This article appears as part of the Inside the NHS newsletter.

How can you persuade people to stay when they want to leave?

Much of the focus when it comes to NHS staffing is on recruitment – on filling vacancies. Less attention tends to go towards preventing those vacancies in the first place through staff retention. Two reports this week suggest that should be a much bigger priority.

Junior doctors

One in three medical students in the UK say they plan on leaving the NHS within two years of graduation.

That was the headline finding from a survey of 10,486 medical students from across all 44 UK medical schools undertaken between January and March this year.

It is the largest study of its kind to date, representing more than a quarter (25.5%) of all those currently studying towards a degree in medicine.

It was published on Tuesday in the journal, BMJ Open.

The results were arguably overshadowed by separate research from England on the same day revealing the shocking scale of sexual harassment and assault faced by female surgeons – a problem that is almost certainly echoed in Scotland.

Nonetheless, alarm bells should be sounding if so many doctors are making plans to leave the NHS before their careers have even begun.

Only 41% of respondents – 4,294 students – said they intended to complete both foundation years in the NHS and go straight into specialty training.

Nearly one in five – 1,859 – said they planned to work as a locum doctor or pursue a "non-clinical" role instead after foundation training.

Some plan to leave medicine altogether.

Around one in 10 wanted to emigrate to practise medicine abroad after a single year of foundation training, while 2,071 planned to do so after two years.

Australia, New Zealand, the USA, and Canada were the most common destination countries.

Some international students planned to head home immediately after graduation to continue their training as a doctor.

Overall, around 1,400 of those questioned – nearly 14% – had no desire to return to the NHS once they started working in medicine abroad.

The reasons: "remuneration at junior level, work-life balance, lack of autonomy over choice of training location, and the working conditions for doctors in the NHS".

The Herald:
The Scottish Government averted strikes by junior doctors by agreeing a pay settlement that awarded them an uplift of 12.4% this year, backdated to April, and a guaranteed pay rise in line with inflation until at least 2026-27.

The hope will be that it does enough to retain the talent we need in NHS Scotland.

The researchers note that "intention doesn't necessarily translate into action, and minds may change".

However, they also stress that the problems extend beyond salaries and that more must be done to address "growing competition for specialty posts".

This is the hopeless situation in the UK whereby we end up with too many doctors-in-training versus the number of specialist training posts we fund, even in specialties like anaesthetics, radiology and psychiatry where we have acute shortages of consultants.

This makes no sense, and understandably drives would-be NHS medics to head overseas.

Read more:


More grim statistics were found in a separate survey of 1,958 NHS staff from across the UK, also published by BMJ Open on Tuesday.

The goal was to find out which "push" factors were most relevant in driving people to quit the health service.

Respondents – including doctors, nurses, midwives, paramedics, and physiotherapists – were asked to score eight factors in order of priority: staffing levels; working hours; mental health/stress; pay; time pressure; recognition of contribution; workload intensity; and work–life balance.

Pay ranked around middle on importance, although the survey was carried out in 2021 – pre-dating recent rampant inflation and the cost of living crisis.

The most important were stress, workload, and understaffing. It is a vicious circle, of course: if you struggle to retain staff, then workload and stress inevitably increase for those left behind, which in turn drives more people to quit.

Improvements in pay and flexible working "may produce a modest impact on retention", said the researchers, but "there is a risk that neither may deliver sufficient good to redress the high and rising exodus" unless the "more fundamental factors driving exit" – staff shortages, stress, and workload – are addressed.

On a slightly less pessimistic note, they caution that voluntary online surveys of this kind come with an element of "selection bias" – in other words, those with strong negative feelings will be most motivated to respond.

So the outlook may not be that bad, but it's still pretty bad.

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