Published: 24/03/2005, Volume II5, No. 5947 Page 36

London trusts are suffering from disproportionately high levels of staff turnover compared to the rest of the country. Ruth Hutt looks at initiatives designed to redress the balance

London continues to experience higher staff turnover and heavier use of internationally recruited staff than the rest of the country, according to a new survey report from the King's Fund. While there has been growth in staff numbers in London (which accounts for 15-20 per cent of England's total NHS workforce) London vacancies account for a third of all those in the NHS in England.

Trends in London's NHS Workforce: an updated analysis of key data examines London's healthcare labour market and finds the picture largely unchanged from an earlier report published in 2003.

There are problems recruiting midwives, with vacancies at over 8 per cent - compared to 3.3 per cent across England. Vacancies for allied health professionals in London are in excess of 9 per cent, compared to just over 4 per cent in England.

International recruitment has had some impact on managing nursing vacancies, but high use of temporary staffing remains a feature of the London NHS. GP vacancies remain a problem, with 424 vacancies reported across the capital in 2004.

Why are these problems continuing when staff numbers have increased?

Trusts may be finding it easier to fill new 'specialist' posts, particularly at higher grades, before they fill long-standing vacancies in more traditional settings.

There are also changing dynamics in the workforce. The proportion of women in medicine is increasing and remains high in other healthcare professions. Many staff want a better work-life balance than the NHS has traditionally offered. This requires employers to be increasingly flexible, otherwise the additional flexibility offered by agencies can be very attractive to those choosing to work part time.

Encouragingly, increasing numbers of mature students are entering professional training, with more people who are already settled in London choosing to train as nurses. Improving Working Lives also appears to be having an impact on retaining staff through initiatives such as increasing childcare provision.

The shift in service delivery from hospital-based services to those delivered in the community will put increasing pressure on community services, which are already stretched and tend to rely on an older workforce.

Increases in training and development opportunities are required to help staff move from acute to community and primary care settings at an earlier stage of their careers.

Most importantly, NHS trusts and London local authorities must collaborate to address broader retention issues such as affordable accommodation, childcare and transport for staff if Londoners are to receive a better deal in the future.

Ruth Hutt is a visiting fellow in health policy at the King's Fund.

The full report is available at www. kingsfund. org. uk