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NHS ‘must learn lessons of past’ to better integrate dramatically expanded staff mix
The recent dramatic expansion of new healthcare roles in the English NHS, including physician associates, has failed to take account of lessons from history about how to embed and integrate them effectively. That’s according to a new report published by the Nuffield Trust, an independent think tank. Expanding the balance of professions is a core
part of any evolving healthcare system and has been central to the NHS since its inception, but too often, in recent years, these changes have happened before issues to do with regulation, training, supervision, and communication have been resolved, meaning action is needed from NHS organisations to manage this transition. The study, In the balance, commissioned
by NHS Employers, looks at the history of how distinct and different roles - including physician associates, nursing associates and advanced nurse practitioners - have been brought into the NHS; how the mix of staff skills in the NHS in England compares to that of other countries; and what issues need to be addressed if the government’s plans to expand the workforce and invest in new and emerging roles are to succeed. The Nuffield Trust’s report draws on published
data from across England and the OECD, a literature review, focus groups with NHS employers and a short survey. It does not offer a view on the right level of new and emerging roles, or what a good balance between doctors, nurses and other staff should be. It comes as an independent review is underway, examining the safety of physician and anaesthesia associates and their contribution to multidisciplinary healthcare teams. Key findings from the research include:
l There has been a huge shift in the balance of roles in the NHS in England in recent years. This
to increase direct patient care staff in general practice.
has been particularly apparent in general practice where, a decade ago, there was one other clinician for every fully-qualified permanent GP, whereas now there is an average of 2.6.
l The hospital sector in England has a higher proportion of staff other than doctors or nurses than other OECD countries: doctors and nurses account for just two-in-five hospital staff in England (39%), compared to nearly two-thirds (63%) in Italy and almost three-quarters (72%) in Austria.
l The government’s Long-Term Workforce Plan assumes significant growth in the numbers of these different roles, with nursing associates reaching 14 times the current level by 2036/37. The proportion of the workforce filled by physician and anaesthesia associates would remain small (at 0.6%), but their numbers are projected to grow to around six times the current level.
l Financial subsidies from the government for new and emerging roles has been a key factor in their growth. For example, three-quarters (78%) of the growth in staff in general practice, over the last five years, has been through the Additional Roles Reimbursement Scheme, a central scheme
The study draws on review papers looking at how nursing associates, medical associate professions and an array of other new and emerging roles have been embedded, and how the non-GP workforce has been expanded in primary care to identify key insights and lessons for NHS employers, policymakers and professional groups involved in reshaping the NHS workforce. It states that plans to grow some emerging roles may be jeopardised by a lack of capacity in the education sector and in over- stretched services that provide practice learning opportunities. While regulation is now being rolled out for physician associates, the previous lack of regulation has been a concern for staff: over three-fifths of doctors and staff in emerging roles, and four-fifths of managers, said regulation or certification requirements stood in the way of implementing physician associates. Commenting on the report, Nuffield Trust Senior
Policy Fellow Dr. Billy Palmer said: “This report shows that there are big challenges to overcome in bringing on any new role – ensuring existing staff have time to supervise them, having clarity on the scope of the new role, having the right checks and balances in place if things go wrong, to name a few. “These challenges can be overcome with
careful planning, time and attention at all levels in the health system. But the NHS must take heed of the well-established lessons from history. The government’s review of physician and anaesthesia associates, and its wider refresh of the Long-Term Workforce Plan provide an important opportunity to set out some clarity over the transition and avoid further repeating the mistakes of the past.”
Deal announced with independent sector to cut waiting lists
A new agreement has been struck with the independent sector as part of plans to end the hospital waiting list backlog set out by the Prime Minister. Hitting the 18-week NHS waiting time standard for operations and other planned procedures is a key part of the government’s Plan for Change. The new deal will mean the NHS makes better use of the independent sector to tackle waiting lists as well as providing millions more appointments itself. The NHS and independent sector partnership
agreement aims to help expand capacity and widen patient choice by setting out how more treatments can be delivered through the independent sector,
with care remaining free at the point of use. The independent healthcare sector estimates that it has capacity to provide an additional one million appointments a year for NHS patients. The new deal will set out how independent
sector capacity can be used to tackle some of the longest waits in specialist areas of treatment, such as gynaecology, where there is a backlog of 260,000 women waiting more than 18 weeks for treatment. Orthopaedics will also be a key focus, where over 40% of patients are waiting longer than the 18-week target. The agreement will also give patients in more deprived areas, where NHS provision is more
limited, a greater choice over where they are treated. Currently, less than a quarter of patients recall being offered a choice of hospital for their treatment. The government wants all NHS patients to have the opportunity to choose who cares for them, and believes that the wider elective reform plans will give them more control over their own care.
Health and Social Care Secretary, Wes Streeting, said: “I’m not going to allow working people to wait longer than is necessary, when we can get them treated sooner in a private hospital, paid for by the NHS. If the wealthy can be treated on time, then so should NHS patients.”
February 2025 I
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