NHS workforce: Challenges and solutions

For practice managers, understanding the challenges of doctor retention in the NHS is crucial for maintaining effective healthcare delivery within their practices. The BMA’s latest report sheds light on the pressing need to address workforce attrition to ensure stability and quality of care in primary care settings

CREDIT: This is an edited version of an article that originally appeared on The BMA

The British Medical Association (BMA) released a damning report highlighting the ongoing workforce crisis in the NHS, revealing the alarming rate at which doctors are leaving the profession prematurely. Titled “When a Doctor Leaves,” the report estimates that between 15,000 and 23,000 doctors quit the NHS in England in the year leading up to September 2023, well before reaching retirement age.

 An unsustainable situation

According to the General Medical Council’s (GMC) workplace experiences report, one in seven doctors in 2022 were taking steps to leave the UK profession, a sharp increase from one in fourteen in 2021. The BMA warns that the NHS cannot simply recruit its way out of this crisis; without addressing retention, efforts to bring in new staff will be in vain. The attrition rate not only costs the NHS billions but also threatens the quality of patient care.

Complex causes of attrition

The reasons behind this exodus are multifaceted, with the BMA report identifying four primary areas of concern: pay, working conditions, diversity and inclusion, and support for professional development.

Pay and financial strain

The fight for better pay has been front and centre, with many doctors having taken or sought strike action in recent months. Declining real-terms pay has driven many UK-trained doctors to seek opportunities overseas. Additionally, substantial student debt is influencing career decisions among recent graduates. The BMA suggests that cancelling debts and covering costs for mandatory exams could significantly help retain newly qualified doctors.

Burnout and working conditions

Poor working conditions and the resultant burnout are major contributors to attrition. The GMC found that, in 2021, 28% of secondary care doctors and 43% of GPs taking leave from medicine cited burnout and work-related stress as their main reasons. The BMA recommends addressing these issues by ensuring flexible working conditions, designing rotas that allow for breaks and leave requests, and enhancing access to occupational and mental health support services.

Diversity and inclusion

While the NHS is celebrated for its diversity, issues of bullying, harassment, and discrimination persist. The BMA’s 2022 report revealed that 9% of respondents left their jobs due to workplace racism, and 16% took sick leave or time off due to discrimination. The BMA urges employers to adopt a zero-tolerance approach to harassment and abuse, ensure fair reporting structures for discrimination, and promote organisation-wide accountability.

Support and professional development

Providing a supportive environment where doctors can thrive professionally is crucial for retention. This includes better parental leave schemes, access to childcare, and support for doctors nearing retirement or returning to practice. Ensuring that doctors with disabilities or long-term health conditions have access to reasonable adjustments is also vital.

The retention crisis in the NHS is a pressing issue that requires immediate and multifaceted solutions. The BMA’s report makes it clear that without significant efforts to retain doctors, recruitment alone will not solve the workforce shortages. By addressing the root causes of attrition—pay, working conditions, diversity and inclusion, and professional development—the NHS can create a more sustainable and supportive environment for its medical staff, ultimately benefiting both doctors and patients.