Why has the NHS deficit ballooned? One word: understaffing (The Guardian: 20 May 2016)

Why are NHS finances in such a mess? The biggest reason is staffing – or, to be more precise, understaffing. The NHS in England is struggling with a serious and growing lack of personnel, especially nurses and some specialist doctors. This is forcing hospital trusts to spend unprecedented amounts of money on locums, especially those supplied by employment agencies, many of which charge what have been described by the NHS England chief executive, Simon Stevens, and the health secretary, Jeremy Hunt, as “rip-off” rates.

The mark-ups these agencies charge takes money away from frontline care. Barts health trust in London – the largest in the NHS – spent about £80m on agency staff in 2015-16, roughly £30m of which was profit for the agencies.

The sharp increase in the bill for agency staff mirrors almost exactly the dramatic decline in the health service’s finances. These personnel cost the NHS £2.5bn in 2013-14, rising to £3.3bn in 2014-15. The bill for 2015-16 was expected to hit £4bn, but new caps on trusts’ agency staff spending, introduced by Hunt last year, brought that down to £3.7bn – a saving of £300m, but still astronomical. There has also been a crackdown on the use of management consultants.

Most trusts have hired extra staff, and increasingly rely on agency workers to fill rotas and wards to standards recommended by Robert Francis’s official report into the Mid Staffordshire hospital scandal,which identified a lack of nurses as a key reason for inadequate care at the trust.

However, Francis’s report was published amid the longest period of austerity in the 67-year history of the NHS, with its 1% annual real-terms budget increases far below the 4% year-on-year rise it had been used more


'Almost half' of junior doctors 'will quit the NHS' if contract is imposed (Pulse: 17 May 2016)

Almost half of junior doctors plan to quit the NHS if health secretary Jeremy Hunt’s threatened contract imposition goes ahead, a survey has found.

The survey, launched by a GP trainee and attracting thousands of responses, was designed to gauge the opinions from doctors and medical students about the junior doctor contract row.

The GPC also reacted to findings, branding them ‘very worrying’ and with ’potentially serious ramifications’.

Out of 4,500 replies via in April, 46% of eligible respondents said they would leave the NHS this summer if the contract goes ahead, with 28% saying they would work abroad in countries like Australia and New Zealand; 15% pledging to leave medicine and change career and 3% vowing to leave to work in private more


Plan to train NHS nurses to cover for doctors sparks alarm (The Guardian: 17 May 2016)

A plan to train nurses to stand in for doctors as a way to tackle the hospital staffing crisis has caused alarm among doctors and patient groups.

A report by the Nuffield Trust, commissioned by NHS Employers, recommends giving extra training to nurses and other support staff to give them “advance practice roles” or “physician associate” status.

It says this will provide a relatively quick solution to the current shortage of doctors and help ease the workload of more qualified medics.

Junior doctors have said the idea is dangerous while the Patients Association said it should be regarded as a quick fix to plug the NHS’s workforce gap.

The report claims that retraining staff “could provide a cost-effective and rapid solution to mitigating some of the pressures on more senior staff”.

The report envisages a new tier of medical staff between doctors and nurses. “Physician associate represent a new cadre of staff with the potential to address a number of workforce challenges,” it says.

The Patients Association said such proposals should not be seen as a cheaper alternative to hiring highly qualified staff.

Junior doctors, who are involved in a dispute with the government over a new contract, said the plans would put patients’ lives at more


Seven-day NHS plans fail to address staffing needs, say MPs (The Guardian: 11 May 2016)

There has been “no coherent attempt” to assess how many staff will be needed to ensure that a seven-day NHS can function, parliament’s spending watchdog has found. 

A report by the public accounts committee says the Department of Health (DH) has not yet worked out if the current supply of staff can adequately meet demand in the health service in England.

“National bodies need to get a better grip on the supply of clinical staff in order to address current and future workforce pressures,” it concludes.

The report will be seized upon by critics of the health secretary, Jeremy Hunt, whose long-running dispute with junior doctors is based on claims that there needs to be more staff working on weekends to ensure patient safety.

MPs add that the DH has failed to assess the staffing implications of the Tories’ pledge for a seven-day more


Hunt: staff shortage due to excessive 'optimism' (BMA: 10 May 2016)

Health secretary Jeremy Hunt has admitted successive governments — including his own — have failed to train enough staff to satisfy the needs of the NHS.

Speaking during health questions in Commons, Mr Hunt blamed the rocketing NHS agency bill, which drained the service of £3bn last year, on an ‘optimistic’ view of how few staff could safely manage a ward.

Mr Hunt (pictured) claimed to be taking action to decrease the vast costs — suggesting the agency cap implemented by the Government last year, which gives hospitals a defined limit on spending with agencies, would save £1bn a year.

Answering a question put to the house, which asked what the Government’s plans were to reduce agency spending, the health secretary said: ‘We’ve taken tough measures to control unsustainable spending on agency staff. Agency spending is now falling.’

Mr Hunt was pushed to respond further by Southport Liberal Democrat MP John Pugh, who said: ‘I don’t share his [Mr Hunt’s] optimism.

‘The real problem is the shortage of permanent staff.’ more


Trust blames 'bad behaviour' of neighbouring providers for staff shortage (HSJ: 4 May 2016)

A financially stricken foundation trust has blamed “bad behaviour” of neighbouring trusts breaking agency spending caps for its staff shortages.

Doncaster and Bassetlaw FT has been forced to suspend inpatient admissions and transfer patients to other hospitals.

In a board briefing last week, chief executive Mike Pinkerton warned the lack of locum agency staff to fill rotas “now poses an escalating continuity of services risk” to the trust. He has complained directly to local trusts and NHS Improvement over the issue.

Papers show staffing became a particular problem in the trust’s Doncaster and Worksop emergency departments following the agency caps being brought down again in February, with staff leaving to “surrounding trusts as a result of them breaking cap rates” more


90% of GP trainees to shun full-time clinical work (Pulse: 5 May 2016)

Only one in ten GP trainees expect to be doing full-time clinical work in five years’ time, a major report from the King’s Fund think-tank has revealed.

The report – Understanding pressures in general practice – also claims that the crisis in general practice has been ‘invisible’ for policy-makers due to failure by the DH and NHS England to collect data.

Its analysis of 30 million patient contacts from 177 practices found that the number of consultations since 2010/11 had grown by 15%, echoing a recent study published in the Lancet.

GP leaders said that the lack of data on general practice had led ‘many to turn a blind eye to the ever-worsening crisis’ in the profession.

The report comes two weeks after NHS England released its ‘General Practice Forward View’, which committed to devoting more than 10% of the NHS budget into general practice.

The King’s Fund welcomed NHS England’s proposed measures, but warned that general practice was in a crisis.

It pointed to an increase in demand and a reduction in funding, as well as a recruitment crisis.

And it warned that the recruitment crisis could get worse, as a survey of 318 trainees revealed they were shunning a full-time career in general practice – and not only because of family more


GPs still in favour of mass resignation despite support package (Pulse: 29 April 2016)

Almost half of GPs are still willing to submit undated resignations, despite the multibillion-pound ‘Forward View’ announced by NHS England last week.

A Pulse survey of 524 English GPs found that 45% would still support mass resignation from the NHS due to the current state of general practice, while a further one in four are undecided.

This is only a small decrease on the 49% who said that they would be willing to resign their contracts in December 2015.

The Special LMC Conference in January voted for the GPC to canvass support for submitting undated resignation letters if the Government fails to implement a ‘rescue package’ for general practice within six months.

Last week, Pulse exclusively revealed that the GPC was still considering the threat of mass resignation following the announcement of the General Practice Forward View, which committed £2.4bn extra funding a year by 2020 plus a £500m support package.

Today’s poll reveals that GP support for the so-called ‘nuclear option’ is maintained, with the percentage of GPs ruling mass resignation out decreasing from 35% in December to 29% more


NHS looks to India for GPs in attempt to make up shortfall (The Guardian: 7 April 2016)

The NHS is looking at recruiting GPs from India in an attempt to tackle the serious shortage of family doctors.

Health Education England, the NHS’s training and recruitment agency, has signed a memorandum of understanding with the Apollo Hospitals chain in India about lending clinical staff between them.

GP leaders said the initiative amounted to “an admission of failure” by ministers to develop enough homegrown staff and that it cast doubt on their pledge to increase the number of GPs by 5,000 by 2020.

It also led to warnings that bringing in doctors who had not been trained in the UK could pose a threat to patient safety.

HEE, which is currently recruiting GPs, provided few details about the link-up.

Dr Ramesh Mehta, the president of the British Association of Physicians of Indian Origin, told the doctors’ magazine Pulse, which revealed the move, that his contacts in India had told him HEE is keen to hire “as many GPs as possible” more


Staff shortages spark CQC warning for mental health trust (The Nursing Times: 23 March 2016)

North Staffordshire Combined Healthcare NHS Trust has been given an official warning about community mental health services for young people, after inspectors found there were not enough staff to provide quality care.

The trust’s child and adolescent mental health services (CAMHS) community provision was rated “inadequate” by the Care Quality Commission following an inspection of all core services in September last year.

Inspectors found staffing levels in community CAMHS were “not safe” because of staffing shortages in various disciplines, including nursing, with “excessively long” waits for treatment.

“There were not enough consultant psychiatrists, nurses, psychologists, or therapists,” said the CQC report. “We found staff on maternity or long-term sick leave were not replaced by temporary staff.”

Inspectors also found risk assessments of young clients were not always completed or safety plans put in more


Junior doctors to withdraw emergency care in escalation of action (Pulse: 23 March 2016)

Junior doctors will fully withdraw their labour, including emergency care, in an escalation of their industrial action, the BMA has announced – the first instance of this ever happening in the NHS.

A statement from the BMA said that the 48-hour industrial action planned for 26 April will now change to full withdrawal of labour between 8am and 5pm on 26 and 27 April. This will follow earlier action – a 48-hour walkout on 6 April – which will continue as planned.

The chair of the BMA’s junior doctor committee Dr Johann Malawana said the Government had left them with ‘no choice’.

The committee had planned earlier this year to withdraw all emergency cover, but did not go through with the action as talks with the Government were more


Hospital shuts beds after CQC raises staffing ratio concerns (HSJ: 21 March 2016)

Southend University Hospital Foundation Trust has been forced into significant bed closures after inspectors raised concerns about staff ratios and its stroke services, HSJ has learned.

The Care Quality Commission’s final report on the trust is not due until next month, but concerns raised by inspectors in preliminary feedback in January were set out in a report from the trust’s February board meeting.

The report said the CQC had raised “concerns over the trust’s ability to maintain registered nursing staffing levels to the ratio as indicated in [the National Institute for Health and Care Excellence] guidance”.

The report added: “While all of the issues noted by the CQC are important the CCG and partners have agreed that the priority areas for immediate action are bed capacity, staff to patient ratios and maintaining safe effective stroke services.”

The report also revealed the trust’s lead commissioner, Southend Clinical Commissioning Group, called an “emergency health care system meeting” just days after inspectors more


Alarm raised over trust's 'risky' proposal to run A&E without specialist consultants (HSJ: 21 March 2016)

Health leaders in Yorkshire are considering options for running an emergency department without dedicated consultants.

Scarborough Hospital, which is run by York Teaching Hospital Foundation Trust, has long struggled to recruit emergency medical consultants, commonly known as A&E consultants, and is exploring options to make its services sustainable.

Senior clinicians believe a new model can be devised whereby patients could initially be seen by “advanced clinical practitioners”, who have typically trained as nurses or paramedics, but then passed on to the specialty consultant in the relevant department more quickly.

The Royal College of Emergency Medicine has raised concern over the proposal, describing it as a “highly risky strategy” more


Health minister admits Government risks not delivering on GP recruitment goal (Pulse: 21 March 2016)

A health minister has admitted that there is a ‘risk’ around whether the Government will achieve its commitment to find 10,000 new GP or GP equivalents, and that failure to achieve the target would make it ‘difficult to deliver our ambitions’.

Lord Prior – who was chair of the CQC before becoming minister for NHS productivity last year – has cast doubt on health secretary Jeremy Hunt’s commitments on GP numbers, which included increasing the workforce by 5,000 GPs by 2020.

The minister said that the Government has increased the number of training places to 3,500 from this year. But Pulse has revealed that there has been a 5% decrease in applications this year, which would lead to only 2,630 places being filled based on last year’s 2,769 filled more


700 community staff to be transferred twice in months (HSJ: 18 March 2016)

More than 700 community staff in Greater Manchester will have to transfer to a new employer twice in quick succession.

Community services in Tameside and Glossop are currently provided by Stockport Foundation Trust, but the trust has given notice on the contract, which ends this month. 

Staff are set to transfer to Tameside Hospital FT on 1 April, but this will only be a “holding place” before they move to a new “integrated care organisation” for the borough, which is in the process of being formed. The ICO is due to start operating later this year.

According to board minutes for February published by Tameside and Glossop Clinical Commissioning Group, there have been concerns for staff welfare, along with assurances that they will be more


Hospital staffing crisis as 40% of consultant posts remain vacant (The Guardian: 15 March 2016)

Royal College of Physicians says ‘gathering storm’ of problems puts health secretary’s seven-day NHS plan at risk.

Hospitals are facing such chronic shortages of medical personnel that 40% of senior doctors’ posts remained vacant, new figures reveal. Vacancies are so widespread that the government’s push to create a seven-day NHS is at risk, according to the head of the Royal College of Physicians.

NHS hospital trusts are finding it impossible to fill key posts because of a lack of consultants equipped to do the job, according to the RCP’s latest annual audit of doctors working in hospitals.

“Our census data shows that 40% of consultant posts remain unfilled, nearly always due to a lack of candidates,” Prof Jane Dacre will tell the college’s annual conference on Tuesday.

“I fell sorry for NHS trusts, I really do. Across the country they have created a raft of new posts to meet the exponentially rising demands for patient care, only to find that there is no one to fill them. And our cash-strapped NHS trusts would not be creating posts unless they really needed them,” Dacre will add.

Severe staff shortages are one of the reasons the NHS is facing “a gathering storm” of pressures, including huge financial problems, disillusioned junior doctors and an unrelenting rise in the number of patients being admitted as emergencies.

Shortages of trainee doctors are so serious that one in five members of the RCP, which represents non-specialist hospital doctors in England, believes that patient care is compromised, she will more


Warning overseas recruitment is only a 'stop gap' for nurse shortages (Nursing Times: 10 March 2016)

Widespread nurse shortages across England that have led to thousands of vacancies will not be solved long-term by overseas recruitment, a report by an independent body that advises on NHS pay has warned.

Such a strategy could only provide a short term “stop gap” to help fill the estimated 12,500 full-time equivalent nurse vacancies, said the group’s latest report.

But the underlying problem causing the shortage is due to previous underestimations of the future demand for nurses, in addition to “an unclear projection of supply”, the NHS Pay Review Body report more


Health trusts reveal thousands of doctor and nursing positions lie vacant (The Independent: 29 February 2016)

One in ten nursing positions and thousands of doctor posts are lying vacant, trusts and health boards have said.

Around two-thirds of UK trusts and health boards, struggling to cope with a shortage of qualified staff, are seeking applicants from abroad to fill the vacancies, a freedom of information request by the BBC showed. Some were travelling as far as India and the Philippines. 

The vacancy rate for doctors is seven per cent and for nurses 10 per cent compared with the Office of National Statistics' average for the economy at large from between November 2015 and January 2016 of 2.7 per cent.

The data shows that on December 1 2015, the NHS in England, Wales and Northern Ireland had more than 23,443 vacant nursing posts and 6,207 doctor vacancies - and 106 out of 166 trusts in the regions also responded with information on the increase in vacancies over the last three more


Junior doctors defy health secretary with three 48-hour strikes (The Guardian: 23 February 2016)

Junior doctors have defied the health secretary, Jeremy Hunt, declaring three 48-hour strikes and an intention to seek a judicial review of the government’s plan to impose new contracts on them.

The industrial action, announced by the British Medical Association on Tuesday, represents an escalation of the already bitter and long-running dispute over pay, working hours and patient safety

Dr Johann Malawana, who chairs the BMA’s junior doctor committee, said: “ If the government wants more seven-day services then, quite simply, it needs more doctors, nurses and support staff, and the extra investment necessary to deliver them.

“Rather than address these issues head on, the government wants to introduce a contract that is unfair and in which junior doctors have no confidence.”

The dates planned for the industrial action, which will not affect emergency care, are 9 March, 6 April and 26 April. All are scheduled to begin at 8am. They follow two 24-hour strikes held this year, which caused thousands of operations to be more


NHS Bosses Plan to sell Temp Agency (The Morningstar Online: 23 February 2016)

Department of Health bosses are planning to privatise a temp agency for NHS medics and support staff, it was reported yesterday.

News channel Russia Today revealed that Deloitte had been hired to work out “the particulars” for flogging off NHS Professionals.

Two separate sources “close to the deal” met the makers of RT’s Going Underground, confirming a sale was in the pipeline, but it depends on “political timing,” said senior producer Olga Masalkova.

Jeremy Hunt’s department is still deciding whether to sell off the whole body or retain a small stake, said Ms Masalkova.

Recruitment company Odgers Berndtson — chaired by Tory former health secretary Virginia Bottomley, who also held Mr Hunt’s South West Surrey seat before 2005 — is believed to be going through the legal stages in order to make a bid.

RT told the Star: “On the company’s website they have a number of top-level NHS executive jobs advertised. “This means that this private, for-profit company, has a say in matters of the health service, and will be collecting a hefty commission from the placement of these jobs.” more


NHS staff survey: more staff working extra hours (HSJ: 23 February 2016)

The percentage of NHS staff reporting that they are working extra hours has reached a five year high according to the NHS staff survey results published on Tuesday.

The results of the 2015 poll, carried out from September to December, show working extra hours has reached a peak. Almost three quarters of NHS staff, 73 per cent, said they work extra hours, up from its lowest level of 64 per cent in 2011.

Sixty-eight per cent said they did not work any paid overtime above their contracted weekly hours, but only 40 per cent of staff said they did not work any unpaid overtime each week.

Almost half of NHS staff disagreed or strongly disagreed that there were enough staff at their organisation for them to do their job properly, while 31 per cent said they were unable to meet conflicting demands on their more


We're not surprised half our psychologist colleagues are depressed (The Guardian: 18 February 2016)

The NHS is in deep trouble. Junior doctors are striking about their contract, the Department of Health keeps requiring emergency cash injections,deaths are up, and morale is at an all-time low. Though there is talk of cash injections into therapy services, on the frontline psychological therapists are feeling the strain. When psychologists and therapists meet nowadays, the talk is often less about work and more about who’s just resigned, the latest edict about time limits and targets, and the pernicious market culture that is eroding what we do.

While junior doctors are protesting in public, we’ve heard less from psychologists or psychological therapists. People are scared of speaking out publicly – fearful for their livelihoods and protective of the profession they believe in. Take Rachel. She is a clinical psychologist, currently off sick with depression and anxiety from her NHS job. One day she heard herself telling a distressed client that they only had four sessions left. Rachel vividly describes her anguish knowing that her client – who had been abused, and dropped from several services before – was about to experience the same thing again. Rachel now feels a failure because she had to put service targets above the needs of the client and above her own values. Hearing Rachel’s compassion and love for her work, it’s impossible not to think that the NHS is about to lose someone whose values, commitment and thoughtfulness make her a brilliant more


Implement junior doctor contract or lose funding, hospital bosses warned (Pulse: 17 February 2016)

Training bosses have threatened hospitals thinking of offering an alternative contracts to their junior doctors with a loss of funding for training places.

In a letter to foundation trust chief executives, Health Education England (HEE) chief executive Professor Ian Cumming warned that ‘implementation of the national contract will be a key criterion’ when HEE decides on training post ‘investment’.

The warning comes as several chief executives had distanced themselves from the Government’s decision last week to impose the contract, with commenters suggesting that hospitals should negotiate their own terms with junior doctors and the BMA urging meetings between junior doctors and hospital more


The number of doctors applying to work abroad surged by 1,000 per cent on the day Jeremy Hunt imposed new contract (The Independent: 17 February 2016)

The number of doctors who applied for documentation to work abroad surged by over 1000 per cent the day Jeremy Hunt announced he would force a new contract on them, new figures show.

300 doctors applied for Certificates of Good Standing on Thursday 11 February – up from an average of 26 a day in February before the announcement.  Each junior doctor costs taxpayers around £300,000 to train – meaning that on just the day of Mr Hunt’s announcement alone doctors who had received £90 million worth of training took concrete steps towards more


Liverpool NHS jobs face the axe because of community health funding cuts (Liverpool Echo: 17 February 2016)

Up to 30 NHS staff in Liverpool could lose their jobs as services including exercise classes for dementia patients and anti-smoking sessions face the axe.

Liverpool council is cutting the amount of cash it gives to Liverpool Community Health NHS Trust (LCH) – leaving staff in a “difficult and uncertain time”, according to trade union Unison.

Services that could be cut include healthy eating campaigns, stop smoking sessions for pregnant women, exercise classes for dementia sufferers and work to promote dental health. Unison warned the cuts will damage the city’s health in the long run by storing up problems for the future.

A statement from the union said 30 LCH staff now fear losing their jobs due to the more


Seven-day NHS may not cut death rates, say Hunt's own officials (The Guardian: 16 February 2016)

Jeremy Hunt’s key argument in his demands for a seven-day service in NHS hospitals has been called into question by his own department, in a leaked report which says it is not able to prove that fuller staffing would lower the numbers of weekend-admitted patients dying.

The report also admits it will be “challenging” to meet the government’s promise to recruit 5,000 more GPs by 2020, a Conservative pledge during the election campaign, and that 11,000 new staff will be needed to run a seven-day service in hospitals.

The increased numbers of deaths among patients admitted at weekends has been the cornerstone for Hunt’s argument in favour of a seven-day health service, with the health secretary citing 15 international studies since 2010, including one co-authored by the NHS’s top doctor Prof Sir Bruce Keogh, which indicate an increase of deaths in hospitals at the weekend.

However, an internal Department of Health draft report, leaked to the Guardian, says the department “cannot evidence the mechanism by which increased consultant presence and diagnostic tests at weekends will translate into lower mortality and reduced length of stay” more


Revealed: GP training targets in doubt as applications tumble 5% (Pulse: 10 February 2016)

Applications for 2016 GP training have slumped by 5% on last year spelling disaster for the Government target of delivering 5,000 more GPs by 2020.

Leaked figures - obtained by Pulse - reveal that despite a national advertising campaign aimed at promoting general practice as a career, the proportion of doctors applying for GP specialty training starting in August 2016 has reached a record low.

Medical specialty training figures revealed by Pulse show just 4,863 applications for 3,790 GP training posts across the UK for August more


Higher number of HCAs linked with increased mortality, says study (HSJ: 9 February 2016)

New research into staffing levels within NHS hospitals has suggested a link between a higher proportion of healthcare assistants versus registered nurses employed by trusts and a rise in patient mortality.

The study looked at 137 acute NHS trusts between 2009 and 2011 and also found an association between higher numbers of nurses and doctors per patient and a reduction in mortality.

The research comes as the NHS prepares for a new non-registered nursing associate role and a new care hours metric calculated by mixing HCAs and registered nurses together, as recommended by the Carter review.

Professor Peter Griffiths, chair of health services research at Southampton University, which carried out the study, told HSJ that trusts that employed more HCAs relative to the number of beds had an increased risk of mortality. The risk of death decreased by 7 per cent for every additional bed per more


Hospital death rates rise if fewer nurses are on wards, says new research (The Independent: 9 February 2016)

Death rates are higher on wards with fewer nurses, according to research that suggests the drive to replaces nurses with less qualified staff should be reviewed.

Experts studied 137 acute hospital trusts in England and found lower death rates when there were more nurses working. However, hospitals with healthcare support workers in higher numbers had patient death rates seven per cent higher.

Of the 31 trusts where the team knew the exact staffing ratio per patient, the researchers found that those with an average of six patients or fewer per registered nurse had 20 per cent lower death rates compared to trusts with more than 10 patients per nurse. The findings, published in BMJ Open, also show a slight increase in patient deaths for trusts with the most healthcare support more

Junior doctors' strike to go ahead next week after talks fail (Pulse: 1 February 2016)

Next week’s planned junior doctor strike action will go ahead after talks with the Government have failed to produce an agreement over the contract.

The BMA confirmed the strike today, but said that junior doctors would still provide emergency care on 10 February instead of the ‘all out’ action originally planned.

It comes as the 48-hour action planned for 26-28 January was called off in favour of further talks facilitated by Acas.

Junior doctors already walked out on 12 January, but still provided emergency care.

The BMA said in a statement: ’Despite the best efforts of our negotiating team, and hours of talks facilitated by Acas, we have not managed to reach agreement with NHS Employers and the Department of Health on the new junior doctors more


Mass GP resignations 'likely' as union urges LMCs to back crisis conference vote (GP Online: 27 January 2016)

GPs are ready to back calls for the profession to resign en masse from practice contracts at this weekend's special LMCs conference, union leaders say.

Doctors from the Unite union said mass resignation was 'on the cards' as GPs faced a crisis driven by a recruitment crisis, soaring workload and falling income.

East London GP Dr Jackie Applebee, Unite representative on the GPC, urged the 400 GPs who will debate the crisis facing the profession on Saturday at a special LMCs conference in London, to back a motion calling for GPs to hand in undated resignation letters.

The union is also urging GPs to support a motion calling for the GPC to explore moving away from the practice-based contract model to a salaried GP more


More than a quarter of trusts asked to breach agency cap (HSJ: 26 January 2016)

More than a quarter of trusts asked Monitor to increase their agency spending cap last year, HSJ can reveal.

A Freedom of Information Act request shows 69 trusts applied to the regulator last September to alter their overall spending limit on agency staff.

Of the 239 NHS and foundation trust acute, ambulance, community, specialist and mental health organisations given a “ceiling” by Monitor, 54 made successful applications to have that altered.

The regulator would not reveal which the organisations were or by how much they had asked to lower their “ceiling”. It said of the 54, 31 applications were only “partially successful” – with the total being lower than the original but higher than the trust’s proposed total.

The news comes as Monitor prepares to further lower the maximum prices agency workers can be paid per shift.


NICE experts called for minimum staff ratios in leaked guidance (HSJ: 20 Janaury 2016)

Suppressed NICE safe staffing guidance for hospital emergency departments called for the NHS to implement minimum nurse ratios to ensure safe care, HSJ reveals today.

The National Institute for Health and Care Excellence’s unpublished final report on emergency department safe staffing, kept secret for months, has been leaked to HSJ alongside a number of related reports.

The guidance, reproduced by HSJ, shows NICE’s safe staffing committee pressed ahead with recommending minimum nurse ratios in English accident and emergency departments despite opposition to the idea of minimum ratios in government and senior NHS circles.

Shortly after the guideline was completed, last June NHS England controversially suspended NICE’s safe staffing work, which left areas such as mental health and community nursing without more


A&E departments may be too short-staffed 'almost half the time', says report (Independent: 20 January 2016)

Report recommends that A&Es should build in a 'margin of safety' into their staffing plans

A&E departments may be too short-staffed to cope with demand “almost half of the time”, according to a suppressed report by patient safety experts.

Experts at the National Institute for Health and Care Excellence (NICE) called for the NHS to introduce minimum nurse-to-patient ratios on A&Es last year, but the report was never published and NICE’S research was controversially suspended.

Ministers and NHS chiefs faced accusations at the time that they were seeking to hide the scale of the staffing crisis in the NHS and water down recommendations for more nurses that would have come at a huge cost to the Government.  

In a copy of the NICE guidance, obtained by the Health Service Journal after frequent requests for its publication were denied, experts say that A&E staffing levels set according to historical patient demand leave emergency departments unprepared to cope with frequent surges in demand.

The report recommends that A&Es should build in a “margin of safety” into their staffing plans, even if this meant they were overstaffed during quiet periods... read more


Industrial action: junior doctors provide emergency-only care (BMA: 12 January 2016)

Tens of thousands of junior doctors are today taking industrial action over their contract dispute with the Government.

Trainees in England are providing emergency care-only cover — similar to a Christmas Day service — in the first of three planned periods of industrial action.

Doctors are taking the action over the Government’s failure to address junior doctors leaders’ concerns about contractual safeguards on safe working, and proper recognition for those working unsocial hours.

Conciliation talks paused last week with both sides saying, while discussions had been ‘constructive’, they were not enough to call off today’s planned action by the BMA.

BMA junior doctors committee chair Johann Malawana said: ‘Junior doctors feel they have been left with no option but to take this action.

'We have been clear throughout this process that we want to negotiate a contract that is safe and fair, and delivers for junior doctors, patients and the NHS as whole.

‘This remains our goal and our door is open to talks, but the Government must address our concerns around safe working patterns and ensure the contract recognises the long, intense and unsocial hours which junior doctors do.’ more


All NHS staff support the junior doctors’ strike action (The Guardian: 12 January 2016)

As health workers who are not junior doctors, we want to make clear that all of the NHS team are 100% behind their strike against attacks on unsocial hours arrangements. Proposals to stretch five days’ staff over seven days, paying each one less, will not improve anything for patients. Unsocial hours reduce life expectancy and impact on family and social wellbeing. Increases in unsocial hours, accompanied by further cuts in pay for doing this, is one of many final straws which we no longer feel we can allow to go unchallenged. As junior doctors say, it is “unsafe and unfair”. We know these proposals are coming to the rest of us next, impacting on our patients and our more


London nurse shortage 'critical' as vacancies rise to 10,000 (Nursing Times: 7 January 2016)

London’s NHS nurse shortage worsened last year, with trusts in the capital operating with more than 10,000 empty posts, new data has revealed.

According to research carried out by the Royal College of Nursing’s London branch, the shortage was equivalent to a 17% vacancy rate – meaning trusts had on average nearly one in five of their nurse jobs unfilled.

Some organisations had far higher vacancy rates though. According to the RCN’s analysis, the worst in 2015 were London North West Healthcare NHS Trust with 800 empty posts and South West London an St George’s Mental Health NHS Trust with 160 jobs unfilled – both equivalent to 30% of their funded nurse establishments.

Acute provider Barts Health NHS Trust had the largest actual number of vacancies out of the 36 organisations, with more than 1,000. This was equivalent to 19% of its establishment.

The data, which was collected from trusts in July using Freedom of Information requests (see attached PDF below), showed there were around 2,000 additional whole-time equivalent vacancies in 2015, compared with the same time the year before.

However, the majority of trusts have increased their number of nurse posts in that time. Since last year, funded establishments in London have gone up by an average of 4%. But trusts have only managed to employ on average an extra 2% staff, compared with the year before... read more


GPs under 50 leaving profession due to fear of burnout, NHS study finds (Pulse: 7 January 2016)

GPs under the age of 50 are abandoning UK general practice as they feel ‘unsupported and vulnerable to burnout’, an NHS England-commissioned study has concluded.

The study, published today in the British Journal of General Practice, found that personal reasons were rarely a factor for GPs relocating abroad, changing jobs or leaving on medical grounds.

The researchers concluded that ’to improve retention of young GPs, the pace of administrative change needs to be minimised and the time spent by GPs on work that is not face-to-face patient care reduced.’ more


Junior doctors and Government to hold fresh conciliation talks (Pulse: 6 January 2016)

The BMA and the Government will hold fresh conciliation talks around the junior doctors’ contract in a bid to reach an agreement before strikes take place next week.

Strike action is set to take place on 12 January, after the BMA announced on Monday that its talks with NHS Employers had broken down.

However, mediation body Acas announced today that they ‘have invited the sides involved in the junior doctors dispute for Acas talks this Friday. Talks are expected to start at 10am’ more


New wave of practice closures could mean 25,000 patients lose their GP (Pulse: 6 January 2016)

Tens of thousands of patients could be forced to register with another GP, as several practices prepare to close their doors early in 2016.

Pulse has learnt that six practices in England and Wales are closing due to GPs retiring early or becoming ill, leaving over 25,000 patients facing the prospect of moving practices.

GP leaders say the figures are a ‘terrible concern’ for patient access to primary healthcare and are the result of years of underfunding.

This latest wave of closures comes months after Pulse revealed last year that 160,000 patients were displaced across the country between 2013 and 2015. Pulse launched a ‘Stop Practice Closures’ campaign in 2014 to highlight the numbers of practices at risk of going under, but only recently have managers recognised there is a more


Directors to review NICE chief's decision not to release staffing guidance (Nursing Times: 5 January 2016)

Two non-executive directors at the National Institute for Health and Care Excellence will meet tomorrow to review a decision by its chief executive not to release evidence on safe nurse staffing levels.

The meeting is part of an appeal against the decision by Sir Andrew Dillon not to publish details of four evidence reviews into safe nurse staffing across a range of healthcare settings including community, mental health and learning disabilities.

Sir Andrew decided not to publish the information after a request by Nursing Times’sister title Health Service Journal under the Freedom of Information Act, claiming it would “prejudice the effective conduct of public affairs”. After an appeal against that decision, NICE has asked two non-executive directors to review whether the refusal was appropriate, which is the final stage of the appeal more


Junior doctors in England to strike next week after talks break down (The Guardian: 4 January 2016)

Junior doctors are set to go on strike for three days, starting next Tuesday, in protest at the threat by the health secretary, Jeremy Hunt, to impose a new contract on them after talks failed to resolve the dispute.

The British Medical Association – the doctors’ trade union – blamed the walkouts on “the government’s continued failure to address junior doctors’ concerns about the need for robust contractual safeguards on safe working, and proper recognition for those working unsocial hours”.

The first industrial action by junior doctors since November 1975 will result in the 45,000 junior doctors in England providing only emergency cover for 24 hours from 8am on 12 January, leading to a much reduced level of operation. 

They will stage the same withdrawal of labour for 48 hours from 8am on Tuesday 26 January, and then stage one all-out strike between 8am and 5pm on Wednesday 10 more


Higher ratio of nurses per hospital bed linked to fewer patient deaths (Nursing Times: 18 December 2015)

A higher ratio of nurses per hospital bed has been linked to a lower risk of death following emergency general surgery, according to new research looking at mortality rates in England.

The study, published in the British Journal of Anaesthesia, analysed nearly 300,000 cases at 156 trusts over a five-year period.

Researchers behind the study – called Mortality of emergency general surgical patients and associations with hospital structures and processes – estimated the likelihood of patient death at 30 days after emergency surgery was 7% higher in trusts with the lowest numbers of nurses per bed.

In the nine hospitals that had lower than expected death rates 30 days after admission, they found a “significantly greater provision” of nurses, doctors and surgeons per bed than in the 14 organisations with higher than expected mortality rates.

Hospitals with the lower than expected mortality rates had on average 24% more nurses, as well as 44% more doctors, per bed than those with the highest rates.

In these better performing trusts, there were on average 2.3 nurses per bed, compared with 1.8 nurses per bed in those with the worst death rates. The study also found the trusts with lower mortality rates had 65% more critical care beds per standard ward bed... read more.

See also:

Half of GPs willing to resign NHS contracts (Pulse: 10 December 2015)

Number of ambulance staff quitting almost DOUBLES leaving NHS facing crisis (The Mirror: 10 December 2015)

Almost half of junior doctors left NHS after foundation training (The Guardian: 5 December 2015)

NHS England cap on agency payments comes into effect (BBC: 23 November 2015

40% of GPs to quit within five years (Pulse: 26 October 2015)

Junior doctors: 7 in 10 to leave NHS if Hunt pushes through new contract (The Guardian: 21 October 2015)

Staff sh

Key Facts

Since the Coalition came to power in 2010 the NHS has lost as many as 6000 nursing posts.

Paramedics stress-related sick days increase by 28% between 2012 and 2014

Hospital staff absences for mental health reasons double

Key Trends:

Between May 2010 and July 2012: the total NHS workforce decreased by 2%.

Within this change:

The number of doctors rose by 7.5%, qualified midwives by 5%, and qualified scientific, therapeutic and technical staff by 2%.

The number of qualified nurses decreased by 2%.

Largest decrease in NHS infrastructure support at 9%

A decrease in support to doctors and nursing staff by 2.5%.



Health and Social Care Information Centre Workforce Statistics
"The latest statistics show that the cuts to NHS staff show no sign of slowing down" Peter Carter, chief executive and general secretary of the Royal College of Nursing

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