The state of the community workforce
Community providers deliver a wide variety of services, from urgent community response and district nursing to occupational therapy and children and young people's speech and language therapy; services which give people vital support at or closer to home.
The NHS staff survey 2023 results were positive for the community sector, scoring above the national average against every theme (which are aligned with the NHS People Promise). Standalone providers of community services had the highest response rate across all sectors (60%) and scored highly on questions about staff looking forward to going to work, flexible working patterns and the extent to which they feel that their line managers or organisations take positive action on their health and wellbeing. Not only did the community sector achieve the highest scores in these questions, but there were also notable improvements compared to the 2022 results.
The results echo what we hear from community provider leaders who are proud to work in the sector. Many feel privileged to be leading organisations where frontline staff care for people in their homes over the course of their lives, in many cases helping them retain their independence and stay close to family and friends.
But significant staff shortages persist. Latest data from December 2023 showed there were 5,605 vacancies in the community sector (a vacancy rate of 9.2%), an increase from 4,392 in December 2021. Trust leaders tell us staff shortages are particularly concerning in community podiatry, health visiting, children and young people's speech and language therapy and community dentistry.
Likewise, a recent survey by the Royal College of Nursing found that 40% of shifts were missing up to half the registered number of nurses needed, in some places resulting in rising hospital admissions and concerns about patient safety. This can, in turn, impact on staff morale and recruitment and retention to the sector.
Growing the community workforce is key to providing safe and timely care in the community and achieving national ambitions to deliver more care at and close to home.
Breaking down the barriers to recruitment and retention in the community sector
Several barriers to recruitment and retention remain in the community sector, in part due to a lack of national prioritisation and investment. Since 2016/17 community trusts have only received 14% funding growth, compared to 27% for the acute sector. This is despite growing demand for services, and the stated policy ambition to deliver more care close to home.
The use of block contracts for community providers, which provide a fixed annual payment for a service, regardless of increased activity or demand, also limits capacity to invest in growing and developing the workforce.
Alongside greater investment and a financial architecture that supports the expansion of the community workforce, there is a need to strengthen career pathways and opportunities for professional progression to improve recruitment and retention to the sector. Leaders in the sector also say there are challenges around the status and visibility of careers in the sector. Providing greater visibility and direct experience of community services for more existing NHS staff, managers and those on the frontline, is therefore vital in promoting careers in the sector.
The importance of implementing the NHS Long Term Workforce Plan
The ambitions set out in the NHS Long Term Workforce Plan (LTWP) represent an important step towards addressing some of these barriers. The plan sets out a vision to double the community workforce by 2037 through increasing the number of training places available for community roles. This includes for health visitors, district nurses and qualified school nurses where the ambition is to increase training places from 1,811 in 2022 to 3,788 in 2031. To tackle retention, NHS England is also developing a capability and career framework for allied health professionals to support community workforce development.
However, the new government must fully fund the plan and ensure there is a robust strategy for implementation. Even with these factors in place, results will take time. The LTWP does not address the immediate capacity constraints within the sector. Community providers are therefore developing innovative initiatives to recruit and retain staff to ensure they have the capacity to scale up provision to meet the existing demand for care.
This briefing showcases the work of four community providers that are innovating to improve recruitment and retention at a local level.