The first sustained fall in UK GP numbers in the NHS for 50 years has been recorded (Triggle, 2019). This sustained drop in GP numbers will have an impact on patients and those nurses and other healthcare staff working in GP surgeries. In England, there is one GP for every 2160 patients, which is an increase of 8% in 3 years (Gerslick and Fisher, 2019). This is the first time since the 1960s that GP numbers have fallen. Those living in less affluent areas have seen their GP workforce shrink by 50%. These areas often include patients with the most complex needs.
The Health Foundation report that, on average, a GP working in the most deprived boroughs is responsible for 370 more patients than those in the most affluent boroughs (Gerslick and Fisher, 2019).
The vicious cycle of high nurse vacancies, the fall in GP numbers and population growth are key drivers in increased workload—bringing discord and unhappiness. This must surely represent a public safety issue. Such a shortage cannot be sustained, the goodwill of nurses and other staff is being abused as a result of the Government's failure to make a meaningful response to reducing the 40 000 NHS nurse vacancies in England (Royal College of Nursing, 2017).
Ministers must be called to account. This is a crisis and they must take into consideration the economical and human costs of not filling these job vacancies now. More worrying is the impact that this will have in the future. It is high time that England legislates on safe staffing levels in health and social services—the route taken by Scotland and Wales. Staffing accountability has been set in law in these two UK countries, there can be no obvious and just reason why England cannot follow suit. Mortality rates rise when there are insufficient numbers of registered nurses on a shift.
Appeals were made many years ago, imploring employers, decision-makers and ministers to consider carefully the impact of foolhardy policy decisions such as removing the student bursary.
The NHS Long Term Plan (NHS England and NHS Improvement, 2019) had the potential to be a watershed as it aims to ensure that our NHS is fit for the future, breaking down organisational barriers, embracing technology, and recruiting and retaining the right numbers of staff. The Plan brags about an NHS where funding is apportioned to population need, where most care is provided through list-based general practice, and where a planned approach to local and specialist hospital provision is adopted. It also states that the NHS is going to be using its new funding to improve staffing and expand needed services.
To do any of these things, the Government must start by ensuring that the cornerstone of our NHS, general practice, is staffed appropriately. It must also take urgent measures to address the unacceptable shortage of nurses in England.
There is a commitment in the Plan for the NHS to play a greater role in reducing health inequalities. Yet this can only be achieved when people are able to have access to good care that is provided by sufficient numbers of well-educated health and social care professionals.
Nurses are the professionals who will fulfil the Plan's pledges. The Plan will come to nothing unless the dire staff shortages that nurses and other staff face are addressed. It is essential that workforce planning is given a higher profile and those who are on the shop floor are listened to. The chronic workforce shortage is the biggest challenge.
Unfortunately, I believe that the vision of the NHS Long Term Plan will never come to fruition as the damage that has been caused by failing to recruit and retain the right numbers of staff prior to its implementation will be its biggest downfall.