Billy Palmer

Yesterday's workforce data paint a concerning picture on nursing employment in England
> increase over Sep and Oct, when new grads typically recruited, at +3,982 (1.1%) is lowest in over a decade.
> cumulative increase over calendar year (2,569 to the end of October 2025) is the lowest since 2018.

Certainly, the status quo is failing - around one in four (24%) doctors in ‘core training’ leave NHS within 2 years - and bold policymaking is needed.
Further details about our @NuffieldTrust work on this here:
www.nuffieldtrust.org.uk/sites/defaul... 6/6

But it wouldn't necessarily immediately increase take-home pay for new graduates so policymakers might want to also consider loan repayment holidays (which, if interest free, would also have longer-term benefit to the graduate) and job guarantees. 5/6

The exact impact is untested - and depends on policy design - but will likely: ⬆️applications to study including from low-income 🏠; ⬆️participation and retention within NHS services; ⬇️anxieties around financial security from debt; and no time lag (unlike ⬆️undergrad posts). 4/6

In fact, the costs to cover medical graduates may be lower as data suggest their average student loan is less than previously suggested / assumed (c. £42k in 2023). And, in comparison, a 1% increase in pay for NHS workforce costs ~ £900m. 3/6

Such policies require careful design: how much debt to forgive, over how long, and which sectors covered? We modelled gradually writing off all debt over 10 years in eligible service. We estimated costs of ~ £230m for nurses, midwives & AHPs + £170m for doctors per cohort. 2/6

Other countries (🍁🗽) do it; various professional associations, economists, politicians have previously called for it; Shakespeare new it ("And ask of thee forgiveness" Lear); and now @wesstreeting is considering it: student loans forgiveness is in the headlines. Some thoughts🧵1/6

Grateful for @nhsemployers.bsky.social's support and funding of this research - and reviewers and participants input - and hope it can feed into e.g. the forthcoming independent review of PAs/AAs which will also look at important aspects of patient safety which were outside our scope.

We make recommendations on support, capacity, regulation and public awareness and reiterate (frustrated they need repeating) the lessons we set out over 8 years ago👇. But before any efforts to introduce new roles, national/local bodies should resolve issues with established roles.

Our research suggests that a variety of emerging roles have been introduced before significant issues have been addressed, and a much greater level of resource needs to be dedicated to role design, supervision, management and training if roles are to be successfully integrated

International comparisons need to be treated with caution but doctors + nurses account for smaller proportion of NHS hospital workforce than in most countries, albeit USA has gone much further with e.g. physician associates and advance practice in nursing

The scale of change in some services has been dramatic - the ratio of fully qualified permanent general practitioners (GPs) to other clinicians has fallen from 1:1.1 in September 2015 to around 1:2.6 now. That said, NHS's projections to 2036 suggest a fairly similar balance

In the balance: Lessons for changing the mix of professions in NHS services The NHS workforce has gone through shifts and rebalances of roles since the service began, driven by changing needs as much as financial constraints and staff shortages. In recent years there has been...

The NHS workforce has gone through shifts and rebalances of professions ever since the health service began when 4 in 9 staff were domestic & maintenance and only 1 in 30 doctors. Our research outlines oft-forgotten lessons on integrating emerging roles www.nuffieldtrust.org.uk/research/in-...