AS ALWAYS FIRST THINGS FIRST:

NMC Social Media Compliance Disclaimer

This article represents my personal professional reflections as a registered nurse in Somerset. It has been written in strict accordance with the Nursing and Midwifery Council (NMC) Code of Professional Standards (2018) and the NMC’s Social Media Guidance. Specifically, it complies with section 5 (confidentiality) and sections 20.10–20.11 (responsible communication and upholding public trust).

No patient‑identifiable information or confidential data are disclosed. All examples are anonymized and based on peer‑reviewed evidence. The views expressed are entirely my own and do not represent the official positions of any NHS organization, employer or regulatory body.

LET’S GET TO THE MEATY BIT:

Introduction

The UK nursing profession is at a pivotal juncture. Years of systemic underinvestment, coupled with a changing population profile and heightened workplace pressures, have culminated in a workforce crisis. Nowhere is this felt more sharply than in rural counties such as Somerset. As a senior nurse based in Somerset, I have witnessed first-hand the intensifying recruitment and retention issues, compounded by an aging workforce and structural inequities in pay and development opportunities. This blog entry examines these intersecting challenges through a regional and national lens, framed within the Nursing and Midwifery Council (NMC) Code (NMC, 2018) and current workforce research.

Pay Disparities and Workforce Motivation

Real‑terms NHS pay for nurses has declined significantly since 2010, with cumulative losses exceeding 10% for Band 5 nurses (RCN, 2023). At the time of writing (May 2025), the Government has tabled a further consolidated rise of 3.6% for the 2025/26 financial year. The Royal College of Nursing has opened a consultation ballot asking members whether this offer is acceptable, with the possibility of renewed industrial action should it be rejected (Royal College of Nursing, 2025).

In parallel, the British Medical Association is balloting doctors on a separate pay deal and has not ruled out coordinated strikes if the proposal is deemed insufficient (British Medical Association, 2025). The 2023/24 NHS pay deal, offering an average 5% uplift, failed to keep pace with inflation (NHS Employers, 2023). While Foundation Trusts have the legal autonomy to offer recruitment and retention premiums (RRPs), this flexibility is inconsistently applied, and often inaccessible to less affluent Trusts (Appleby et al., 2022).

Pay remains a cornerstone of workforce morale. Financial insecurity has led some nurses to rely on food banks or undertake multiple jobs (RCN, 2022). This undermines professional dignity and leads to attrition. Pay also affects recruitment; new graduates are increasingly drawn to private or international sectors where compensation is more competitive (Buchan et al., 2023). Somerset, with its lower average housing affordability and limited pay flexibility, is disadvantaged in attracting talent when compared to neighbouring urban centres such as Bristol or Exeter.

Retention and Burnout

According to the NMC (2023), over 27,000 nurses left the UK register in the last year. Health Foundation data (2022) indicates that job dissatisfaction, burnout, and limited progression routes are principal drivers. In Somerset, retention is further challenged by geographic isolation, limited public transport, and higher workloads in community and primary care settings due to GP shortages (Somerset ICB, 2023).

Staffing gaps exacerbate workload pressures, creating a vicious cycle of burnout and departure (West et al., 2020). Moreover, retention strategies often neglect mid-career nurses, focusing on new starters and overseas recruits. Flexible working, clinical academic roles, and protected supervision time have been shown to increase longevity in practice (HEE, 2021).

Impact on Standards of Care

Evidence links poor nurse staffing with negative patient outcomes. Aiken et al. (2014) demonstrated a 7% rise in hospital mortality for every additional patient added to a nurse’s workload. The CQC (2023) continues to cite staffing as a key contributor to poor care ratings.

In Somerset, under‑resourced community services mean patients are often managed at home with minimal clinical oversight (Somerset ICB, 2023; Care Quality Commission, 2023). This increases reliance on newly qualified staff and agency workers, affecting continuity and safety (Health Foundation, 2022).

The Aging Workforce

Nationally, one-third of registered nurses are aged over 50 (NMC, 2023). In Somerset, 32% of community and mental health nurses are over 55 (Somerset LWAB, 2020). This presents an impending retirement cliff. Older nurses often have specialist skills and act as informal mentors, meaning their loss creates a dual deficit — both in expertise and team cohesion.

Many aging staff in Somerset also cite physical fatigue, inflexible shift patterns, and limited phased retirement options as reasons for early exit. Role redesign — such as educational, advisory, or hybrid remote positions — could help retain their expertise longer (Phillips et al., 2021).

Can Trusts Offer Higher Pay?

Foundation Trusts can offer RRPs and flexible pay bandings under Agenda for Change provisions, but this practice varies significantly. In Somerset, few posts have leveraged such tools due to financial pressures and historical workforce planning gaps. Trusts such as Northumbria Healthcare have used RRPs effectively to retain staff, reducing turnover by up to 15% (Buchan et al., 2023).

However, this creates inequity. Nurses may move between Trusts for marginal pay gains, increasing instability. A national framework for equitable use of RRPs, especially in rural areas, is urgently needed. Otherwise, wealthier Trusts will continue to attract staff at the expense of regions like Somerset.

Local Innovation and Workforce Expansion

Somerset NHS Foundation Trust has implemented several forward-thinking strategies:

• Volunteer to Career Programme: Converts volunteers into clinical support workers and eventually qualified nurses (Somerset NHS FT, 2022).
• Flexible Staffing Pools: NHS Professionals bank partnerships reduce agency dependency.
• Digital Recruitment Platforms: Collaborations with Oleeo have improved application-to-offer times and candidate diversity (Oleeo, 2022).

These initiatives demonstrate that innovation is possible — but they require sustainable funding and must be scaled with workforce forecasting.

Personal Reflection

Nursing in Somerset is a privilege — but also a profound challenge. Our teams are compassionate, creative, and resilient. But goodwill alone cannot sustain safe staffing. Policy must meet professionalism. Pay must reflect purpose. And planning must include voices from every region.

References

Aiken, L.H. et al. (2014) ‘Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study’, The Lancet, 383(9931), pp. 1824–1830.

Appleby, J., Gershlick, B. and Charlesworth, A. (2022) Pay and the NHS workforce. London: Health Foundation.

British Medical Association (2025) BMA launches consultative ballot on government pay offer. London: BMA. Available at: https://www.bma.org.uk (Accessed: 24. May 2025).

Buchan, J., Ball, J. and Shembavnekar, N. (2023) Resilience and Renewal: NHS Workforce Trends Post‑Pandemic. London: Nuffield Trust.

Care Quality Commission (2023) State of Care 2022/23. London: CQC.

Health Education England (2021) Enhancing Clinical Academic Careers for Nurses. London: HEE.

Health Foundation (2022) Understanding NHS Workforce Retention. London: Health Foundation.

NHS Employers (2023) Pay deal for NHS staff 2023/24. Available at: https://www.nhsemployers.org (Accessed:  24. May 2025).

Nursing and Midwifery Council (2018) The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. London: NMC.

Nursing and Midwifery Council (2023) Annual Registration Report 2023. London: NMC.

Oleeo (2022) Somerset NHS Foundation Trust Recruitment Case Study. Available at: https://www.oleeo.com (Accessed:  24. May 2025).

Phillips, J.L., Davidson, P.M. and Jackson, D. (2021) ‘Advancing workforce retention through adaptive role design’, Journal of Nursing Management, 29(6), pp. 1443–1450.

Royal College of Nursing (2022) Nursing Pay and Living Standards. London: RCN.

Royal College of Nursing (2023) Fair Pay for Nursing: 2023 Update. London: RCN.

Royal College of Nursing (2025) RCN launches consultation on Government’s 3.6% pay offer. London: RCN. Available at: https://www.rcn.org.uk (Accessed:  24. May 2025).

Somerset Integrated Care Board (2023) Primary Care Workforce Report. Taunton: Somerset ICB.

Somerset Local Workforce Action Board (2020) Workforce Summary: Community and MH Services. Taunton: LWAB.

Somerset NHS Foundation Trust (2022) Volunteer to Career Scheme. Available at: https://www.somersetft.nhs.uk (Accessed:  24. May 2025).

West, M.A., Bailey, S. and Williams, E. (2020) The Courage of Compassion: Supporting Nurses and Midwives to Deliver High Quality Care. London: King’s Fund.