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Underfunded, underdoctored, overstretched - the NHS in 2016

Today the Royal College of Physicians launches a stark report on the challenges facing the NHS. The report paints a grim picture of an NHS struggling to cope under the increasing pressure of rising demand and inadequate funding, with resulting workforce pressures threatening patient safety.

Underfunded, underdoctored, overstretched: The NHS in 2016 draws on the experiences, views and concerns of consultant and trainee physicians, which, added to national evidence, show the grave situation we face.


The NHS budget has not kept pace with rising demand for services. Demand for NHS services increases by 4% every year but, in real terms, NHS funding will increase by only 0.2% per year to 2020, whilst social care cuts are piling pressure on NHS services. With recorded hospital deficits hitting £2.45 billion, money to transform services risks being sucked into a financial black hole.


The UK does not train enough doctors. The number of medical students has fallen and there is a shortage of doctors training to be medical specialists. This has left seven out of ten physicians-in-training working on a rota with a permanent gap. It has also had a knock-on effect on consultant physician posts, with hospitals failing to fill two in five of the posts that they advertise. Nurse shortages have increased the pressure, with 96% of physicians-in-training reporting gaps in nursing rotas. 


NHS staff increasingly feel like collateral damage in the battle between rising demand and squeezed budgets. Four in five physicians-in-training report that their job causes them excessive stress; three-quarters go through at least one shift a month without drinking enough water. When NHS staff wellbeing suffers, patient safety and experience suffer too: 95% of physicians-in-training report that poor staff morale is having a negative impact on patient safety in their hospital.

As a doctor, I realise that this is a tough diagnosis for the NHS. However, a diagnosis is the first step towards working with colleagues to find solutions. We are keen to find the best treatment for the NHS over the coming weeks, months and years.

RCP president Professor Jane Dacre

The pressures of an underfunded, underdoctored and overstretched NHS put patient safety and recovery at risk every day of the week – patients are facing longer waits for treatment, and the number of patients stuck in hospital because of delays in being discharged has increased by 80% in the past 5 years.  Reports of hospitals temporarily closing their doors owing to extreme pressure on beds and staff, usually associated with winter pressures, are now common throughout the year.      

Patients and communities deserve to know the true choice that we face – increase funding or cut care. The RCP believes they deserve more than that – an NHS funded and staffed to meet their needs, now and in the future. The NHS needs to meet the UK’s health and care needs in the long term, and to value, support and motivate NHS staff.

Increase NHS funding

The NHS budget has not kept pace with rising demand for services. We need a new NHS budget that:

  • meets the demand for health services
  • sets realistic targets for efficiency savings
  • protects funds for transformation
  • invests in the long-term sustainability of the NHS.

Train more doctors

The UK does not train enough doctors. Hospital teams are feeling the pressure of staffing gaps. That’s bad for them, and it’s bad for patients. We need to:

  • increase the number of medical students and doctors training to be hospital specialists
  • ensure overall training numbers are sufficient to deliver enough doctors across all parts of the medical workforce, from GPs to physicians
  • incentivise doctors to work in the most challenging and in-demand areas of medicine
  • address nurse shortages and promote innovative models of staffing, such as physician associates working alongside doctors
  • take cross-governmental action to relieve immediate pressure on the NHS workforce.

Improve the working lives of NHS staff

Being a doctor is intense, rewarding and challenging. A cared-for workforce delivers better outcomes for patients. In late 2016, the RCP will launch a new campaign to value and support doctors working in the NHS. We will:

  • work with our member doctors to find new solutions to workforce pressures
  • push for action from across government and the NHS
  • showcase the very best of medicine.

RCP registrar Dr Andrew Goddard said:

It is clear to all of us working in the NHS that we are at a point of no return and the NHS in its current form is unsustainable without a significant increase in funding. We can’t continue to provide ever-more-expensive treatments to an ever-increasing group of patients and not expect the system to collapse.

As doctors, we see the problems this creates on a daily basis, be it at the front door of the hospital, in A&E or in outpatients. Patients can see it too and realise that the NHS is no longer the envy of the world and isn’t fit for our changing world.

There are some big decisions that society has to make and the political parties have to stop blaming each other for where we are and work together to build a health and social care system that is fit for the UK in the 21st century.

Follow @RCPLondon on Twitter for more about the report and join the conversation using the hashtag #missionhealth

Notes to editors

A link to the report can be found on the RCP's Mission Health page.  Due to the large number of references, these are available separately. To arrange interviews and for further information, please contact Linda Cuthbertson on +44 (0)20 3075 1254 or +44 (0)7748 777919, or via email: linda.cuthbertson@rcplondon.ac.uk.