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The End: Conclusion

The End: Conclusion
By Kathy Oxtoby
9 March 2023


May the workforce be with you
What primary care wants
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about What primary care wants

Chapter 1
Integrated care boards
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about Integrated care boards

Chapter 2
General practitioners
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about General practitioners

Chapter 3
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about Pharmacists

Chapter 4
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about Dentists

Chapter 5
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about Optometrists

Chapter 6
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about Nurses

Healthcare Leader’s look at the primary healthcare workforce crisis shines a light on the deep concerns about recruitment and retention across all the individual primary care professions.

GP practices nationwide are experiencing significant and growing strain, with thousands of GPs and practice nurses predicted to leave the workforce in the next few years. Nursing bodies report that district nursing has had massive and sustained underfunding over the years, while school nursing is said to have lost 35-40% of its workforce. And while recruitment is not a particular issue for midwifery, retention is – midwives are leaving the profession at all stages of their careers due to workplace pressures.

PCNs have created a huge additional demand for pharmacists to work in ARRS roles, but without a workforce plan, this exacerbates pressures within community pharmacy. And those pharmacists who do move into PCNs to use their prescribing skills and become clinical specialists fully may find their new role does not meet their expectations. 

Morale among NHS dentists is said to be at an all-time low, and there is an exodus of dentists from the NHS. And primary eye care providers in England could be better utilised to address the workforce issues in secondary care.

Each of the primary care professions is facing its own particular workforce challenges. But the different sectors are united by a common frustration – that staffing shortages mean frontline staff in every profession cannot provide the quality of service they hoped to give when joining the NHS.

Each profession also has its own recommendations for tackling the workforce crisis, which includes a wish list for integrated care boards (ICBs).

An evaluation and revamp of existing retention schemes and ICB escalation plans – in which excess work is absorbed by system working – are some of the suggestions for tackling the GP workforce shortage.

For General Practice Nurses (GPNs), there is a need to be comparative with NHS colleagues’ terms and conditions, and for ICBs to support their career development and work with local universities to develop a prescribed programme for them. 

ICBs could do an audit of district nursing services to help them identify where there has been investment and the difference that makes to patient flow, including the release of patients from hospital. An urgent plan with workforce modelling is required to tackle the shortage of school nurses and an increase in health visitor specialist posts. And leadership development could help to retain experienced staff. In addition, employers could deliver tailored preceptorship programmes to welcome and integrate new nurses, midwives, and nursing associates into their teams and help them grow in confidence.

Pharmacy funding needs an urgent review, and pharmacists believe pharmacy should be included in the upcoming workforce plan. ICBs could consider an ARRS scheme for local pharmacies to provide the staffing levels that would enable services such as structured medicines reviews in convenient community locations.

For dentistry, there is a pressing need to reform the NHS dental contract, while dental services should be represented in the governance structures of integrated care systems (ICSs).

Better use of primary eye care providers’ skills would allow more care to take place in the community, reducing unnecessary hospital attendance where there is limited capacity.

The professions are also united in wanting to have a strong voice at the ICB table. Already, some ICBs are building on the solid collaborative working they have established to take a more integrated approach. And it is important that all ICBs encourage the different sectors to work collaboratively rather than taking staff from each other.

Some ICBs are introducing workforce programmes such as diverse leadership, reverse mentoring, and working with training hubs to boost recruitment and retention. Drawing on the expertise of different primary care professionals, they are also developing networks to bring together colleagues to discuss workforce issues and solutions.

While filling workforce gaps with temporary staff recruited from agencies is a ‘quick fix’, ICBs also need to focus on longer-term, coordinated and sustainable approaches to recruit and retain health professionals. This could include promoting careers in healthcare in schools and developing clinical services that primary healthcare professionals will find valuable while relieving pressure on other parts of the system. And being on top of the workforce data will also help ICBs to prioritise and focus on workforce gaps that need addressing. 

But local initiatives won’t be enough to plug the gaps in the NHS workforce. The scale of the crisis demands national intervention. Ultimately, healthcare professional bodies say that a strategic long-term workforce plan is needed. It must look at the big picture in health and care, prevent people from moving about the system in an unplanned and unsupported way, and set out the different responsibilities for ICBs.  

But in the absence of such a plan, the pressure is on ICBs to continue developing new and innovative ways of recruiting and retaining staff at a time when primary care is stretched to its limits.

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