Building the workforce for neighbourhood health

The Government’s 10-Year Plan for Health aims to reorient the NHS away from hospital-centred care and towards neighbourhood services that support people closer to home.
However, a Health and Social Care Committee update on 8 January 2026 warned that this transformation will falter unless the community workforce is strengthened.

Evidence presented to MPs highlighted serious shortages of district nurses, physiotherapists, pharmacists and occupational therapists, caused by worse pay, fewer opportunities for advancement and inadequate training in community settings compared with acute hospitals.
For providers like HomeCareDirect, the skills gap is less of a worry, as full and ongoing training is provided alongside specialised, nurse-led support.

Community careers are undervalued

The committee’s letter to Health Minister Karin Smyth described the community sector as less attractive to work in because it is perceived as lower status and offers limited career progression. Witnesses told MPs that most pre-registration training focuses on hospital settings, leaving students with little exposure to community practice.
Steph Lawrence, Chief Executive of the Queen’s Institute of Community Nursing, said many colleagues fear they will “de-skill” if they move into community roles.
A lack of advanced practice roles and a “glass ceiling” for allied health professionals were also cited as barriers to retention.

Pay is another issue. District nurses are typically paid at Band 6, yet they manage workloads comparable to hospital ward managers, who are usually Band 7.
The Nuffield Trust found that more than one in four district nurses in England are working below Band 6.
For allied health professionals (AHPs), witnesses noted that only one-third of pharmacists are qualified prescribers, and fewer than 10% work in community pharmacies.
Early‑career practitioners such as dietitians and occupational therapists struggle to find NHS roles; 21% of occupational therapists leave the NHS within two years of graduation.
These figures underscore why community roles struggle to attract and retain talent.

Training and supervision gaps

Committee witnesses emphasised that staff cannot simply be transferred from hospital wards to neighbourhood teams without proper preparation.
Community practice requires generalist and holistic skills, as well as the ability to work collaboratively across health, social care and voluntary organisations.
However, there is a lack of protected continuing professional development (CPD) time and insufficient clinical supervisors in community settings.
As Steph Lawrence explained, there is “no backfill” when staff attend training; without someone to cover their work, it’s difficult for them to take time out.
Amandeep Doll of the Royal Pharmaceutical Society pointed out that community pharmacists must be on site to supply medicines, limiting their ability to train off-site.
Without infrastructure and personnel to support early‑career staff, new recruits often leave the community sector.

Making community careers attractive

The committee concluded that the Government’s Neighbourhood Health Service “will not be delivered if the community sector offers staff worse pay, fewer opportunities to advance and poorer training and supervision than the acute sector”.
Layla Moran MP, chair of the committee, said there is broad support for shifting NHS services back to neighbourhoods, but the move could flounder if chronic workforce problems aren’t tackled.
She urged ministers to provide concrete action to improve conditions, so community-based clinicians and AHPs see these careers as attractive and valued.

The letter calls on the Government to set out training and support programmes for staff redeployed from hospitals and to ensure they have the capacity to engage with training. Witnesses also argued for leadership opportunities for AHPs within trusts, local authorities and commissioning bodies.
Without representation in senior roles, their expertise in rehabilitation, mobility and community support is underutilised. Investing in CPD, creating advanced practice posts and improving pay parity with hospital roles are essential steps to stop the “leaky pipeline” in district nursing and allied health professions.

Implications for home care

For HomeCareDirect and the people we support, a thriving community workforce is the bedrock of high-quality, personalised care.
District nurses, physiotherapists, pharmacists and occupational therapists not only provide clinical interventions but also help individuals manage long‑term conditions and maintain independence.
Training gaps or shortages in these professions place additional pressure on family carers and personal assistants, and can lead to unnecessary hospital admissions.

As the Government develops its workforce plan and neighbourhood health agenda, it must invest in community careers, create pathways for progression, and provide the training infrastructure needed to build a competent, motivated workforce.
Only then will the vision of neighbourhood health services and the home-care models built around them be truly realised.