Efforts to diversify the workforce in the NHS have not been effective in meeting the increasing demand for healthcare services. The healthcare workforce must evolve to meet the growing complexity of health needs, which requires a more modern and flexible care delivery model. In addition, other healthcare professionals such as pharmacists, physiotherapists, mental health practitioners and social workers must be adequately resourced and supported, and innovative technologies must be explored and embraced. The COVID-19 pandemic has underscored the need for reform, and optimising the contribution of other clinical staff groups in the NHS is necessary to meet these challenges.

I. Introduction

A. Overview of workforce professions in UK NHS

The UK National Health Service (NHS) is one of the largest employers in the world, with a workforce of over 1.3 million people. The workforce consists of a wide range of professions, all working together, aiming to provide high-quality healthcare.

Nurses comprise the largest single group of healthcare professionals in the NHS, with over 280,000 registered nurses and midwives working across various specialities. They work closely with doctors and other healthcare professionals to provide patient care across various settings, from hospitals to community health centres and patients’ homes. Nurses play a vital and varied role in the provision of healthcare, from administering medication and advanced clinical procedures to providing basic care and emotional support to patients and their families.

Doctors are another key group of healthcare professionals, with over 180,000 working in the NHS. Senior doctors are hospital-based consultants or general practitioners (GPs) who work in primary care. Doctors are responsible for diagnosing and treating patients, prescribing medication and guiding on various health issues. The NHS relies heavily on a tier of doctors in training, often referred to as junior doctors, who tend to take on many clinical duties, particularly in hospitals.

Allied health professionals (AHPs) are also vital members of the NHS workforce, including physiotherapists, occupational therapists, radiographers, speech and language therapists, and dietitians. AHPs provide a range of therapeutic interventions to help patients manage their conditions, including rehabilitation and support for mental health issues.

Pharmacists are also essential to the NHS workforce, with over 60,000 registered pharmacists working nationwide. They are involved in managing and dispensing medication, ensuring that patients receive the right drugs at the right time.

Support staff, including administrative and technical staff, are also vital to the functioning of the NHS. They include healthcare assistants, porters, receptionists, and medical secretaries. They help keep the NHS running smoothly, ensuring patients are seen on time and that care administration is effectively coordinated.

The UK NHS workforce comprises diverse professions, each playing a critical role in providing high-quality healthcare. From doctors and nurses to AHPs, pharmacists, and administrative staff, each workforce member is essential to the functioning of the NHS. The dedication and commitment of these healthcare professionals are crucial in ensuring that patients receive the best possible care.

B. The dependence on an outdated clinical care delivery model

The NHS has come a long way over the years, but one aspect remains outdated: the clinical care delivery model. Nurses and doctors deliver most of the clinical care to patients. While this model may have been effective in the past, it is time for the healthcare industry to acknowledge that it is no longer sustainable or efficient.

One of the key reasons for this is the growing shortage of healthcare workers. With an ageing population and the increasing demand for healthcare services, there simply aren’t enough doctors and nurses. The demanding nature of their work requires extensive training and education, yet their compensation does not match the level of expertise and dedication required for the job. Many healthcare professionals are struggling to make ends meet due to low salaries. The lack of proper remuneration for healthcare professionals has resulted in a shortage of staff in hospitals and clinics. They are overworked and underpaid resulting in job dissatisfaction, stress, and burnout which ultimately has a negative effects on patient care.

This care delivery model that is heavily dependent upon nurses and doctors fails to take advantage of recent technological advancements. For example, telemedicine and other digital health tools can help to provide patients with more convenient, accessible care while also improving outcomes. However, relying solely on in-person visits, the current care delivery model fails to capitalise on these innovations.

Perhaps most importantly, however, this outdated care delivery model simply does not prioritise the needs of patients. Patients deserve access to high-quality, personalised care that meets their needs and preferences. Unfortunately, relying solely on doctors and nurses, the current model does not provide patients with the level of care they deserve.

To address these issues, healthcare providers must be willing to explore and embrace new care delivery models. This must involve utilising more advanced technologies, such as artificial intelligence and machine learning, to help provide more accurate diagnoses and treatment recommendations. It may also involve rethinking the role of nurses and other healthcare professionals, shifting them from purely clinical roles to more holistic, patient-centred ones.

Ultimately, the healthcare industry must recognise that the current care delivery model is no longer effective or efficient. By embracing new technologies and rethinking the roles of healthcare professionals, we can provide better patient care and create a more sustainable future for our healthcare system.

II. The dominance of nurses and doctors in the clinical workforce

A. Statistics on clinical workforce composition in the NHS

According to the NHS Digital Workforce Statistics report published in September 2021, there were 1.2 million staff working in the clinical workforce of the NHS as of June 2021. This represents an increase of 2.2% from the previous year, with most of the growth coming from nursing and midwifery roles. Nurses and midwives comprise the largest clinical workforce, accounting for 40.7% of all clinical staff.

Doctors are the second-largest group in the clinical workforce, representing 16.9% of all clinical staff. There are over 120,000 doctors employed in the NHS, with general practitioners (GPs) making up a significant proportion of this group. The number of GPs working in the NHS has been steadily increasing over the last few years, with a 3.9% rise in the number of GPs between June 2020 and June 2021.

Allied health professionals (AHPs) comprise a smaller proportion of the clinical workforce, accounting for 10.4% of all clinical staff. AHPs cover many roles, including physiotherapists, occupational therapists, radiographers, and dietitians. Over 125,000 AHPs are working in the NHS, with the number of radiographers increasing by 3.3% between June 2020 and June 2021.

Support staff comprise the remaining proportion of the clinical workforce, with healthcare assistants (HCAs) and assistant practitioners (APs) accounting for most of this group. Over 358,000 HCAs and APs working in the NHS, representing 29.4% of all clinical staff.

In terms of gender, the clinical workforce is predominantly female, with women making up 76.2% of all clinical staff. This is particularly true for nursing and midwifery, where women represent 89.1% of the workforce. In contrast, the doctor workforce is more evenly split between male and

B. Limitations of the current clinical care delivery model in the NHS

The National Health Service (NHS) is the pride of the United Kingdom, providing free healthcare to millions of people at the point of delivery. However, the current clinical care delivery model in the NHS has limitations that affect its effectiveness, efficiency, and quality. Public satisfaction with the service is consistently falling.

The current clinical care delivery model faces challenges with technology and data. Despite being a world leader in healthcare research and innovation, the NHS struggles to adopt and integrate digital health technologies, such as electronic health records, telemedicine, and artificial intelligence, into routine care. This results in inefficient workflows, data silos, and missed opportunities for personalised care.

The current model is not sustainable in terms of workforce and funding. The NHS faces a shortage of healthcare professionals, particularly in nursing and allied health professions, which affects the quality and safety of care. Moreover, the NHS is struggling with escalating costs due to the ageing population, rising demand, and technological advancements, which require a substantial investment that may not be available.

The NHS needs to transform its clinical care delivery model into a comprehensive, integrated, and patient-centred model that leverages technology and data to address these limitations. This requires a shift from a reactive and fragmented model to a proactive and coordinated model focusing on prevention, early intervention, and continuity of care. It also requires a greater emphasis on patient engagement, empowerment, and education, supported by digital health tools and personalised care plans.

The NHS must invest in its workforce, infrastructure, and innovation to achieve this transformation and engage stakeholders, such as patients, carers, healthcare professionals, and policymakers. Only through radical transformation will the NHS become sustainable.

III. Potential contribution of other paramedical and technical, clinical staff groups

One way to address the significant staffing shortage, resulting in a high workload for nursing and medical staff is by more effectively utilising non-nursing and non-medical staff. The underutilisation of non-nursing and non-medical staff in the NHS is a significant concern, and exploring the scope of their roles and responsibilities within the system is essential.

Administrative staff

Administrative staff, support staff, and clerical staff, play a vital role in the functioning of the NHS. They are responsible for many tasks that do not require clinical expertise, such as booking appointments, processing medical records, and managing patient data. Their role should be expanded.

Expanding the role of administrative, support, and clerical staff can be beneficial in improving the overall efficiency and effectiveness of the NHS. With the NHS facing numerous challenges such as increased demand for services, staff shortages, and budget constraints, it is important to utilize the skills and expertise of these staff members to their full potential.

One way to expand their role is by providing them with training opportunities to develop new skills and knowledge that can be applied to their work. This can include courses on data management, information technology, and customer service. By equipping them with the necessary skills, they can take on new responsibilities and contribute more significantly to the operations of the NHS.

Additionally, administrative, support, and clerical staff can also be empowered to take on more leadership roles in their respective departments. This can include taking on project management responsibilities, participating in team meetings, and providing input on operational improvements. By involving them in decision-making processes, they can feel more engaged and invested in their work, improving job satisfaction and motivation.

The cost-saving intervention of reducing administrative staff and medical secretaries has reduced the productivity of hospital doctors. The doctors must take on additional clerical work, which is time-consuming and reduces the time available to provide medical services to the patients. The added burden has affected morale among the hospital’s medical staff and has led to increased stress and dissatisfaction among the doctors. As a result, many hospitals are actively looking for alternatives to reduce costs without reducing the quality of patient care.

Paramedical staff

Paramedical staff, such as pharmacists, physiotherapists, and occupational therapists, also have a critical role in the healthcare system. They possess specialised skills and knowledge that can help alleviate the workload of nursing and medical staff. For example, pharmacists and pharmacy technicians could provide medication management services, including reconstitution and administration, dosing and monitoring, which can help reduce nurses’ workload.

The NHS tends not to use certain paramedical staff such as respiratory therapists, as seen in the USA. Respiratory therapists, who specialise in treating and diagnosing lung conditions, are an integral part of the medical services offered in the United States. However, the National Health Service (NHS) hasn’t traditionally used similar personnel in the UK. Instead, if a patient was diagnosed with a respiratory illness, they would be referred to a specialist doctor or a pulmonary consultant.

The lack of respiratory therapists on the NHS has become increasingly apparent over recent years as the population suffers from various respiratory problems. This includes deteriorating air quality due to pollution, a rise in smoking-related illnesses, and an ageing population with a greater risk of chronic respiratory conditions.

The NHS is slowly waking up to respiratory therapists’ importance. In 2018, an advisory group was created, tasked with exploring the model’s potential benefits. The group concluded that there was good evidence to support the introduction of a “multi-disciplinary team approach” which included respiratory therapists.

These professionals are expected to play a vital role in helping to improve the diagnosis and treatment of respiratory illnesses. TheThey’reghly trained in the use of specialist equipment and in providing patient education and advice on lifestyle changes. This can include advice on avoiding triggers that can cause asthma attacks and how to stop smoking to reduce the risk of chronic lung disease.

On top of this, the presence of respiratory therapists would help to take the burden off specialist doctors, freeing them up to focus on the most serious cases. This, in turn, would reduce waiting times and improve the overall quality of care.

The NHS has started to make strides in introducing respiratory therapists into its services. This has included training courses and the piloting of several projects in hospitals across the country.

The structured use of respiratory therapists on the NHS is still in its early stages. Still, the potential for improved diagnosis and treatment of respiratory illnesses is huge. As the NHS continues expanding its services in this area, the UK population will benefit from better access to the care they need.

Technical staff

There are several tasks that doctors traditionally undertake in the UK that could be undertaken by trained technicians, including phlebotomy and venous cannulation, vaccinating patients, administering intravenous medications and performing laboratory tests. It is also possible for technicians to be trained to diagnose and treat minor illnesses and injuries. Several other procedures, including cardiology and ophthalmology, have also been explored as areas that are suitable for technicians to train in.

In addition to the tasks mentioned above, technicians could also be trained to provide some forms of patient counselling and advice on lifestyle. They could also be trained to identify when medical treatment is necessary and to refer the patient to a doctor.

Pharmacy technicians could also be responsible for participating in drug rounds, ensuring that ward medicines are given in the correct amounts and at the correct times. This could include double-checking that the medications given to patients are those prescribed by their healthcare professionals and that the patient has not had any adverse reactions to the medication.

In addition, pharmacy technicians could be more responsible for stocking and restocking medication cabinets and drug trolleys. They could also be responsible for ordering new stocks, disposing expired medicines, and stocking new supplies based on ward needs. Finally, they could be involved in patient education and counselling.

In many cases, using technicians to undertake treatments and procedures could increase the efficiency of the health service, as more patients can be seen and treated in a shorter amount of time. It could also reduce the overall costs for the health service, as technicians generally require less training and can be paid at a lower rate than doctors.

The underutilisation of non-nursing and non-medical staff in the NHS is a significant issue that needs to be addressed. There is an outmoded perception that only medical and nursing staff can deliver high-quality care. Utilising paramedical, technical and administrative staff more effectively could help alleviate the nursing and medical staff’s workload and improve the healthcare system’s overall functioning. Promoting a better understanding of their roles and responsibilities and providing the resources and support needed to enable them to perform their roles effectively is essential.

To address this issue, the NHS needs to re-evaluate the roles and responsibilities of non-nursing and non-medical staff and integrate them into the healthcare team effectively. This can be achieved by developing clear job descriptions and providing specialised training to staff. Ensuring staff access the necessary resources and technology to perform their roles effectively is also crucial.

IV. Challenges in optimising the contribution of non-nursing and non-medical staff groups in the NHS

It is challenging to optimise their contribution and utilise the full potential of non-medical and non-nursing staff due to various factors. One of the main challenges is the lack of recognition and appreciation for the work done by these staff groups. Often, their roles are viewed as peripheral or supporting, and their importance is not considered. This has led to a lack of investment in their training and development, resulting in a skill gap which does not enable them to contribute fully to the NHS.

Another challenge is the limited opportunities for career progression and growth. Non-nursing and non-medical staff groups have limited access to professional development and training, which hinders their ability to contribute to the NHSNHS’serall goals. The lack of career progression also results in low employee morale and disengagement, affecting the service quality.

In addition, resource constraints within the NHS impact these staff groups significantly. Budget cuts lead to reduced staff numbers and limited resources, which results in increased workload and job insecurity. This, in turn, affects the quality of the work and patient care.

There is also a lack of understanding and appreciation of these staff groups’ unique skill sets and competencies. For instance, administrative staff members are often not allowed to use their organisational and management skills to improve the efficiency of the healthcare system. Similarly, catering staff are not recognised for their contribution to providing nutritious meals that aid in patient recovery.

Pharmacy technicians working in hospitals in the NHS could undertake some of the work currently done by nurses. For example, one of the key roles pharmacy technicians could take on is checking and preparing medication doses for patients. This could include measuring doses and calibrating syringes ready for administration, identifying and ordering medicines from stock and ensuring records’ accuracy.

To optimise the contribution of non-nursing and non-medical staff groups, including paramedical staff, there needs to be a shift in mindset and a change in how they are viewed and valued. Their contribution is just as vital as that of medical and nursing staff. The challenges in optimising their contribution need to be addressed urgently. These staff should be provided with more opportunities for training and development, and clear career advancement paths should be established. Recognising their unique competencies and providing them with the necessary resources to contribute fully to the NHS’s overall goals is essential.

Conclusion

The NHS has 1.2 million clinical staff, mostly nurses and midwives. The current clinical care delivery model faces challenges with the use of technology and data and is not sustainable in terms of workforce and funding. The NHS needs to transform its clinical care delivery model into a comprehensive, integrated, and patient-centred model that leverages technology and data to address these limitations. It must also invest in its workforce, infrastructure, and innovation and engage stakeholders. Utilising paramedical, technical and administrative staff more effectively can help alleviate the workload of nursing and medical staff. However, optimising their contribution faces challenges such as lack of recognition and appreciation, limited career progression and growth opportunities, resource constraints, and lack of understanding and appreciation of their unique skill sets and competencies. To optimise their contribution, there needs to be a shift in mindset and how they are viewed and valued. In addition, their unique competencies should be recognised and provided with the necessary resources to enable them to contribute fully to the NHS’s overall goals.