4.2 Human resources
4.2.1 Health workforce trends
As of 2014, 1.57 million people were working for the NHS (ONS, 2014c), making it the largest employer in the United Kingdom, and indeed in Europe (NHS Jobs, 2015). Between 2000 and 2009 the NHS workforce expanded at an average annual rate of 3.4% (The King’s Fund, 2013c). In the figures below, note that because of differences in the way data are recorded and physicians are defined, they are not fully comparable across countries.
The number of physicians working in the United Kingdom has been steadily increasing for the past 25 years, as shown in Fig4.4. In 1990 there were 162 physicians per 100 000 people, and by 2013 that number had risen to 278. However, the United Kingdom still has among the lowest number of physicians per capita in the EU, despite the rapid increase in numbers between 1997 and 2010. While all specialties have been growing, the lowest growth rate has been in psychiatry, and the rate of growth in GP numbers is also insufficient to meet current or future demand (Addicott et al., 2015).
As shown in Fig4.5, the number of nurses has decreased rather sharply since 2010, when health spending in the United Kingdom fell. After a high-profile scandal over the quality of care at one NHS FT (Robert Francis’s 2013 report), trusts that were worried about safe staffing levels hired more nurses (The King’s Fund, 2013d). The number of nurses in the United Kingdom is consistently above the EU average, as is the nurse to doctor ratio (Fig4.6), although this average conceals a wide variation across the EU. Despite this growth in staff numbers in the United Kingdom, shortages remain a concern, particularly as providers have to rely on more costly solutions such as hiring agency staff as the number of patients per nurse has been increasing too (Addicott et al., 2015).
The number of dentists in the United Kingdom has increased steadily in recent years, at an average annual growth rate of 2.1% between 2007 (the earliest year for which data are available) and 2013 (Fig4.7). The number of dentists per capita remains lower than that of comparable countries and the EU average.
Data on the supply of pharmacists reveal an increase from 58.9 per 100 000 population in 2002 to 78 per 100 000 population in 2012 (Fig4.8). The jump in numbers between 2011 and 2012 is due to changes in the way the number of pharmacists has been estimated in the WHO Health for All database.
4.2.2 Professional mobility of health workers
Historically the United Kingdom has employed health workers from Commonwealth countries and the EU, and at times there has been intensive international recruitment, such as for nurses in the Philippines. The Migration Advisory Committee makes shortage occupation lists for the Home Office United Kingdom Border Agency; only consultants in a small number of specialties are on this list, meaning overseas workers from outside the EU should only be entering if they practise a listed specialty.
Most professional groups move freely around the United Kingdom. However, to the extent that employment conditions are centralized, this may change in the future.
4.2.3 Training and career paths of health workers
The 2003 Modernising Medical Careers programme changed how medical training worked in the United Kingdom. There are minor variations between England, Scotland, Wales and Northern Ireland, but generally the training and career paths of health workers are as below.
To train in medicine, students spend five years on an undergraduate degree course, which takes place under the supervision of the United Kingdom GMC. There are 34 medical schools in the United Kingdom. Graduates then enter a two-year foundation programme (F1 and F2), entering placements in several specialty and health care settings. Specialist training begins after F1 and F2 rotations. Medical royal colleges create curricula and assessments for specialist training. The GMC approves curricula, assessments and the distribution of training posts (specialty registrar posts).
Specialists train in hospitals for five to seven years, and then join the GMC Specialist Register and can be appointed to a consultant post. GPs train for at least three years – two years in hospitals and the third in a GP practice. They then join the GMC’s GP Register and can work as a GP. On average it takes nine years of clinical training after medical school to become a GP, and 11 years to become a hospital consultant. Staff grade doctors are those who do not become consultants, either by choice or by failing to gain a post.
CPD is required of all doctors. Doctors show their proficiency in CPD by two methods: the annual appraisal process (one for GPs and one for consultants), and the five-yearly revalidation process introduced in 2012.
To train as dentists, students attend five years of undergraduate dental school at one of the 16 dental schools in the United Kingdom. After undergraduate school, they register with the United Kingdom GDC to practise as a dentist. More training is required for dental specialists, such as orthodontists. Specialists usually work in hospitals. Dentists are revalidated through the GDC, a process that began in 2011.
Nurses and midwives
To train as nurses or midwives, students attend a three- or four-year pre-registration degree course; the nursing diploma in higher education has been phased out and nursing is now a graduate-entry career. Courses are at universities that have placements in hospital and community settings. Generally, the first year for all nurses in training is the Common Foundation Programme. After this, students specialize. Midwives have to have a midwifery degree, or, if they are already a nurse, they can do a short additional training programme. After training, nurses and midwives register with the United Kingdom Nursing and Midwifery Council (NMC) to practise. Nurses and midwives have to re-register annually, and every three years revalidate with the NMC to illustrate they have met the standards required for safe practice in their chosen area of work. Midwives also have to annually confirm their intention to practise to the NMC. The revalidation process has been piloted in 2015 and will roll out from April 2016. The requirements of revalidation include minimum hours of practice, evidence of CPD and reflection of their experiences with other nurses or midwives. The profession remains predominantly female; however, a growing number of men are entering the profession across all fields of practice. Programmes are in place to encourage nurses back into practice following a break in their career.
To train as pharmacists, students must obtain a four-year Master of Pharmacy postgraduate degree from one of the 26 accredited universities in the United Kingdom. After that, they spend a year training in a community or hospital pharmacy, and then register with the Great Britain GPhC in order to practise.