The Health Foundation claimed there has been a “hollowing out” of the NHS workforce and said the country needs to recruit at least 5,000 international nurses a year until 2023-24 to prevent shortages impacting on patient care.

Although there was the biggest annual increase in overall workforce for a decade between March 2018 and March 2019, this “masks an ongoing shift” in the mix of clinical staff employed by the NHS, the charity said.

While there was 4,500 more nurses recruited in the year – an increase of 1.5% – there was a 2.6% increase in support staff doctors, nurses and midwives (6,500 more), according to the analysis.

Nursing vacancies also reached record levels at 44,000 in the first quarter of 2019 while NHS output – including the number of operations, consultations and diagnostic procedures – grew by 23% between 2010-11 and 2016-17.

“The figures suggest that in some cases, clinical support staff are effectively filling in the gaps left by the widespread shortages of nurses, raising questions of quality and safety,” the report added.

The Health Foundation also said figures show that in response to a “severe drop off” in the supply of EU nurses since 2016, the UK has ramped up its recruitment of nurses from non-EU countries over the last year.

Since the Brexit referendum nurses recruited from EU countries has fallen by 85% – from 6,382 in 2016-17 to 968 in 2018-19.

The charity noted there had still been recruitment from outside the EU in 2018-19 – including 1,791 nurses from India and 3,118 from the Philippines.

A similar trend occurred with doctor recruitment, where there was a fall of 1.6% between March 2018 and March 2019 of permanently employed GPs. The Health Foundation added: “It now appears impossible that the government’s original target of recruiting 5,000 additional GPs by 2020 will be met”.

Anita Charlesworth, director of research and economics at the Health Foundation, said: “Nursing shortages continue to deepen and are inevitably impacting on the front line.

“Services are being forced to make do with shortfalls of increasingly pressurised nurses and rely on less-skilled support staff to pick up the slack.

She added: “Two obvious solutions to the nurse staffing crisis would be to train more nurses in this country and retain more existing staff. But the UK is struggling to grow the numbers starting nursing degrees, and while there must also be action to address this – for example, by giving nurse students the cost-of-living support they need – it will take time to have a significant impact on the numbers of nurses.”

Charlesworth noted that clinical support staff played an important role but added there appeared to be an unplanned increased recruitment of such staff to fill nursing staff shortages.