Ruth Bailey, FSRH Council Nurse Member reflects on the actions needed to address the SRH nursing workforce crisis

As the FSRH Council Nurse representative, I recently had the opportunity to address leading MPs and policymakers at the All Party Parliamentary Group on Sexual and Reproductive Health (APPG SRH) on the nursing workforce issues that impede the delivery of sexual and reproductive healthcare (SRH). It is vital that policymakers address these concerns to maximise the contribution of nursing expertise.

Nurses are the largest component of the SRH workforce and are critical to the delivery of contraception and sexual health, but – with currently over 46,500 vacancies in nursing coupled with unprecedented healthcare pressures – the workforce is in crisis. Nurses are facing physical, mental and emotion exhaustion post-COVID, with many feeling demoralised and burnt out by their increasing workloads and chronic understaffing. While some progress to ensure safe levels of staffing has been seen in Scotland via the Health and Care Staffing Act (which comes into force in 2024), there is currently no such legislative accountability in other nations – and poor staffing was cited as the most common reason for leaving the Nursing and Midwifery Council (NMC) register after retirement.

Widespread concerns have also been raised regarding nurses’ pay, and the Royal College of Nursing is calling for action to address the workforce crisis and its impact on patient safety. I am pleased that FSRH has put out a supportive statement during this particularly challenging time, recognising the vital contribution of nurses.

The number of nurses reaching retirement age is increasing and Primary Care is particularly affected as the average age of nurses is older in this setting. Two thirds of all contraception is delivered in Primary Care and increasing numbers of practice nurse vacancies directly impact on the provision of SRH. There is disparity in both salary and terms and conditions for nurses working in Primary Care, as most nurses are not employed on Agenda for Change contracts, which means there is a disincentive for nurses to transition to Primary Care.

There are also significant issues in SRH nurse education, training and development which limits service provision, particularly in terms of Long-Acting Reversible Contraception (LARC). The lack of clearly defined career pathways for nurses in SRH has stilted the development of many working in this field. At present, funding is only available to cover education course fees – as opposed to the backfill that is needed to cover a nurse on an educational programme, which is rarely available. This is a significant barrier to skills development. In addition, access to Faculty Register Trainers is limited in many areas and skills acquisition is not clearly linked to pay or career progression – meaning nurses may be disincentivised from progressing in their role.

Despite this bleak picture, the nursing workforce is filled with highly committed and skilled nurses who have enormous potential to broaden access to high quality SRH. In order to maximise the contribution of nurses, I believe the following changes are required;

1. Accountability for nurse safe staffing – Accountability for safe staffing levels must be enshrined in law in England, Wales and Northern Ireland to protect staff and people accessing services.
2. Investment in nursing workforce – Nursing pay must reflect the skills and expertise of this profession and investment in the workforce must be embedded in the NHS Workforce Plan.
3. Parity for nurse pay, terms and conditions – The introduction of standardised contracts in Primary Care that ensure equal pay scales and terms and conditions for nurses across all areas in SRH.
4. Commissioning SRH education and development, including backfill – Commissioning in SRH must include comprehensive commissioning in education and development, including backfill for learners, that reflects demand for SRH.
5. Structured career development that rewards advanced practice – There is a need to clarify standardised nurse career pathways in SRH, ensuring that skills acquisition and advanced practice is recognised and rewarded.

I am also pleased to Co-Chair of the FSRH Nurses Task and Finish Group, which has been established to take forward a set of separate recommendations developed by FSRH nurse members – including looking at nurse spread across devolved nations and forging a pathway for nurses to connect with each-other.

Change is urgently needed to equip the nursing workforce to deliver its central role in providing SRH across the UK. I look forward to continuing to advocate on behalf of FSRH’s nurse membership.

Ruth Bailey (She/Her)

Advanced Nurse Practitioner Sexual Health

FSRH Council Nurse Member

RuthRGNBrighton

If you would like further information on Nurse membership or want to get more involved, please contact Ruth Bailey at rbailey@fsrh.org