Research report
17 May 2016

Recent national developments, including the Five Year Forward View, have driven an emphasis towards new care models to meet the needs of a rising population with complex needs. Yet the capacity for NHS staff to deliver these models has often been overlooked, in spite of a growing disparity between patient needs and the skills and knowledge of the workforce that treats them. This research report argues that there is an urgent need to rethink the nature of the NHS workforce if new care models are to succeed in meeting the needs of patients in the future.


The Nuffield Trust was commissioned by NHS Employers to examine how best NHS staffing can be reorganised to support new ways of delivering care to patients. The authors conducted a survey of local Health Education England (HEE) leaders, examined a number of case studies around the country, convened an expert seminar, interviewed a wide range of stakeholders, and carried out a review of relevant literature.

The report finds that equipping the existing non-medical workforce – NHS nursing, community and support staff – with additional skills is the best way to develop the capacity of the health service workforce.

In the paper, authors offer practical guidance on implementation to those wishing to reshape their workforce, and identify opportunities to ‘grow’ the workforce. Key recommendations include:

  • Utilising the support workforce: This subset of the workforce is large and highly flexible, while short training times mean that numbers can be expanded relatively quickly. Evidence suggests that support workers can provide good-quality, patient-focused care, as well as reduce the workload of more highly qualified staff.

  • Extending the skills of registered healthcare professionals: such as nurses, pharmacists, physiotherapists and paramedics. This provides opportunities to manage the growing burden of chronic disease more effectively, could release some savings, and could help bridge some of the workforce gaps that are forecast.

  • Advanced practice roles for nurses: including those that require a further period of study, typically a two year Masters qualification, offer opportunities to fill gaps in the medical workforce.

However, the report also warns that reshaping the NHS workforce, if not carefully implemented could increase patient demand, and cost money rather than save money.

Therefore, the authors identify 10 important lessons for organisations seeking to redesign their workforce.

In addition, the authors argue that the Health Education England (HEE) budget and specialist workforce planning expertise should be protected by ring-fencing monies to support local workforce design.

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