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Stress and high workload confirmed as main reasons staff leave NHS

Pay increases alone will only have ‘a modest impact’ on NHS staff retention because the main problems are stress and high workload, according to the findings of a recent survey.

The survey of 1,958 NHS health professionals from across the UK also highlighted understaffing are a main factor pushing healthcare workers to leave the NHS.

Researchers from the universities of Bath, Sheffield and Leicester wanted to assess ‘push factors’ behind decisions to leave the NHS, and whether these were ranked differently by profession and NHS setting, a year after exposure to the effects of the pandemic.

The survey, carried out in summer and autumn 2021, determined the relative importance NHS staff gave to eight factors as the key reasons for leaving NHS employment.

It was completed across acute, mental health, community and ambulance services by 227 doctors, 687 nurses/midwives, 384 healthcare assistants and other nursing support staff, 417 allied health professionals and 243 paramedics.

Each respondent was presented with two push factors at a time, for all combinations of pairings, and asked to indicate which of these two factors is the bigger influence on why staff in each job role leave the NHS.

The factors compared were staffing levels, working hours, mental health/stress, pay, time pressure, recognition of contribution, workload intensity and work–life balance.

The findings, published in BMJ Open, showed that health professionals ranked work-related stress, workload intensity and staffing levels as the primary ‘push factors’ underpinning decisions to leave the NHS.

This prompted the authors to suggest that pay increases alone may not be sufficient to fix NHS staff retention.

They concluded: ‘Rankings of leave variables across the different health professional families exhibit a high degree of alignment, at the ordinal level, and highlight the primacy of psychological stress, staff shortages and work intensity.

‘While increases in pay are transparently important to NHS staff, findings from this research suggest that enhancements in that domain alone may produce a modest impact on retention.’

They said that ‘an equivalent conclusion’ might be drawn with respect to the ‘current high-profile emphasis’ on increased access to flexible working hours as a solution within contemporary NHS staff retention guidance to employers.

The authors added: ‘Both have potential to do good, but there are grounds for inferring there is a risk that neither may deliver sufficient good to redress the high and rising exodus in the absence of attention to what present as more fundamental factors driving exit.

‘Importantly, scope for addressing the highest-ranked factors driving exit, in large degree, lies beyond the gift of NHS employers.’

RCGP chair Professor Kamila Hawthorne said: ‘This latest survey highlights the point that resolving the workforce issues in UK healthcare is not about pay alone – we can’t expect issues which have been decades in the making to be resolved overnight.‘

A version of this article was originally published by our sister publication Pulse.