Why 97,475 vacancies do not turn into locum sessions

The NHS in England reported 97,475 vacancies at 31 March 2026, and the NMC register has never held more nurses, midwives and nursing associates. Both sit alongside a third fact: GPs who cannot fill a diary, nursing graduates who find nothing permanent, and locums whose income now arrives in lumps. The numbers are not contradictory. They describe how money reaches a rota, which is a different question from how many clinicians exist.

What the vacancy count actually measures

NHS England Digital published its vacancy statistics for the year to 31 March 2026 on 28 May 2026, and the headline was a fall. Total vacancies stood at 97,475, a rate of 6.5%, down from 100,114 and 6.7% a year earlier. Nursing and medical posts moved the same way.

Two things are worth holding on to. The series is experimental, so direction matters more than level. And a vacancy is a post reported as unfilled, not a post an organisation can afford to fill, and not a session a practice would like covered but cannot pay for. The last two are where locum work comes from.

The registers are at record size

The NMC reported 867,935 nurses, midwives and nursing associates on its register at 31 March 2026, 14,228 more than a year earlier and around 2.5% of the UK working population. Growth slowed to 1.7% from 3.3%, with 41,542 joiners against 30,323 leavers, and international joiners fell to 26.4% of new registrants from 39.1%.

General practice shows a similar shape. The Nuffield Trust's workforce analysis, using December 2025 data, records fully qualified GPs flat at 28,800 full-time equivalents, the share of the GP workforce holding a partnership down from 68% in 2015 to 46% in 2025, and leaving rates for professional clinical staff at 9.4%, the lowest in a decade. The RCGP counts 4,090 GPs qualifying in 2024, a 43% rise on the 2,861 in 2019.

There are more people, and in general practice fewer of them in the traditional job. The register is not the constraint.

Funding routes decide who covers the gap

In general practice, the money that pays a locum invoice is not the money that funds a reimbursed role. Core practice funding rose 3.6% (£485m) for 2026/27, about 1.4% in real terms. The same contract removed the ARRS restriction that limited PCNs to recruiting newly qualified GPs, and lifted the top GP reimbursement rate to the top of the salaried GP pay range plus on-costs.

Read that from the practice's side of the desk. A GP employed through ARRS is reimbursed. A locum session comes out of the practice's own funds. When both would fill the same clinic, the reimbursed route wins on cost, and the vacancy stops being locum work.

The pressure on those own funds is real. The Lowdown reported in May 2025 that 45% of practice managers named funding shortages as the main barrier to employing more GPs, with general practice staff seeing 22.5% more patients in 2024 than in 2019 while GP funding fell by nearly £350m in real terms, a 6.9% reduction, since 2019. In the RCGP's November 2025 survey of 493 practice managers, 301 (61%) expected to need more GPs within 12 months, while 451 (92%) cited lack of funding as a major barrier and 411 (83%) cited the 2025 rise in employer National Insurance.

In hospitals the mechanism differs but the effect rhymes. NHS England's agency rules cap what a trust may pay per hour, inclusive of holiday pay, employer National Insurance, pension and the agency's fee, and trust-level limits now sit on bank spending as well. A shift that once reached an agency locum is offered internally, then to the bank, and only then outside.

The squeeze lands hardest on the newly qualified

The RCN audited advertised nursing jobs in July 2026 and found that of 317 vacancies in England, only 82 (26%) were full time, permanent and open to applicants without professional experience. It says graduates were "blocked from at least a third of entry-level nursing jobs" that month, with 33% of Band 5 vacancies requiring experience a new registrant cannot have. Its own regional figures, an audit rather than an official series, put that 26% at 13% in the East of England and in Yorkshire and the Humber. The RCN counts more than 20,000 unfilled full-time equivalent nursing posts in England.

General practice shows the same pattern one grade up. In the RCGP's survey, of 156 final-year ST3 registrars who had looked for work, 103 (66%) found it difficult. Of the 79 who had not found a job, 56 (70%) said there were not enough suitable roles anywhere in the country and 51 (65%) were considering leaving the UK. At least 456 GPs had applied to the GMC for Confirmation of UK Training during 2025 as at 31 October 2025, a proxy for working abroad.

What the surveys agree on, and where to be careful

The RCGP surveyed 2,316 GPs through its GP Voice Survey. Of 1,841 practising GPs excluding first and second year registrars, 490 (27%) had looked for work in the past year and struggled to find a vacancy: 143 of them (29%) could not find a job offering enough sessions and 388 (79%) said there were no appropriate roles where they wanted to work. The same wave found practices with a GP role open for more than three months had fallen to 9%, from 21% in 2024 and 44% in 2022. Long-open GP posts are becoming rare while GPs looking for sessions are not.

The BMA reports higher numbers still on its GP unemployment campaign page: 56% of respondents wanting more NHS hours without finding suitable opportunities, 15% unable to find any GP work and 60% reporting falling pay rates. A separate BMA survey reported by The Lowdown in May 2025 found 84% of locum GPs in England struggling to secure consistent work. The page does not state how many GPs answered, so treat these as findings among respondents rather than a measured share of the profession. The direction matches the RCGP evidence; the magnitude should not be quoted as a population figure.

What to do about an income that arrives in lumps

• Measure in sessions or shifts per month across a rolling quarter, not against last month. A thin fortnight is noise. Two thin quarters is a trend, and the trend is what should change your rate conversations.
• Reserve tax from each payment as it lands, not from what survives the month. Sessional's tax reserve calculation does this per invoice, and the guide to tax for locums covers how the reserve behaves on uneven income.
• Ask which budget pays before counting a vacancy as work. Reimbursed ARRS post or practice funds, trust bank or agency framework: the answer tells you whether the gap is purchasable.
• Widen the routes deliberately. Direct engagement by practices, hospices, private providers, occupational health and insurers sits outside the NHS agency and bank limits, and current compliance documents are what let you accept at short notice.
• Use the quiet weeks for the appraisal and revalidation evidence you would otherwise write in a hurry. An empty Friday is good for that, if nothing else.

If you are a GP, a nurse or a hospital doctor wondering why the vacancy headlines never reach your diary, the work has not gone. The funding route that bought it has moved, and the record on your side of that is the part you control.

Sources

• NHS Vacancy Statistics England, April 2015 to March 2026, Experimental Statistics (NHS England Digital, 28 May 2026)
• The NMC Register 1 April 2025 to 31 March 2026 (Nursing and Midwifery Council, 29 July 2026)
• Nursing students face unemployment despite NHS vacancies (Royal College of Nursing, 27 August 2026)
• Nurses stacking shelves as graduates blocked from third of entry level NHS jobs last month (Royal College of Nursing, August 2026)
• The GP workforce gap: survey evidence on GP employment (Royal College of General Practitioners, November 2025)
• Our campaign to tackle GP unemployment in the UK (British Medical Association)
• The NHS workforce in numbers (Nuffield Trust, December 2025 data)
• GP contract 2026/27: what you need to know (NHS Confederation and NHS Alliance, 24 February 2026)
• GPs trained but unable to find work: why the NHS funding crisis is causing GP unemployment (The Lowdown, NHS Support Federation, 27 May 2025)
• Agency rules (NHS England, 5 April 2023, updated 19 November 2025)