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13th March 2024
Almost one in 10 doctors across the European Union (EU) intend to leave their profession, according to a new cross-sectional study from the EU-funded METEOR Project, highlighting widespread retention issues.
Researchers from the METEOR Project – which collects scientific knowledge on job retention of healthcare workers in Europe to develop policy recommendations to increase job retention – asked 381 physicians and 1,351 nurses at hospitals in Belgium, the Netherlands, Italy and Poland about their intention to exit the profession or leave their current hospital, and the factors influencing their decisions to quit.
The results showed 9% of doctors and nearly 14% of nurses declaring an intention to leave their profession, citing low job satisfaction, growing depersonalisation and emotional exhaustion as the primary factors.
The survey also revealed 16.3% of doctors and 8.4% of nurses are considering leaving their current jobs. Factors impacting nurse and physician retention in hospitals highlighted job dissatisfaction, lack of career development and poor work-life balance as the main determinants of intention to leave,, which the researchers suggested can ‘help governments and hospital administrators combat the trend’.
Laura Maniscalco, co-author of the study and research fellow at the University of Palermo (UNIPA), said: ‘Many doctors want to leave their current workplaces because of the management and personal issues. In the high-stress environment of a hospital, they can face challenges in terms of work-life balance or conflicts that can result in bullying.
‘Additionally, the ineffectiveness of the management system and understaffing can force them to work in areas outside of their expertise, leading to role conflicts and reducing opportunities for career advancement.”
Domenica Matranga, a professor at the UNIPA and co-author of the study, added: ‘Our research suggests that nurses may [also] no longer find their job rewarding or valued. This issue is connected with relatively low salaries, tough working conditions and, of course, the physical and emotional pressure caused by the pandemic.‘
This latest study adds to ongoing research highlighting and addressing the pressures on clinical workforces across the EU and UK.
Recommendations to enhance the wellbeing of doctors in Europe were published in November 2023 as part of a new policy from the Standing Committee of European Doctors. These aimed to improve patient care, professional excellence and overall job satisfaction and included focusing on adequate staffing and workload management, embracing a people-focused working culture, championing mentoring and peer support networks and supporting doctors as parents and carers.
Staff retention and mental health issues have also been noted amongst UK clinicians in recent months. A survey of 1,958 NHS health professionals from across the UK in September highlighted understaffing as a main factor pushing healthcare workers to leave the NHS.
A UK surgical workforce census report published in January 2024 found that 61% of respondents cited burnout and stress as the main challenge in surgery due to excessive workloads, and 50% of respondents across all career grades indicated that they considered leaving the workforce in the past year.
And last summer NHS chief executive Amanda Pritchard acknowledged that the NHS was seeing higher levels of sickness among staff compared to pre-pandemic, particularly due to poor mental health and anxiety, some of which she said was ‘directly related to what people have been through over what was an extraordinarily difficult few years’.
The turnover crisis comes as the healthcare sector struggles with an existing shortage of medical personnel. Projections from the World Health Organization indicate that in six years Europe will need 18.2 million healthcare workers to meet the growing demand for healthcare services driven by an ageing population and increased prevalence of chronic diseases.
As a result, the authors of this latest METEOR Project study are urging healthcare managers across the EU to ‘devise effective retention strategies, taking into account job satisfaction, work engagement, and a positive working climate’, adding that ‘such internal policies are crucial, given the difficulty of finding replacements for departing professionals’.
15th December 2023
Senior doctors should get flexible or part-time working options and from the age of 60 should opt into on‐call only if they wish to, according to joint guidance from the Royal College of Physicians (RCP), the Royal College of Physicians of Edinburgh and Royal College of Physicians and Surgeons of Glasgow.
The new ‘Later Careers 2023’ guidance aims to support senior doctors aged 50 and over – some 47% of the physician workforce – to continue working sustainably and help to mitigate the current NHS workforce crisis.
Supporting the retention of senior doctors in this way ‘brings benefits to patients, the individual doctor, the hospital, and the wider medical community‘, the RCP said.
The document is an update of similar guidance from 2018 and is based on findings from a survey of doctors aged 50 and over conducted in 2022 by the three Royal Colleges.
The guidance also advises that the appraisal of senior doctors should be ‘sensitive and proportionate to their working arrangements‘, and that clinical leads ‘should begin discussions about doctors’ intentions for the next 10 years as early as felt necessary’, and certainly by the time a doctor turns 55.
Recommendations set out in the guidance include:
The survey underpinning the guidance found that one in three consultants who are not yet retired express they wish to retire early.
But over half of respondents (58%) said they would delay retirement and continue to work if they could reduce hours and/or work flexibly.
RCP censor and consultant gastroenterologist Dr Harriet Gordon said: ‘Senior doctors are incredibly valuable to the NHS and have much to contribute clinically, but also in teaching and mentoring the next generation of physicians.
‘Our survey showed that a large proportion of senior consultants have a strong interest in continuing working if it was possible to work more flexibly.
‘Considering the significant demands facing health services due to workforce shortages, this finding is encouraging. The guidance offers key recommendations that would support experienced hospital doctors to continue working sustainably in the NHS.‘
The Royal Colleges said they ‘will continue to promote this approach to governments and employers‘.
Earlier this year, data showed that one in five (19%) of consultant physicians are at risk of burnout, and an NHS consultant missing three days of work for mental health reasons is 58% more likely to leave three months later.
In June, NHS England published its own guidance for retaining doctors in late stage career within the NHS and supporting them to stay well.
After the publication of NHS England’s long-term workforce plan in July, Amanda Pritchard admitted that there were no ‘specific costs’ associated with retention elements of the plan.
The senior doctor workforce is a major concern for the NHS and last month the UK Government offered a 4.95% investment in pay for this financial year, on top of the 6% uplift, in order to avert further strike action.
But a 2023 survey showed that pay increases alone will only have ‘a modest impact’ on NHS staff retention because the main problems are stress and high workload.
11th December 2023
A new report from the British Psychological Society (BPS) is urging the Government to commit to further long-term funding for NHS staff mental health and wellbeing services, calling it ‘fundamental‘ for workforce retention, the delivery of the NHS Long Term Workforce Plan, and protecting patient care.
The BPS ‘Learning from the NHS Staff Mental Health and Wellbeing Hubs‘ report highlights the need for standards for staff mental health provision, amid concerns that staff struggling with their mental health could face a postcode lottery to access the support they need from a dwindling number of NHS Staff Mental Health and Wellbeing Hubs.
Set up in February 2021 to provide health and social care staff with rapid access to mental health support, ring-fenced Government funding for NHS Staff Mental Health and Wellbeing Hubs ended in March 2023, with integrated care systems (ICSs) either identifying short-term interim funding for their Hub for a defined period of time, or closing them.
The report highlights a data analysis from the Nuffield Trust showing six million sick days recorded for NHS staff due to anxiety, stress, depression and other psychiatric illnesses in 2022, with sickness absence associated with a higher likelihood of staff leaving the NHS.
And the same Nuffield analysis revealed that a consultant missing three days of work for mental health reasons is 58% more likely to leave three months later.
Further figures outlined in the BPS report showed demand for NHS Staff Mental Health and Wellbeing services is increasing.
Data from one hub recorded 404 people registering for one-to-one support between July 2023 and September 2023 – a 65% increase on the same period in the previous year during which 245 referrals were made – with one in five of those accessing one-to-one support identified as senior leaders.
BPS says its report aims to support health and care leaders make ‘crucial decisions‘ about future investment in local mental health and wellbeing services for their teams.
It cites evidence of the cost benefits for investment in mental health and wellbeing that shows an investment of £80 per member of staff in mental health support can achieve net gains of £855 a year through savings from absenteeism and presenteeism.
Noting ‘more than 121,000 unfilled jobs across the NHS in England today‘, Saffron Cordery, deputy chief executive of NHS Providers, said: ‘Heavy workloads and huge pressure on stretched services are leading to lots of staff feeling worn out. The effects of financial pressures on trusts and the cost of living crisis on staff amid the longest period of industrial action in the history of the NHS’ history have compounded problems of high staff turnover.‘
As a result, the report makes a series of recommendations, including that:
Dr Roman Raczka, president-elect of the BPS, said: ‘The ambitious measures set out in the NHS Long Term Workforce Plan are not a quick fix.
‘Existing and future staff members deserve to work in an environment that gives them the support they need, to provide the safe, high-quality care they as health and care professionals are proud to give.
‘Put simply, NHS and social care employers cannot afford to ignore the mental health needs of their workforce, if they wish to create a system that’s fit for the future.‘
25th September 2023
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.
13th June 2023
A chronic shortage of NHS radiographic professionals, coupled with anticipated surges in demand for heart and kidney scans due to the hot weather, will put patients’ lives at risk this week, the Society of Radiographers (SoR) has warned as it urges members in England to vote for strike action.
Already overstretched radiography teams will be putting in excessive hours to meet a rise in A&E visits caused by the current spell of hot weather, and patients arriving into A&E during this time will have to wait significantly longer for vital scans and diagnosis before their treatment can progress, says the SoR.
Hot weather typically means more cases of heatstroke, heart failure and kidney problems, as well as cuts, sprains, fractures and respiratory problems, which similarly need the attention of radiographic professionals, the Society adds.
Dean Rogers, executive director of industrial strategy and members relations at SoR, said: ‘Doctors and nurses cannot do their jobs without radiographic professionals.
‘Our members are dangerously overstretched. Even when the NHS is not facing increased demands because of the hot weather, nine out of 10 patients will need to see a radiographer, and waiting lists are growing.’
On 19 July 2022 – the hottest UK day on record – there were 638 excess deaths, and 496 excess deaths the following day, according to the Office for National Statistics. The July 2018 heatwave led to a record 2.2 million patients visiting A&E departments in a single month – the highest number since records began in 2010.
Vacancy rates for diagnostic radiographers have risen from 12% to 13% in the last year, and the SoR states that pressure on the radiographic workforce is growing due to widespread training and retention issues.
The SoR is urging its members to vote yes in favour of strike action. Launched on 7 June 2023, its ballot will close at 5pm on 28 June. This follows an indicative ballot in April 2023, in which members voted to reject the Government’s 5% pay offer and non-consolidated lump sum for 2022/23.
Mr Rogers added: ‘We know low pay and poor conditions are forcing radiographers out of the workforce, and they are not being replaced in adequate numbers. Vacancies are running at a minimum of 10 per cent and that’s even with radiographers working considerably more than their contracted hours to ensure that their patients receive the best-possible care.
‘That’s why we’re currently balloting our 20,000 members in England for better pay and working conditions. Every day, the crisis deepens, and this week’s weather will only increase the intolerable pressure on an already overstretched NHS. Our members deserve better. Our patients deserve better.’
Risks to patient safety due to staff shortages have also recently been highlighted by oncology professional organisations in an open letter to the health secretary.
30th May 2023
Burnout, retirement and a reliance on locum staff are among a host of concerns raised in a new report from the Royal College of Emergency Medicine (RCEM), which urges the UK Government to take action to support and maintain the emergency medicine (EM) workforce.
The report, entitled ‘Emergency Medicine Workforce in England’, published on 28 May, reveals the extent of the capacity and staffing issues experienced by emergency departments, which is having a negative impact on staff morale and retention, as well as on patient care.
For example, there should be one whole-time equivalent consultant for every 4,000 annual attendances, but the report states that this ratio currently stands at 1:7052. What’s more, some 45% of the total EM workforce is made up by trainee doctors, posing a potential threat to service provision, especially out of hours.
Another particularly pressing issue, the RCEM notes, is the ageing pool of consultants employed within emergency departments. Some 29% of its consultant members are now aged over 50. Many are doing fewer hours during this stage of their careers, and ‘with a third of the workforce approaching retirement age at the same time, we may witness a mass exodus of experienced senior clinicians’, the report states.
These issues have resulted in an overreliance on locum staff, which takes a significant percentage of the wage bill.
Highlighting that the system is stretched beyond capacity and requires the next generation of EM doctors to bolster it, the RCEM’s president Dr Adrian Boyle said: ‘You have to keep the topping up the team, and that is why we are urgently calling on the Government to commit to ensuring there will be at least 120 extra training places for EM doctors every year for at least six years.’
This recommendation from the report, which would see more than 700 new trainee EM doctors being trained between 2024 and 2030, aims to help achieve safe staffing levels, ease pressure on existing staff and support capacity and resilience in emergency departments.
Dr Boyle concluded: ‘We are still waiting for the long-promised NHS workforce plan. And it is becoming increasingly important that this is published as soon as possible to avoid the crisis in the NHS worsening; and that it contains specific numbers, details and costings. Nothing less would be a disservice to our members, their colleagues, to patients and the public.’
Staffing shortages are being seen across the UK and Europe, with a mass-exodus of hospital and healthcare staff being widely reported. In the UK, the much-anticipated NHS workforce plan has indeed been delayed once again as rumours circulate around its prohibitively high cost.
11th May 2023
The Essex Cardiothoracic Centre celebrates its 16-year anniversary this summer, and with a recent funding injection leading to the development of a new cardiac catheter lab, the centre is gearing up to support more patients requiring thoracic procedures in the county.
The Essex Cardiothoracic Centre (CTC), located at Basildon Hospital and part of Mid and South Essex NHS Foundation Trust, serves a population of 1.8 million people across the county.
Each year, approximately 900 cardiac surgeries, 500 thoracic operations and close to 2,400 cardiology procedures are performed.
The CTC recently received £2.3m in national funding, which has been spent on a new 60 square metre cardiac catheter lab, expected to open in May 2023. The development will free up theatre space for thoracic surgery and increase lung cancer surgery numbers by a third.
Hospital Healthcare Europe caught up with Michael Catling, deputy director of operations for the Essex Cardiothoracic Centre and Mid and South Essex Cardiology, to find out more.
Pre-2007, patients who needed heart or lung treatment had to travel to London as there was poor provision for these services in the county. The CTC was set up following a national requirement to increase capacity for cardiac surgery and specialist interventional cardiology procedures. The Department of Health selected Basildon as the site for a new Essex centre.
Our core capacity for thoracic surgery will increase by around 150 cases annually as heart procedures that were previously carried out in the hybrid theatre will be moved to the new cath lab, freeing up space.
We perform around 500 thoracic surgeries per annum of which around 180 are lung cancer cases. Demand has risen over the past five years, and until now, we have been reliant upon ad hoc additional lists, often taking capacity from cardiac surgery, which is not sustainable.
The ability to have an extra thoracic list every week in core capacity on the schedule without having to take any other service away releases the pressure and gives us the capacity to meet increasing demand in the coming years.
We provide a wide range of thoracic services for conditions of the lung, airway, pleura, mediastinum, chest wall and diaphragm. These incorporate cancer and benign disease with both open and minimally invasive approaches.
The main driver is improvements in diagnostic services for lung cancer, including targeted screening, which increases the detection of early-stage cancers. Local community and hospital services are shortening diagnostic pathways and increasing access to diagnostics.
One of our communities within Essex was in the first wave of the national Targeted Lung Health Check (TLHC) programme that launched in November 2020. In April 2022, this rolled out to a second location and current plans are to extend this to all populations.
As of March, at least nine people in Southend had previously undiscovered lung cancer found and treated thanks to the TLHC. The same programme is also benefiting residents living in Thurrock. The latest data shows that 4,834 checks have been completed in Southend.
In addition, there has been a total of 1,827 CT scans and 127 referrals into hospitals after those scans to follow up care linked to cardiovascular disease, gallbladder, respiratory, breast, gastro, urology, liver and renal findings.
A 16-bed cardiothoracic ITU, 32-bed cardiothoracic surgery ward, 28-bed cardiology ward, cardiothoracic theatre suite with four theatres including a hybrid IR theatre, cath lab suite including EP (electrophysiology) and structural labs, cardiac imaging including CT, MRI, special echo, outpatient suite, cardiac rehab department, pulmonary physiology department and overnight facilities for on-call teams and for relatives.
We offer a wide range of specialist tertiary services. Our higher volume procedures within cardiology are PCI (percutaneous coronary intervention), cardiac pacing, TAVI (transcatheter aortic valve implantation) and EP. Within the surgical service these are CABG (coronary artery bypass graft), AVR (aortic valve replacement), MVR (mitral valve repair), and complex aortic.
Additionally, over the past three years there has been a move from open lung surgery to minimally invasive lung surgery and our programme includes VATS (video-assisted thoracoscopic surgery).
Around 600. This includes consultant cardiologists, surgeons, anaesthetists, thoracic histopathologists, specialist nursing teams, cardiac physiologists, clinical perfusion scientists, surgical care and operating department practitioners.
We also have UK training posts and international clinical fellows and have developed a strong national and international reputation for research within the centre. This is supported by our excellent relationship with the Anglia Ruskin University Medical School faculty with which we have a research fellow programme.
We have several colleagues with roles in external organisations and learned societies such as the British Cardiovascular Intervention Society. They contribute regularly to national and international events including presentations at Society for Cardiothoracic Surgery 2023, and by providing live-streamed cath lab cases for the 2023 physiology course at the Cardiovascular Centre in Aalst, Belgium.
We’re very focused on doing what we do well, developing genuine tertiary services and particularly looking after our talented and passionate staff through training opportunities.
As a centre we are committed to offering excellent specialist training both to our own specialists and to related teams across Essex. The surgical team has delivered a programme of eight clinical simulation training events and wet labs over the past 12 months.
This has included two specifically related to the thoracic surgery service. In November 2022, we ran a lung resection day covering the teaching of both anaesthetic and surgical perspective with attendees from several other major tertiary centres in the UK.
In January 2023, we conducted a chest drain insertion day run jointly with the respiratory team, including hands-on simulation. Other courses in the past year have covered CABG, aortic and mitral valve surgery. This helps with staff development and retention.
As a specialist centre serving a large population and a number of local hospitals, our clinical plans incorporate continued development of specialist interventions and increased collaboration with local hospitals and primary care teams. This will include introduction of mitral TEER (transcatheter edge-to-edge repair), minimally invasive cardiac surgery, complex aortic surgery and thoracic port surgery techniques. We will be extending multi-disciplinary team working in chronic long-term conditions such as heart failure and atrial fibrillation through virtual ward models supported by latest technologies.
Our most important asset is our workforce, and we will continue to invest in training and education for our teams as well as developing new extended scope roles for advanced care practitioners.
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