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Failure to train enough doctors and nurses is costing the NHS money and undermining patient care

  • Government should invest more in training to reduce reliance on locums and agency staff
  • Greater competition for jobs would encourage the take-up of permanent posts in hard-to-recruit specialisms like A&E and general practice
  • A larger pool of dependable permanent staff would enhance workforce stability and patient safety

A failure to train enough staff in the NHS is leading to an over-reliance on agency staff, locums and overseas recruitment which is wasteful of money and undermining patient care, a new report from the cross-party think tank Civitas warns.

Researcher Edmund Stubbs argues that insufficient investment in training is to blame for shortfalls in permanent staff in areas like A&E and general practice, which are less appealing as a career path to many doctors.

As a result, non-permanent staff like locum doctors and agency nurses are costing the NHS about £2.5 billion a year.

He calls for the NHS to train more staff and increase competition for jobs. This would help fill less desirable specialities and save money in agency costs and locums.

“It is evident that a lack of staff – or at least of staff willing to enter some specialities – is currently leading to excessive spending on agency staff, locums and overseas recruitment; exhausting financial resources that could be better used in training and employing full time staff,” Stubbs writes.

“Some competition for medical placements and even the risk of unemployment within the sector might in fact prove advantageous. If numbers training for medical careers were to be substantially increased, personnel might be encouraged to embark on careers in specialities such as A&E which are currently experiencing difficulty in recruiting and retaining staff.

“Competition might also be engendered between staff to obtain positions in currently unpopular or remote regions. More locum and agency staff would also want to work on a permanent basis (giving them increased job security) which would be far more cost efficient for the NHS.

“At present staff shortages in less desirable specialities are met by employing overseas trained, locum and agency staff at great expense and with a possible risk of reduced care quality and patient safety. A larger dependable permanent staff pool would result in enhanced workforce stability and patient safety.”

The typical charge for a consultant from an agency is £1,760 a day, equivalent to a pro rata salary of £459,096. Given that the salary of an NHS consultant is between £75,249 and £101,451, four consultants could be employed by the NHS for the price of one agency staff member.

Agency nurses cost in the region of £24 to £29 an hour, equivalent to between £47,000 and £56,000 a year; while the salary for an NHS band 5 nurse is between £21,478 and £27,901.

As well as the costs, there are safety considerations too, for example in emergency medicine where there are major difficulties with recruiting enough contracted staff.

“The number of specialist emergency medicine training post vacancies is huge. At present only half of these vacancies are being filled and this will, it is claimed, eventually result in a ‘lost cohort’ of consultants,” Stubbs writes.

“It is therefore imperative to address training problems in this speciality to avoid a serious lack of senior doctors in emergency medicine in the near future. Such a lack would be dangerous.

“Junior doctors often need to discuss cases with more senior staff before they can make appropriate decisions on how to proceed. A lack of senior staff available for consultation might mean that patients requiring rapid intervention were attended more slowly.”

Government figures suggest the need for 27,000 more doctors by 2025. Yet in 2012 the Department of Health recommended that fewer students should be admitted to medical schools from the following year to avoid “a glut of NHS consultants in the future” which would, it said, “be a waste of taxpayers’ money”.

Medical school intake was reduced from 6,195 places in 2012 by 124 places in both 2013 and 2014, justified as an attempt to ensure that the UK does not finance doctors through medical school without jobs for them at the end of their training.

Nursing training places have been cut in recent years from 25,904 in 2010-11 to 21,529 in 2012/13. This is particularly worrying given that almost half (45 per cent) of nurses in England, Northern Ireland and Scotland are over the age of 45 and approaching retirement.

Going some way towards meeting these shortfalls is overseas recruitment, including of 3,000 doctors in the past year (26 per cent of NHS doctors are now foreign nationals). About 10 per cent of nurses and midwives in the NHS were trained abroad.

Stubbs argues that this is “unethical”, because as the UK benefits from health workers trained at large expense by developing countries. “In effect we are treating their healthcare provision as being of secondary importance to our own,” he writes.


Edmund Stubbs is healthcare researcher at Civitas. He studied Biomedical Science at the University of Sheffield and has a Master’s degree in Health, Population and Society from the London School of Economics and Political Science. Edmund also worked as a healthcare assistant for four years at Addenbrooke’s Hospital, Cambridge, and as a freelance health consultant for one year.


Training our NHS Health Workers: Should the UK train more of its staff?

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