Voting with their feet

‘Two steps forward and one step back.’

To the BMA, this turn of phrase aptly summarises the workforce crisis in the NHS and how the failure to stem the loss of existing and experienced doctors is undermining efforts to bring in new staff.

In a new and damning report titled When a Doctor Leaves, the association highlights how dire the staff attrition rate in the health service is, estimating that, in the 12 months from September 2022 to 2023, between 15,000 and 23,000 doctors quit the NHS in England ahead of retirement age.

The GMC’s most recent workplace experiences report found that, in 2022, one in seven doctors were taking ‘hard steps’ to leave the UK profession, compared with just one in 14 in 2021.

In its new report, the BMA warns bluntly that the health service cannot seek to recruit its way out of a staff-retention crisis, and attrition could ultimately cost the NHS billions and diminish the quality of patient care.

‘We cannot afford to lose more doctors,’ the report states. ‘The UK has a shortage of doctors [and] while these shortages are finally getting some much-needed attention on the national stage, the policy focus is almost exclusively on expanding recruitment and training extra doctors. Better recruitment is essential, but we also need to stop the flow of doctors leaving the health service prematurely.

‘Unless there is immediate action to better retain staff, plans to abate the workforce crisis will fall short. Recruitment, without retention, will be inefficient and ineffective at addressing workforce shortages in the UK’s health systems.’

While the factors driving staff attrition are complex and vary hugely, the report identifies four areas of discontent consisting of pay, conditions, diversity and inclusion in the workplace and the level of development and support offered to doctors.

The fight for better pay is one that will be unfamiliar to precisely no one, with doctors across almost all branches of practice having taken or sought strike action in the name of pay restoration during the past 18 months. 

While the phenomenon of UK-trained doctors opting to take up jobs overseas owing to declining real-terms pay is well documented, the BMA’s report also emphasises the role of student debt totalling tens of thousands is affecting career decisions made by recent medical graduates.

In addition to restoring long-term cuts to pay, the report makes clear a cancellation of debts and provision to cover costs for mandatory exams, would make a potentially enormous difference to keeping newly qualified doctors in the health service.

Poor working conditions, and the effect these have on doctors’ mental wellbeing, is a long-standing problem in the health service, and one the BMA’s report highlights as another prime cause of attrition.

In addition to the countless examples of anecdotal evidence provided to the association by its members, the GMC’s own research into attrition found that, in 2021, 28 per cent of secondary care doctors and 43 per cent of GPs taking a leave of absence from medicine pointed to burnout and work-related stress as the main motive for doing so.

Addressing unsustainable workloads and inadequate facilities and conditions are issues the BMA has campaigned for, and it reiterates recommendations made in its fatigue and facilities and mental wellbeing charters, as ways of addressing staff attrition.

These include employers committing to ensuring flexible working for all doctors and designing rotas to ensure staff can take breaks and access leave requests and enhancing access to occupational and mental health support services.

While the medical workforce and the NHS as a whole can be celebrated for its diversity, the need to improve inclusion and the challenges of bullying, harassment and discrimination towards staff with protected characteristics are unfortunately another factor in the issue of attrition.

The BMA’s 2022 report revealed 9 per cent of respondents had left their jobs owing to racism in the workplace, with 16 per cent taking sick leave or time off owing to discrimination, while doctors from the LGBTQ+ community having also felt forced to consider their positions owing to discrimination.

Tackling discrimination and making the NHS more inclusive should therefore be seen as critical to reducing attrition, with the BMA’s report urging employers to implement a zero-tolerance approach to harassment and abuse. 

It also calls for all doctors experiencing discrimination to have access to ‘fair and transparent reporting structures’ and for employers to adopt ‘organisation-wide accountability’ for addressing discrimination in the workplace.

Providing doctors with a supportive and nurturing working environments in which they can make the most of their skills and experience while also having the opportunity to enhance their professional development, is the final component towards addressing attrition cited by the report.

These include improving parental leave schemes and access to childcare, providing better support to doctors nearing retirement or those considering returning to practise from retirement, through ensuring flexible working arrangements.

Doctors with disabilities or long-term health conditions meanwhile can be helped to stay in the medical workforce through greater access to reasonable adjustments and ensuring that requests for such changes are met in a timely and supportive fashion.