Behind the headlines of NHS efficiency targets and financial recovery lies a deeper human impact: a significant reshaping of the workforce. As part of the 2025/26 financial plan, NHS England has mandated:

• A 2% reduction in total workforce headcount (substantive, bank, and agency).
• A 40% reduction in agency spend by March 2026.

For the clinicians, nurses, midwives, and allied health professionals delivering care day in and day out, these numbers translate into real consequences: rota gaps, mounting pressure, and strategic uncertainty.

This blog explores what these workforce targets mean in practice, the risks they carry, and how system leaders can respond to protect frontline capability while delivering required savings.

 

The Scale of the Workforce Shift

What’s Changing

• The overall NHS workforce is already 1.4% smaller than at the end of 2024/25.
• Pay costs have plateaued in real terms, but demand for care remains high and growing.
• Agency controls are being rigorously enforced, with reporting linked to deficit support.

Where Cuts Are Concentrated

• High agency-usage services, especially high-cost service providers.
• Support roles and intermediate care functions.
• Areas under transformation where services are being consolidated or digitised.

Strategic Takeaway: Workforce contraction is no longer theoretical. It is happening now, and frontline teams are feeling it. This does not mean the demand for service is reducing; instead, expectations to do more for less persist.

 

Key Risks to Frontline Care

1. Increased Burnout and Turnover

• Thinner staffing models mean fewer rest periods, higher stress, and less resilience.
• Morale risks escalate if reductions feel imposed rather than managed.

2. Skill Mix Dilution

• Loss of senior clinical expertise; approximately 12,000 clinicians have left the GMC register over the last two years.
• Band reconfigurations can erode supervisory structures and peer support.

3. Access Delays and Quality Deterioration

• Reduced staff availability can impact elective recovery, diagnostics, and community wait times.
• Safety risks rise where teams are overstretched or agency capacity is withdrawn too quickly.

 Strategic Takeaway: Workforce planning must look beyond headcount, quality, mix, and sustainability are equally critical.

 

Building a Resilient Response

Redeploy, Don’t Just Reduce

• Identify services with overcapacity and retrain or redeploy staff to priority pressure points.
• Create internal mobility schemes to retain skills within the system.

Rebuild and Strengthen Staff Banks

• Invest in trust-led and ICS-led staff banks where genuinely cost-effective.
• Many bank solutions, however, can be more expensive than agencies when factoring in premiums and operational costs.
• Enhance flexibility, onboarding, and incentives to boost internal deployment.
• Use agency where banks cannot safely meet needs, agency should complement care demand to keep patients safe.

 

Beware the Bank-Only Illusion

Over-reliance on banks can mask systemic strain. Banks depend heavily on permanent staff taking extra shifts, compounding fatigue and increasing the risk of burnout.

Moreover, paying external providers to run staff banks can lead to scenarios where Trusts pay a premium to utilise their own exhausted workforce.

Furthermore, it’s important to acknowledge that most bank solutions are underpinned by large agency supply chain. Banks themselves often engage hundreds of agencies to fulfil shifts. No single bank operator can sustainably satisfy system demand without this support, yet agency continues to bear the brunt of policy scrutiny. If agencies disappeared overnight, many banks and ultimately trusts would collapse under the weight of unmet staffing needs.

 

The Risk of Forced Migration

Severe budget pressures are driving some providers to accelerate the migration of agency staff onto bank arrangements. However, there is a fine legal and ethical line, workers must actively choose to join a bank; they cannot be compelled or coerced. Reports of Trusts or their intermediaries directly approaching agency staff to switch are not only contrary to fair practice, they may expose organisations to employment law risks and reputational damage, particularly where duty of care is compromised.

A sustainable strategy must respect staff autonomy, ensure safe working conditions, and preserve workforce goodwill, not merely shift costs from one ledger to another.

Support Wellbeing and Psychological Safety

• Prioritise mental health, rest spaces, and reflective practice.
• Leaders must be visible and proactive in supporting staff morale.

 

Enhance Workforce Planning Capability

• Use real-time data to match workforce supply with service demand.
• Collaborate across ICSs to develop shared workforce resilience strategies.

Strategic Takeaway: Shrinking the workforce without destabilising care requires thoughtful redesign, not blunt reduction.

The Role of Leaders

Leaders at every level must:

• Be honest with teams about the reasons for change.
• Involve clinical leaders and frontline staff in co-designing solutions.
• Balance national directives with local realities, advocating for flexibility where risks to patient care emerge.

Crucially, leaders have a responsibility to apply the lessons of Exercise Aegis consistently and honestly when assessing any workforce changes. The question must always be: is it safe to do so? Not just on paper, but in practice, under pressure, and at scale for the long term.

Boards must ensure that workforce cuts do not outpace safe operating levels and that Quality Impact Assessments (QIAs) are applied robustly.

 

Final Word from Altin Biba, MBA, AMBA Chief Executive of ProMedical

Efficiency in workforce strategy should never be a race to the bottom. Taxpayers’ money must be spent wisely, but not at the expense of deteriorating care for the very people who pay those taxes. A cheaper shift today is no victory if it leads to burnout, patient harm, and legal claims tomorrow.

At ProMedical, we champion a balanced, ethical approach, where agencies, banks, and permanent staff each have a role in a cohesive workforce strategy. We also caution against aggressive cost-cutting that shortcuts clinical judgement, legal safeguards, or respect for workforce choice.

As leaders apply Exercise Aegis principles, the question is no longer just ‘can we afford this?’, but ‘can we afford the consequences if we get it wrong?’. Workforce resilience is not an optional extra, it’s the frontline defence of patient care and public trust.

References

• NHS Financial Performance Update, July 2025
• NHSE Integrated Operational Performance Report, July 2025
• NHS England Board Meeting Minutes, July 2025
• NHS Staff Survey 2024
• The King’s Fund – Workforce Pressures Analysis
• Nuffield Trust – Workforce Resilience and Planning