Recent analysis of UK workforce data has highlighted significant pressures across clinical immunology and allergy services, with consultant shortages leaving some services extremely fragile, and wide variation in staffing across the country and across professional groups.
This report was funded through the provision of educational grants from BioCryst, CSL Behring, Grifols and Octapharma. These organisations have neither influenced nor contributed to the content of the report or any of its associated activities.
A workforce report from the British Society for Immunology Clinical Immunology Professional Network (BSI-CIPN), published in December 2025, brings together available national and regional data to present a clearer picture of staffing across the specialty. The findings show that workforce capacity varies substantially between regions and professional groups, with implications for service resilience and patient access to specialist care.
Clinical immunology and allergy services play a central role within the wider immunology landscape, providing specialist expertise in the diagnosis and management of immunodeficiencies, complex allergies, autoimmune and autoinflammatory conditions, alongside essential laboratory and diagnostic services. As immune-based therapies become more widely used across healthcare, the need for specialist immunology input continues to grow, making the resilience of this workforce increasingly important for the health system as a whole.
“Clinical immunology and allergy is a small but critical NHS specialty, yet years of inadequate workforce planning have left services under-resourced and, in some areas, close to collapse,” said Professor Sinisa Savic, Chair of the BSI-CIPN and Consultant in Clinical Immunology and Allergy, Leeds Teaching Hospitals NHS Trust. “Despite the dedication of our clinical teams, current staffing levels cannot keep pace with clinical demand. This report sets out clear evidence of services at breaking point, with staff stretched to look after huge populations. Too many patients are facing a postcode lottery when it comes to access to services, with the situation in Scotland and Wales particularly critical.”
“With this report, we are calling for an urgent, nationally led workforce review with sustainable, long-term planning at its centre. To inform this, we need better data on workforce activity, capacity and demand. Policymakers must act now to reduce pressure on services and ensure specialist clinical immunology and allergy services can be accessed by everyone who needs them – no matter where they live. The BSI-CIPN stands ready to work with the wider sector to implement the report’s recommendations and build vital capacity within the specialty.”
The report identifies fifteen services across the UK that are operating with only one or two medical consultants. These services are particularly vulnerable, as the departure, illness or retirement of a single consultant could leave them without a medical lead and place the service at risk of collapse. Such fragility not only affects service continuity but also has consequences for patients, who may experience delays, fragmented care pathways or the need to travel out of area to access specialist expertise.
Staffing pressures are not limited to medical consultants. The report highlights substantial variation across nursing, healthcare science, technical and support roles, underlining the need for a more comprehensive understanding of workforce capacity across all professional groups. Specialist services rely on multidisciplinary teams, and gaps in any part of that workforce can affect how care is delivered, how services function day to day and how resilient they are to further pressures. This variability contributes to inconsistent service provision and reinforces the need for coordinated national planning.
"This new report showcases just how fragile the workforce has become due to a lack of workforce planning. My nursing colleagues work hard to deliver quality care to our clinical immunology and allergy patients as part of a multi-disciplinary team, and as workload increases, support for the workforce must keep pace,” said Jill Edmonds, Nursing Representative for the BSI-CIPN and Consultant Nurse, Liverpool University Hospitals NHS Foundation Trust. “Support for our patients is at the heart of what we do, and our patients deserve to be confident in accessing services no matter where they are in the country. It’s clear that now is the time for a national workforce review and for policymakers to establish a long-term plan to stabilise and grow clinical immunology and allergy services.”
Adding to this, Rachel Dale, Healthcare Scientist Representative for the BSI-CIPN and Clinical Scientist, University Hospitals of Derby and Burton NHS Foundation Trust, said, "Healthcare scientists are a crucial part of the clinical immunology workforce. We must better support our valued staff currently working within clinical immunology and allergy to ensure that a career in the sector is both rewarding and attractive and promotes ongoing professional development. This report demonstrates that additional resource is needed to be able to nurture and retain new talent coming into the specialty across professional groups. Longer term, comprehensive, workforce planning is needed, with training pathways at the core of this. It’s time for policymakers to commit to bolstering the immunology and allergy workforce for the future."
Currently, nowhere in the UK meets recommended consultant-to-population levels of one consultant per 451,000 (recently published by the Royal College of Pathologists). Particularly concerning figures are shown in Scotland, where there is just one medical consultant for every 2,054,407 people, and Wales, with one for every 1,062,333 people. Scotland is also significantly understaffed in specialist nursing, with just one immunology nurse per 1,180,191 people.
Where local staffing is insufficient, services increasingly rely on cross-border referrals to maintain access to care – for example, Newcastle supports Scotland, Manchester supports North Wales, and London supports the South East. While this helps mitigate immediate gaps, it can result in fragmented care pathways and places additional pressure on better-resourced centres. The report emphasises that every region should be adequately staffed in its own right to support equitable access to specialist services.
Beyond visible pressures on clinics and waiting lists, the report highlights that much of the work delivered by immunology and allergy teams happens behind the scenes. A significant proportion of care for people with immunodeficiency and complex allergies occurs outside formal outpatient clinics, including telephone advice, email communication, review of results and essential laboratory liaison. These activities are often not captured in routine service metrics, meaning that staffing needs may be underestimated during workforce and service planning.
This ‘hidden’ workload reflects daily reality for many clinical immunology and allergy staff and reinforces the need for better data to accurately represent the full scope of clinical, scientific and nursing practice within these services.
BSI-CIPN recommendations
In response to these findings, the BSI-CIPN sets out a series of evidence-based recommendations. These include urgent, nationally driven full-service reviews of clinical immunology and allergy services in each UK nation to establish the workforce required to deliver safe and sustainable care.
The report also calls for improved national data on service activity, workload and outcomes to support more accurate workforce planning, alongside routine long-term workforce strategies that include training pathways across all professional groups. Increasing training and consultant posts, strengthening support for nursing and healthcare science roles, and ensuring protected time for education and professional development are identified as key priorities.
Clinical immunology and allergy services provide vital care for their patients. When these services are understaffed, it creates a challenging and unsustainable situation for the dedicated teams working to keep them running. We urge national decision-makers to implement the recommendations in this report to prevent the situation from worsening and to ensure that patients across the UK can receive the care they need from these specialist teams.
Acknowledgements
We would like to thank the professional organisations that contributed insights and recommendations to inform this report, providing valuable perspectives on the specific challenges in their own areas and helping to support the clinical immunology and allergy workforce. These organisations are:
- The British Society for Allergy and Clinical Immunology
- The Immunology and Allergy Nurses Group
- The LabMed Immunology Professional Committee
- The Institute of Biomedical Science
- The Royal College of Pathologists
- The Association of Clinical Pathologists