Record numbers of registered nurses but potential stormy waters ahead, warns NMC

Around 18,000 more nurses, midwives and nursing associates – the largest ever annual increase – are now on the Nursing and Midwifery Council’s (NMC) permanent register to work in the UK compared to a year ago. But concerns around the long term impact of COVID-19 on international recruitment, retention and supporting the workforce mean stormy waters may lie ahead.

‘The NMC Register’ , the professional regulator’s most comprehensive annual registration data report to-date, shows the number of people on its permanent register has grown considerably, rising from 698,237 as at 1 April 2019 to 716,607 by 31 March 2020, driven primarily by those joining and staying from the UK and from countries outside the EEA.

The NMC’s latest figures highlight an increase to the permanent register of 9,012 (1.5 percent) nurses and midwives from the UK, and in England only, nursing associates. The number of people leaving the register from the UK has also fallen to a five-year low of 21,306 compared with a peak of 29,434 in 2016-17.

At the same time, the number of nurses and midwives on the NMC’s permanent register from outside the EEA has risen by 11,008 (15 percent). This increase has been driven by a surge of first time joiners, rising from 6,157 to 12,033 during the last 12 months, representing a 95 percent increase.

Almost half of the permanent register’s total growth comes from people who originally trained in the Philippines and India. Numbers of registered professionals from these two countries who are now registered to work in the UK rose from a combined total of 48,359 in March 2019 to 57,303 in March 2020 – an increase of 8,944 (18.5 percent).

The figures show numbers of nursing and midwifery professionals from within the EEA continue to decline, with the number this year reducing to 31,385, a 5 percent drop on the previous year.

The NMC also invited a sample of more than 6,000 people to take part in a small survey to find out reasons why they had left the NMC’s permanent register.

Carried out before the coronavirus pandemic took hold, the survey findings show the top reason cited for leaving after retirement was too much pressure leading to stress and/or poor mental health.

Finally, the report acknowledges the NMC’s establishment of its COVID-19 temporary register to help support the UK’s response during the emergency period. Since its launch in March this year, numbers have nearly doubled from 7,658 at the end of March 2020 to more than 14,000. These people are not counted in the overall numbers on the permanent register.

Commenting on the NMC’s most recent data report, Andrea Sutcliffe CBE, Chief Executive and Registrar, said: “COVID-19 has meant the vital skills, specialism and resilience of our nursing and midwifery professionals have never been more publicly recognised and valued. It’s therefore great to celebrate record numbers of people on the NMC register.

“However, while the increased figures from within the UK and overseas are very welcome for everyone working in and using health and care services, there are potential stormy waters ahead.

“As a result of the pandemic and subsequent travel restrictions, we may no longer be able to rely on the flow of professionals joining our register from overseas in the same way. Going forwards, the significant growth we’ve seen recently may not be sustained.

“Nor can we afford to ignore existing pressures, exposed and exacerbated by COVID-19, which may challenge employers’ ability to retain our essential nursing and midwifery professionals as health and care services seek to recover.

“We all need to use the insight our registration data reveals to focus on creating the right environment, conditions and incentives to support the sustainable recruitment and retention of nursing and midwifery staff now and for the future.”

Responding to the publication of the annual registration figures, Professor James Buchan, senior fellow at the Health Foundation, said:  "It’s positive that the total number of nurses and midwives on the register increased by over 30,000 in the year to March 2023. However, with over 43,000 nurse vacancies in NHS Trusts in England alone, recruiting and retaining sufficient nurses remains critical to addressing the NHS workforce crisis. 

"Almost half of the new nurses and midwives joining the register in the last year were educated outside the UK, which once again reinforces how reliant we have become on recruitment from abroad to tackle domestic shortages. The number of new international registrants is now at its highest point in over three decades. This continued reliance on international 'quick fix' recruitment carries the risk that the UK is not investing in its domestic supply of nurses. It is also striking that one in 10 of all the new registrants are from World Health Organization ‘red list’ countries that experience severe staffing shortages, such as Nigeria and Ghana, a tenfold increase from four years ago, where red list countries accounted for just 1% of new registrants. 

"The NMC’s survey of people leaving the register also paints a concerning picture, with over half of respondents saying they are leaving the profession earlier than planned, pointing to burnout, lack of support and high workload as contributing factors. In order to retain existing nurses, and train and recruit the skilled professionals we need, a fully funded long-term workforce plan for the NHS and social care is urgently needed and long overdue."

 

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