered nurses, with proposals including fast-track training schemes and a focus on recruitment, retention and training of senior nurses to potentially replace medical locums.
It also includes plans to develop flexible working contracts and “passports” for staff to allow them to work across organisational boundaries within a region.
“The NHS will need more registered nurses in 2020 than today, as will the social care system”
The document, which is a follow-up to the 2014 Five Year Forward View strategy, said: “The NHS in 2020 is going to be looking after more patients, better funded and larger than the NHS of today.
“We are therefore going to need to continue to improve productivity and grow our frontline workforce, especially in priority areas such as nursing, mental health, urgent and primary care,” it said.
“Achieving this will require more training, more recruitment, better retention and greater return to practice after time out of the workforce. The NHS will need more registered nurses in 2020 than today, as will the social care system.”
A new two year fast-track scheme would offer financial support to graduates from other disciplines to take a top-up programme to train as a graduate nurse, the plan said. This “nurse first” scheme will initially be targeted at mental health and learning disability nursing, which have both seen significant declines in recent years.
Regulator NHS Improvement and NHS Employers, which represents trusts, will also launch a new retention project targeted at the 30 trusts with the highest turnover of nursing staff. The document said if the NHS can get retention back to the level it was two years ago this would deliver 4,000 more whole-time equivalent nurses each year.
The NHS will also invest in a new scheme to attract 1,500-2,000 former nurses back to the profession, building on work by workforce planning body Health Education England. The document estimates there are 50,000 registered nurses in England not currently working for the NHS. HEE will publish an annual workforce plan in April.
Other plans include boosting the number of advanced clinical practice nurses who are educated to master’s degree level with the ability to work independently and to prescribe medication, which reflects comments made recently by Mr Stevens about the potential of such staff at the chief nursing officer’s annual summit.
The plan said an advanced clinical practitioner framework will be published by HEE and NHS Improvement, with nurses deployed in the first instance to trusts where “they can make a demonstrable impact on high priority areas such as A&E, cancer care, elective service or reducing locum costs by converting medical posts”.
Health service will need more registered nurses, says NHS chief
The delivery plan also repeated the aim to roll out e-rostering and job planning for all workforce groups.
But it said there will be a focus on doctors in 2017-18, concentrating on “maximising direct clinical care time, eliminating unwarranted variation in the number of patients treated per clinic and per theatre list, and reducing extra-duty payments”.
On flexible working, the plan said the NHS needed to find ways of “de-risking” service change for staff. It said: “This could take the form of an NHS staff ‘passport’ to enable, for example, nurses to work in both primary care and in hospital, helping support team based working.
“Since only 52% of staff are currently satisfied with the current opportunities for flexible working, it might also mean discussing with staff side representatives and unions new options to encourage individuals who are currently choosing agency or locum work back into substantive employment,” it said.
“The practicability of term time contracts, seasonal hours, and annualised hours contracting will also be tested,” it stated.
Unison head of health Christina McAnea said: “The staff ‘passport’ sounds interesting but health workers will want more than warm words.
“They need to be sure they can embrace the changes planned, without worrying about cuts to their pay or pensions,” she said.
Danny Mortimer, chief executive of the NHS Employers organisation, which represents trusts, said: “Flexible working is integral to staff retention, but is not always easy to implement, especially as the health service remains under unprecedented strain.
“Alongside employers and staff organisations, we will work together to set out the best possible practice, and share this swiftly for the benefit of staff in all our organisations,” he added.
The aim of increasing nurse numbers comes as further concerns have been rasied that the current nursing shortage will be exacerbated by Brexit.
Latest workforce figures, published this week in a report by NHS Digital, have also revealed a fall of over 1,000 whole-time equivalent NHS nurses and health visitors working in the six-month period between March and September 2016 – the latest for which such information is available.
- Number of nurses and health visitors falls by 1,000
- Health and social care workforce ‘must be Brexit priority’
However, NHS England’s new national plan appears to be at odds with some of the 44 regional sustainability and transformation plans, which have advocated reducing the number of qualified nurses and replacing them with generic support workers, to deliver millions of pounds of savings.
- Unpublished STPs forecast thousands fewer NHS nurses
- New taskforce to ‘challenge’ weak STP workforce proposals
Five Year Forward View Next Steps: Summary for nurses
Education and training – The number of newly qualified nurses available to be employed will increase by up to 2,200 more per year in 2019, as a result of expansion in nurse training places commissioned by HEE between 2013 and 2016.
Retention – Improving the number of nurses staying in the profession to the level of two years ago would mean around 4,000 more nurses per year. A new nurse retention collaborative run by NHS Improvement and NHS Employers will support 30 trusts with the highest turnover
Return to practice – There are over 50,000 registered nurses in England not currently working for the NHS. It takes three years and £50-70,000 to train a nurse, but only £2000 and three to twelve months to retrain a returning nurse. A further 1500-2000 nurses will be supported to return to work over the next two years
General Practice nursing – A 10-point plan for General Practice Nurses will be published in April that will support these nurses to further demonstrate their leadership and value in primary care. The actions will include improving recruitment and retention, return to practice opportunities and new advanced roles, as well as access to a programme of support and development. The £15m investment for GPNs identified in the General Practice Forward View will be aligned to this 10-point plan.
Profile and image of nursing – Nurses and midwives are the largest profession in this country with the largest reach. There is a wealth of competency, skill, experience and dedication but we need to work to consistently harness this talent to keep it alive and energised. The CNO will work with the wider system to champion a programme that brings together existing and future work actions that promote the image and pride in the nursing and midwifery professions.
New fast track ‘Nurse First’ programme – A Nurse First route to nursing, similar to the Teach First programme, will be created. It will provide financial support for graduates from other related disciplines to undertake a fast track “top up” programme to become a graduate registered nurse, in the first instance targeting mental health and learning disability nursing.
Support new advanced clinical practice nurse roles – HEE and NHS Improvement will publish a new national ACP framework, and deploy ACPs in trusts in the first instance where they can make a demonstrable impact in high priority areas such as A&E, cancer care, elective services or reducing locum costs by converting medical posts.
Use e-rostering and effective job planning – Building on successful pilot projects for nurses and healthcare support workers in 2016-17, NHS Improvement will publish guidance on electronic rostering to ensure high quality effective care at the bedside (measured by number of care hours delivered per patient according to their clinical needs).