For years, the NHS has faced the twin challenges of recruiting enough staff and keeping them. Now, in an unexpected reversal, some parts of the health service have more newly qualified nurses and midwives than vacancies to fill. This unusual situation has been driven by a surge in graduates following the Covid pandemic and improved retention rates among existing staff. While it is good news that more people are joining and staying in the profession, it has created a problem for those trying to take their first steps into an NHS career.
The “Graduate Guarantee” is the government and NHS England’s answer. Developed with the Royal College of Nursing and the Royal College of Midwives, the plan is designed to help new entrants find secure employment and receive the support they need to succeed. The initiative is a mix of early recruitment, targeted investment, and structured mentoring, with the aim of giving graduates a smoother and faster route into the workforce.
One of the key changes is allowing NHS providers to recruit newly qualified nurses and midwives before vacancies formally arise. Instead of waiting for posts to become available, organisations can hire based on projected demand. This approach should reduce delays and give graduates more certainty about their career plans. The scheme also includes £8 million to convert vacant maternity support worker posts into Band 5 midwifery roles. This is a relatively modest sum in the context of NHS budgets, but it creates meaningful opportunities for midwifery graduates who might otherwise have struggled to find suitable roles.
An online support hub will offer guidance during the job search and application process, while enhanced onboarding will give new staff structured preceptorship programmes and access to mentors. These steps are designed to build confidence, improve job satisfaction, and reduce early attrition: a persistent problem in the NHS workforce.
The logic behind the Graduate Guarantee is sound. Having invested heavily in training nurses and midwives, the NHS should make sure they can put their skills to use. Leaving graduates without roles risks losing them to other sectors and undermining morale. A better transition from education to employment should help retain talent and strengthen teams, ultimately benefiting patients through improved staffing levels and continuity of care.
But there are questions that need to be addressed. The first is funding. The Graduate Guarantee has been welcomed, but without a clear commitment to long-term investment, it risks being a short-lived fix. Workforce planning requires stability, and short-term funding cycles make it harder for providers to commit to permanent roles.
There is also the question of equity across the health professions. Nurses and midwives are not the only groups facing job market pressures. Other professions, such as physiotherapists and occupational therapists, also report challenges in securing NHS roles after graduation. Policymakers will need to decide whether similar guarantees should be extended more widely, or whether resources should be focused where the pressures are greatest.
The Graduate Guarantee should be judged not only on how many graduates it places in roles but also on how well it supports them to stay. The risk with any recruitment drive is that the emphasis falls on filling vacancies rather than building careers. The mentorship and preceptorship elements are encouraging, but they will need to be delivered consistently and to a high standard if they are to make a real difference.
If implemented well, the Graduate Guarantee could become a model for other parts of the NHS workforce. It tackles a very specific challenge with targeted, practical measures, and it acknowledges the importance of supporting staff through their early years. The ultimate measure of success will be whether those who benefit from the scheme are still working in the NHS in five or ten years’ time.
For now, the Graduate Guarantee offers hope to new nurses and midwives looking for their first opportunity to serve. Turning that hope into lasting careers will require not just a well-designed scheme but the political will to sustain it.
