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24th July 2024
Improving working conditions and introducing incentives in four key areas have been suggested as ways to retain healthcare professionals in hospitals, according to the EU-funded METEOR Project.
Published in the journal Qualitative Health Research, the findings highlight professional and personal support, education, financial incentives and regulatory measures as the main factors that healthcare organisations should focus on to retain their staff, in addition to improving working conditions.
The study involved a series of eight online co-creation workshops and four Delphi sessions surveying nurses and clinicians at eight European hospitals in four countries: Belgium, the Netherlands, Italy and Poland.
A thematic analysis was conducted, resulting in multiple interventions that were clustered into the four pre-defined themes.
Interviewees in all four countries emphasised the importance of leadership training, interdisciplinary teamwork and support for the non-clinical workload as key factors that could improve their working conditions.
Anke Boone, a researcher at the Centre for Environment and Health at KU Leuven and a co-author of the METEOR study, said: ‘In our workshops, healthcare professionals told us that personal support is key to enhancing job satisfaction. It also creates resilience against workplace stressors, mainly by knitting teams together more strongly.’
The professional and personal support interventions highlighted in the study to retain staff included regular interprofessional team meetings, leadership training programs, self-scheduling and sabbaticals, support for administrative and non-clinical work, and the provision of psychological counselling.
When it came to education, interviewees from all countries stressed the need for continuous professional development opportunities, including onboarding and mentorship programmes. They also advocated for a hospital-based development budget, allocated to each employee, as part of a comprehensive personal development plan.
Financial incentives included the provision of competitive salaries, adequate spending on infrastructure, extra benefits such as secure, permanent employment contracts.
However, as Olivia Lavreysen, a researcher at the Centre for Environment and Health at KU Leuven and a co-author of the METEOR study, pointed out, ‘many healthcare professionals say they’re willing to take a pay cut if it would mean an improvement in their current working conditions. That clearly shows that job quality and the level of support from healthcare organisations is more important than money.’
Desired regulatory measures addressed the need for harmonised legislation spanning local, national and international levels, fixed healthcare worker-to-patient ratios, and effective workload monitoring tools.
Interviewees hoped that such measures would alleviate workload pressures, support retention and ensure sustainable staffing levels, which are crucial for mitigating burnout and fostering professional satisfaction.
The authors concluded that while there is no one-size-fits-all approach to workforce retention, tailoring these interventions to address pressures within an organisation is encouraged.
Co-author Lode Godderis, professor at the Centre for Environment and Health at KU Leuven, added: ‘Healthcare providers need to look closely into their organisations and listen to employees to address their needs.’
Earlier METEOR findings revealed that 9% of doctors and nearly 14% of nurses intend to leave their professions, citing low job satisfaction, growing depersonalisation and emotional exhaustion as primary factors.
18th July 2024
The NHS is at growing risk of losing critical senior staff unless the new Government urgently prioritises action on poor working conditions and retention of the consultant physician workforce, data from the UK’s three Royal Colleges of Physicians shows.
Results from the latest annual UK consultant physician survey conducted by the Royal College of Physicians (RCP) on behalf of the RCP, the Royal College of Physicians of Edinburgh (RCPE) and the Royal College of Physicians and Surgeons of Glasgow (RCPSG) reveal overwhelming workloads, poor IT equipment that erodes physicians’ time, widespread staff vacancies and plummeting job satisfaction.
The survey of 22,253 consultant and SAS physicians between November 2023 and January 2024 had a response rate of 16.6%. Almost half of UK consultant physicians (47%) reported that enjoyment in their job had decreased over the last year – with clinical workload, poorly functioning IT equipment and staff vacancies cited as the top three reasons, followed by a lack of administrative support and lack of capacity in social care to discharge patients in a timely manner.
Other key findings from the survey showed vacancies and rota gaps at consultant or trainee level were having a negative impact on patient care, and physicians’ abilities to supervise and train others.
Some 59% of UK consultant physicians reported that they have at least one consultant vacancy in their department, and 69% felt that consultant physician rota gaps were having a negative impact on patient care, with reduced access to outpatient care, increased length of stay, the care of inpatients out of hours and delays in diagnosis the most commonly cited issues.
A total of 62% of consultant physicians reported daily or weekly trainee rota gaps when on acute duty over the past year, with rota gaps also impacting consultant physicians’ ability to supervise and train others. When asked whether rota gaps at consultant or trainee level were having a negative impact on their ability to supervise and train others, 32% said a lot, 41% said to some extent, 16% said a little and 12% said no impact.
In addition, most UK consultant physicians said they take part in educational and clinical supervision but the time allocated is not always sufficient. Of the 85% who did so, 94% said they supervised doctors in training, 41% said they supervised doctors not in a training post and 41% said it was other health professionals under their remit. Some 61% said they had time in their job plan to undertake this supervision, and while 65% of those said the time was adequate, 35% said it was not.
Calling the medical workforce ‘the lifeblood of the NHS’, Dr Mumtaz Patel, vice president of education and training at the RCP, said: ‘While we must train more doctors to meet demand, retaining the staff we already have is critical to getting our health service back on firm footing and delivering many of the new Government’s promised commitments on the NHS.
‘Right now, we have dedicated staff working in a health service which simply doesn’t work for them. They are overworked, undervalued, job satisfaction is falling and many are clearly becoming disenfranchised. Unless we urgently improve working conditions, we face losing many of our brightest and most committed.’
The stresses of significant workloads were also borne out by the survey results. Almost a fifth (18%) of consultant physicians said they almost never feel in control of their workload, and only 36% said they feel in control of their workload most of the time or almost always. Furthermore, 14% of respondents said they were very stressed at work, and 55% said they were somewhat stressed at work.
The data also show consultant physicians continue to work beyond their job plans, with over half of respondents (52%) saying that their job plan does not adequately reflect all of the work that they do, compared to 48% who said that it did. On average, full-time consultant physicians are contracted to work 11 programmed activities but actually work 12, while those who work less than full time are contracted to work eight programmed activities but work 8.5.
As a result, respondents said the top three things that were squeezed out of a week when things get too busy were continuing professional development, quality improvement activity and education, training and supervision of doctors of all grades, including appraisals.
When asked what top three things would improve work satisfaction, improved IT systems, reduced clinical workload and increased workforce/fewer gaps were most cited as measures that would most improve work satisfaction.
In addition, less-than-full-time and flexible working continues to grow, with just under a third (32%) of UK consultant physicians saying they work either flexibly or less than full time. This breaks down into 46% of female consultants and 21% of male consultants.
The three Royal Colleges, representing over 60,000 physicians, said the census makes clear that retention – including efforts to improve working conditions for staff – must be a key priority for the new Labour Government.
‘The findings of our latest census show the new government must prioritise retention,’ said Dr Patel. ‘From improving NHS IT systems and affordable childcare to embracing flexibility and getting the basics right, there is much that would make a difference. We need to urgently alleviate pressure – boost doctor numbers to close rota gaps and reduce the clinical workload to manageable levels.’
Noting that the NHS relies on the doctors working today and those who will join the health service in the near future ‘to turn the tide on long waiting lists and backlogs’, Mike McKirdy, president of the RCPG said: ‘It is important that our new Government reflects their value and recognises their contributions and sacrifices through workforce planning that has wellbeing at its core.
‘That 59% of consultant physicians reported at least one consultant vacancy shows the pressure on our ability to deliver care and prepare our next generation of doctors to move to consultant level positions. We strongly urge as a first action that the new Government seriously address the ongoing crisis in the NHS workforce, which any reform in our health system will depend upon.’
Professor Andrew Elder, president of the RCPE, added that while focus on the recruitment and retention of the consultant physician workforce is ‘vital’, it ‘means little without serious investment in public health’ and a ‘strategy for health-promotion activity and the avoidance of ill-health and health inequalities’.
As such, he highlighted that the RCPE has been calling on the new Government to introduce a range of measures around restricting advertising of unhealthy food, extending the sugar tax and introducing a sugar and salt reformulation tax, and introducing minimum unit pricing on alcohol to better support healthy diets. Professor Elder also encouraged the new Government to ‘follow through on proposed new legislation making it an offence for anyone born on or after 1 January 2009 to be sold tobacco products’. Indeed a number of these were referenced as priorities for the Government in this week’s King’s Speech.
Earlier this year, a census carried out by the three Royal Colleges of Physicians in the UK warned of a rise in patients with poor health due to their socio-economic circumstances.
21st June 2024
Escalating workforce shortages are causing ‘growing delays’ in cancer diagnosis and treatment in the UK that are ‘putting patients’ lives at risk’, according to two new reports published by the Royal College of Radiologists (RCR).
Based on 100% response-rate surveys of cancer centre heads and clinical directors of radiology departments, the RCR 2023 clinical radiology and clinical oncology workforce census reports reveal dangerous shortages of doctors essential in the diagnosis and treatment of cancer, and other conditions including stroke.
The data showed patients in half (47%) of cancer centres faced weekly delays to start systemic anti-cancer therapy (SACT), an increase from 28% the previous year. The RCR said the situation is ‘similarly dire’ for radiotherapy, with weekly treatment delays nearly doubling from 22% in 2022 to 43% in 2023.
More than eight in 10 cancer leaders (85%) expressed concern that workforce shortages that contributed to the treatment delays were impacting patient safety.
Released at the same time, a report from Cancer Research UK found that 382,000 cancer patients in England were not treated on time since 2015. The charity warned that only 66.6% of people in England received their diagnosis and started their first treatment within two months of an urgent referral in April 2024, with the 85% target having not been met since December 2015.
The RCR said the results of it 2023 clinical radiology workforce census report reveal a 30% shortfall of clinical radiology consultants (1,962 doctors) and stressed that ‘without further action this shortfall is forecasted to increase to 40% (3,670 doctors) by 2028’.
The RCR report also showed almost all (97%) of the radiology leaders it surveyed saying that workforce shortages caused delays and backlogs.
Noting that the demand for SACT, including chemotherapy, surged by 6-8% in 2023, while the consultant workforce expanded by only 3.5%, the RCR said this ‘glaring imbalance has created a crisis where demand vastly outstrips the capacity of the cancer workforce’.
Similarly, while the clinical radiology workforce grew by 6% in 2023, demand for CT and MRI reporting surged by 11%. As a result, the data showed nearly three quarters of a million patients (745,290) in England waited over four weeks to receive the result of their imaging test following the scan.
Dr Katharine Halliday, president of the RCR, said: ‘[These] reports reveal a stark reality: the crisis in the radiology and oncology workforce is jeopardising patients’ health.
‘Despite our dedication to providing the best possible care, severe workforce shortages are significantly hindering our efforts. We simply do not have enough doctors to manage the increasing number of patients safely, and this problem will only worsen as demand continues to rise and more doctors leave the NHS. The immense strain on an overburdened system, coupled with exhausted staff and increasing demand, creates a toxic cocktail for our NHS.’
Indeed, according to the RCR, every service leader reported concerns that workforce shortages were impacting staff morale and burnout, which is having ‘a clear impact with earlier retirement’ – the average age that clinical oncologists left the workforce in 2023 was just 54, compared to 57 in 2022.
The survey also showed inequities in access to cancer specialists persists across the country, with rural areas disproportionately affected, and the RCR warned that ‘disparities in workforce distribution exacerbate these inequalities, leaving some regions with significantly fewer doctors per patient’.
For example, according to the data, the West Midlands has only 4.9 clinical oncologists per 100,000 population aged 50 plus, while London has almost three times that number in its workforce at 11. The RCR said this ‘introduces clear inequalities whereby people living in certain regions are likely to receive results of their imaging test or start cancer treatment more quickly than those in other regions’.
The RCR warned that despite advancements in cancer treatments, workforce shortages are impeding delivery, depriving patients of potentially life-saving therapies’, adding that ‘any delay is critical for cancer patients, as every month delay in cancer treatment raises the risk of death by around 10%.’
The survey results have led the RCR to issue an urgent call to action to the next Government to address what it calls ‘the dire state of cancer care in the UK due to escalating workforce shortages’.
In a statement, the RCR said: ‘Despite being one year into the Government’s NHS workforce plan, the reports highlight a critical failure to address the worsening workforce crisis. Insufficient training and retention efforts have exacerbated shortages, leaving hospitals struggling to meet patient demand. This is one of the most pressing challenges the new Government must address, and it is imperative that they get it right.’
The RCR said it has written to major political party leaders warning that, without immediate intervention, the UK risks undoing decades of progress in cancer care.
The Royal College is demanding ‘urgent investment in workforce development to ensure patients aren’t left waiting for a diagnosis and can begin lifesaving treatment as soon as possible’, and said it is calling on the next Government to work with the NHS ‘to spell out how they intend to recruit, train and retain clinical oncologists and radiologists ensuring the stability and strength of the workforce for future generations’.
Commenting on these demands, Dr Halliday said: ‘Action from the new Government is essential. Time is critical. Doctors are working under extreme stress and are deeply concerned for their patients.
‘We urge the new Government to heed the advice of doctors and implement a forward-thinking strategy to recruit, train and retain staff. Only this approach can help reset the system, safeguard the NHS, and guarantee patients receive the quality care they deserve.’
Cancer charities have also added their voice to the call to action for the next Government to improve workforce issues and safeguard patient care.
Cancer Research UK’s chief executive Michelle Mitchell said: ‘These reports demonstrate that worsening shortages of radiologists and oncologists are directly impacting cancer patients, with some facing worrying delays in receiving vital treatment.
‘Cancer services are struggling to see people as quickly as they should, and the last time all cancer wait time targets were met in England was as far back as 2015. Demand will increase too. By 2040, there are projected to be around half a million cancer cases a year across the UK.’
She added: ‘To address these issues it is imperative that all political parties commit to making this general election a turning point for cancer. Post-election, any UK Government must invest in the staff and equipment that are desperately needed to ensure patients have access to the best cancer care. Cancer patients expect nothing less.’
Mairaid McMahon, policy manager at Macmillan Cancer Support, said: ‘The incoming Government needs to do more to address recruitment and retention, not just in generalist roles, but also specialist roles that are key to cancer treatment. We need to see targeted funding to increase the size of the cancer workforce, ensuring that everyone receives the timely and quality care they critically need.’
In January 2024, a census report from the Royal College of Surgeons of England also highlighted workforce challenges, treatment delays and staff burnout.
This was followed by the latest NHS Staff Survey results in March, which shows that while the NHS workforce appears to be recovering from the impact of the Covid-19 pandemic, there are still issues around workforce shortages, mounting pressures and widespread dissatisfaction with pay.
25th March 2024
NHS staff who are black or minority ethnic (BME) face more harassment, bullying and abuse by patients, patients‘ families, the public and other staff members, according to NHS England figures.
Around 30% of BME staff were harassed, bullied or abused by patients, patients‘ families or the public in 2022, compared to 26.8% of white staff. In the same year, 27% of BME staff experienced the same from colleagues, compared to 22% of white staff.
The figures have been released as part of the NHS workforce race equality standard 2023, which looks at how trusts are addressing race and inequalities.
NHS England said there was ‘continued evidence’ of ‘sustained improvement’ since 2016 when the first report was published, with the total number of BME staff at very senior manager level up 61.7% since 2018 (from 201 to 325).
However, it added there was still work to be done. Although the percentage of BME board members increased in all seven integrated care system (ICS) areas of England – in London, the Midlands, North East and Yorkshire, North West and South West – the gap in representation between board and workforce widened because the increase in BME representation was slower than the growth in the wider workforce.
The NHS workforce disability equality standard report 2023 was also published this week, which found that disability declaration rates by NHS staff had improved in 2023 by 19.9%. But, 33.2% of disabled staff reported experiences of bullying, harassment or abuse from patients, service users or the public. Some 16.1% reported this from managers and 24.8% from colleagues.
Health secretary, Victoria Atkins, said: ‘I want to see the NHS recruit and retain brilliant people from all backgrounds. It is important that the NHS at all levels represents the people it cares for, and I welcome progress in appointing more black and minority ethnic staff to senior positions and better representation of disabled people in the NHS workforce.’
Deputy chief executive at NHS Providers, Saffron Cordery, said: ‘Trust leaders remain dedicated to improving working conditions for ethnic minority and disabled staff, but substantial challenges persist, including in relation to supporting career progression and tackling harassment, bullying and abuse.
‘While ethnic diversity in the NHS workforce has increased, the speed at which this is happening at board level, particularly among executives, is not keeping pace with overall diversity of the workforce. This has led to a stark disparity in board representation.’
She added: ‘These report findings, along with the latest NHS staff survey showing ethnic minority and disabled staff are more likely to experience abuse from patients and the public, underline the need for urgent action to ensure staff feel safe.’
The NHS staff survey, published earlier this month, revealed widespread reports of discrimination and sexual harassment by patients and colleagues during the past year.
A version of this article was originally published by our sister publication Healthcare Leader.
13th March 2024
By some indices, the NHS workforce appears to be recovering from the impact of the Covid-19 pandemic, according to the newly-released NHS Staff Survey 2023, but concerns were raised over issues with sexual harassment identified in a new survey question.
Across England, over half of the 700,000 surveyed staff (55.17%) reported that they now look forward to going to work – the best result since 2020.
Some 69.02% reported being enthusiastic about their job, which was, again, the best result since 2020 but remains around six percentage points lower than in 2019. Enthusiasm amongst medical and dental staff increased following four consecutive years of decline on this measure, the results showed.
When it came to the issue of wellbeing, staff reported experiencing less pressure at work than before, with the work pressure sub-score having improved in 2023 after a sharp decline between 2020 and 2021 and little change in 2022.
A total of 46.71% said they were able to meet all the conflicting demands on their time at work, however this remained lower for medical and dental staff (34.44%) than for many other staff groups and over 12 percentage points lower than the average.
Professor Em Wilkinson-Brice, director for staff experience and leadership development at NHS England said: ‘It is really encouraging that the experience of NHS staff at work improved over the past year, even as they faced near record levels of pressure including the busiest summer recorded in A&E, as well as managing the disruption of industrial action.‘
And Dr Navina Evans, chief workforce, training and education officer at NHS England, said: ‘While there is still more to do, it is good news that less than 12 months on from the publication of the NHS Long Term Workforce Plan staff are happier at work than last year thanks to initiatives such as flexible working hours, clinical support squads to help menopausal women at work, and human resources stay advocates.‘
However, Dr Emma Runswick, deputy chair of the British Medical Association council, noted that ‘while there have been some small positive changes made in certain aspects from staff shortages to time pressures, it’s imperative to differentiate between “improvements” and what is deemed as satisfactory or acceptable’.
The NHS Staff Survey arrives at a time of ongoing workforce shortages, mounting pressures and widespread dissatisfaction with pay.
While satisfaction with pay recovered to levels similar to 2021 across a number of staff groups, the survey found only 32.05% of medical and dental staff were satisfied with their pay. This adds to the persistent decline over the last three years and is 23 percentage points lower than in 2020.
Dr Runswick said: ‘The vast majority of medical and dental staff (68%) are dissatisfied with their pay, all while clearly struggling with unacceptable workloads, unreasonable time pressures, and inadequate resources.
‘The Government must recognise the urgent need for fair pay and systemic improvements to support and prioritise the wellbeing of our invaluable healthcare workforce.’
The survey results also revealed widespread reports of discrimination and sexual harassment by patients and colleagues.
Discrimination hit a record high, with one in 12 staff (8.48%) having reported facing discrimination from patients, service users, their relatives or other members of the public, up from 7.20% in 2019. This rose to 9.07% for people who reported personally experiencing discrimination from managers, team leaders or colleagues, up from 7.68% in 2019.
However, overall, staff were reportedly increasingly likely to feel their organisation respects individual differences such as cultures, working styles, backgrounds and ideas (70.63%). This measure is up two percentage points since 2021.
This was the first time the NHS Staff Survey ran a question on sexual harassment, and the results showed that 8.67% of staff said they had faced sexual harassment from patients, patients’ relatives, or other members of the public within the last year.
In fact, more than 58,000 NHS staff reported experiencing ‘unacceptable’ levels of unwanted sexual behaviour from the public.
The survey also found 3.84% of staff faced unwanted sexual behaviour from staff or colleagues.
Commenting that these figures are very distressing, Dr Evans said: ‘Such conduct should not be tolerated in the NHS. That is why the NHS launched its first ever Sexual Safety charter last year which provides clear commitments to improve reporting on unacceptable behaviour, as well as appointing more than 300 domestic abuse and sexual violence leads who will review and improve trust policies for reporting of sexual harassment.
Medical leaders condemned the survey findings on sexual harassment. Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said: ‘Discrimination or abuse of any kind must not be tolerated – anywhere, ever. Everyone has a responsibility to call it out.
‘Such behaviour is abhorrent and in a clinical setting, utterly disrespectful to our hardworking NHS staff and to patients receiving or waiting for medical attention. Staff are most effective when they feel psychologically safe in a workplace.
‘NHS staff cannot walk away when someone needs help – being harassed or feeling vulnerable should never be considered “part of the job”.’
Professor Vivien Lees, vice president of the Royal College of Surgeons of England (RCS England) and lead on sexual misconduct, said: ‘Gathering this data is an important step as it gives us a better picture of the scale of the problem.
‘It is essential that staff members feel empowered to report instances of misconduct without fear of reprisal or negative impact on their career progression. They also need to feel confident that reports will be believed.’
She added: ‘RCS England is committed to a zero-tolerance approach to sexual misconduct, and we will actively work to eradicate this behaviour in surgery and healthcare.’
Coinciding with the publication of the NHS Staff Survey, the Royal College of Physicians and Surgeons of Glasgow launched its 10-point action plan aimed at tackling sexual misconduct in healthcare.
A 10-point action plan aimed at tackling sexual misconduct in healthcare has been launched by the Royal College of Physicians and Surgeons of Glasgow (RCPSG).
The plan includes a range of measures to support healthcare professionals, from providing education and training on recognising and taking appropriate action on sexual misconduct, to strengthening the College Code of Conduct and supporting the collection of data on inappropriate behaviours.
The launch coincides with the publication of the NHS Staff Survey, which highlights sexual harassment as an issue within the NHS, and was informed by the findings of an independent report by the Working Party on Sexual Misconduct in Surgery (WPSMS).
This independent report entitled ‘Breaking the Silence: Addressing sexual misconduct in healthcare‘, which was published in September 2023, detailed the findings of a survey distributed to members of the surgical workforce in the UK and the Republic of Ireland.
It revealed that two thirds of female respondents (63.3%) reported having been the target of sexual harassment from colleagues, along with just under a quarter of men (23.7%).
Almost 30% of women reported being the target of sexual assault in the last five years.
Mike McKirdy, president of the RCPSG, which has more than 16,000 members in the UK and internationally, called the WPSMS findings ‘bleak‘ and said the Royal College was ‘appalled by these statistics‘ on sexual misconduct and wanted ‘to ensure that every member of our extended College community feels safe and respected in their place of work‘.
The 10-point action plan therefore ‘sets out the measures we are taking to help tackle inappropriate behaviours wherever they may occur‘.
He added: ‘The 10-point action plan is not an exhaustive list – we will continue to work with Fellows and Members to listen, and hear, what other actions we might take.‘
Professor Christine Goodall, dean of the Faculty of Dental Surgery and the RCPSG’s representative on the Working Party on Sexual Misconduct in Surgery, said: ‘Sexual misconduct and inappropriate behaviours affect every area of healthcare.
‘We believe that medical Royal Colleges have an important role to play in building safer communities, and by showing leadership, healthcare professionals can help to drive the change that is needed in society more generally. It is incumbent on us all to speak out if we witness inappropriate behaviour and to properly support those who come forward to report it.’
Since the publication of the WPSMS report, the Royal College of Surgeons of England (RCS England) has ‘redoubled our efforts to stamp out sexual misconduct, sexual harassment, and sexual assault’ in healthcare.
Professor Vivien Lees, vice president of RCS England and lead on sexual misconduct, said: ‘We have written to NHS Trusts that haven’t yet signed the NHS sexual safety in healthcare charter, encouraging them to do so as soon as possible.
‘RCS England is actively lobbying accountable government and NHS organisations on the Working Party on Sexual Misconduct in Surgery recommendations including the need for reforms of reporting and investigation processes.’
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’.
16th February 2024
Introducing a national programme of weekend high-intensity theatre lists to reduce backlogs and offering hospital consultants protected time for research are among the recommendations outlined in a major new report.
In its ‘Report into the state of health and social care in Britain today’, the Times Health Commission called for high-intensity theatre lists to be launched once a month in 50 hospitals to get through a week’s worth of planned operations in a day and create seven-day surgical hubs.
It also outlined incentivising NHS staff to take part in research, and put the case for research to their patients, by giving 20% of hospital consultants and other senior clinicians 20% protected time for research.
These two recommendations form part of the report’s 10-point plan for the Government to transform the NHS.
To support the plan’s development, the Times Health Commission visited hospitals, care homes, GP surgeries and research laboratories in the UK, Japan, Denmark, Israel, Ireland and Spain to source examples of best practice.
The commissioners then established three core principles to underpin the report and recommendations, which they said are ‘pragmatic, practical, deliverable and could be taken up by any political party or government’.
The principles are rebalancing the health system away from hospitals and a putting greater emphasis on prevention and community care, reforming social care to reduce overcrowding in hospitals and give patients better support, and enabling the system to become more personalised and predictive through the use of technology.
The Commission called for doctors, nurses and midwives who stay in the NHS for three years to have their student debt cut by 30%, rising to 70% for those still working after seven years, and 100% after 10.
It said the health services must become a ‘much better employer’ in ways that go ‘beyond health settlements’, including affordable staff canteens, night transport and on-site childcare.
The requirement for junior doctors to rotate across the country must also end to better balance work and family, it said.
Other recommendations included creating digital health accounts or ‘passports’ for patients to book appointments; order prescriptions; view records, test results or referral letters; and contact clinicians.
And establishing a National Care System with the aim of giving everyone the right to appropriate support locally and in a timely fashion. This should be delivered by a mixture of the public and private sectors, the report said.
Chair of the Times Health Commission Rachel Sylvester said: ‘Despite its huge challenges, there is enormous cause for optimism for our health service. The NHS and social care system must seize the extraordinary opportunities on offer in the modern digital world to empower patients, liberate clinicians, improve services, drive efficiencies and create a healthier Britain. Other countries have done it and so could we.’
Commenting on the report, Royal College of Physicians president Dr Sarah Clarke said: ‘At a time when the NHS faces significant demands, we welcome the Times Health Commission’s report. Its 10-point plan places an important focus on increasing and supporting the medical workforce, fostering an environment where existing staff can flourish, and taking an important preventative approach to tackling health inequalities and ill health.
‘We also welcome the inclusion of social care within the report’s recommendations for reform – social care must be staffed and funded as an equal partner to the NHS to deliver optimal care for patients.’
Also responding to the report, Professor Philip Banfield, British Medical Association council chair, welcomed its focus on staff retention and supported the student loan write-off recommendation.
However, he said: ‘The Commission sadly fails to make the obvious recommendation of restoring doctors’ pay, which would have a real impact on retaining clinicians.
‘Without this, any meaningful hopes of addressing the near record-waiting lists will be dashed. Indeed, accelerated weekend theatre lists are all well and good, but the premium required to fund such activity risks detracting from essential investment elsewhere; doctors are already exhausted after working beyond their hours all week, already spread too thinly.’
Professor Banfield added: ‘There is a lot to unpack and consider in this report and its recommendations, but ultimately the ability to improve the state of the country’s health and services is bound by the Government’s will to act, and crucially, invest. This change must come from listening to the doctors and colleagues that give their all on the front line every day. We are the solution, not the problem.’
Matthew Taylor, chief executive of the NHS Confederation, who was a commissioner involved in the report, also called for greater Government funding to align with the report’s recommendations.
He said: ‘The NHS is recognised as one of the most efficient healthcare systems in the developed world, but we know that more can be done to improve productivity, and health leaders and their teams are always looking at ways to generate even greater efficiencies.
‘One of the crucial ways that this productivity challenge can be addressed is by providing the NHS with the capital investment it needs, which has not been covered in this comprehensive report. Specifically, in England, capital funding needs to increase to at least £14.1bn annually, a £6.4bn increase from the current level of £7.7bn. This is vital if we are to increase productivity and reduce waiting lists.’
In January 2024, a surgical workforce census report found that over half of the UK surgical workforce face problems accessing theatres, which is contributing to long waiting times for hospital treatment and excessive workloads.
30th January 2024
Over half of the UK surgical workforce face problems accessing theatres, which is contributing to long waiting times for hospital treatment and excessive workloads, according to a new census report.
The ‘Advancing the Surgical Workforce: 2023 UK Surgical Workforce Census Report’, revealed 56% of respondents found access to theatres was a major challenge, and this rose to 61% among all surgical trainees.
Some 47% of respondents said they believed that ‘system challenges’ had an impact on their ability to deliver their work, including balancing clinical and managerial responsibilities.
Access to theatre/operating lists, adequate support staff and admin support were listed as the top three responses to a question asking what would increase productivity.
The Royal College of Surgeons of England (RCS England) said the results show ‘too many staff are trying to navigate a system that often frustrates the delivery of surgical care, rather than enabling all members of the team to deliver services to patients in the most timely and efficient way’.
It added that the report ‘paints a stark picture of a surgical workforce working long hours and in stressful environments’.
Indeed, 61% of respondents cited that burnout and stress was the main challenge in surgery due to excessive workloads.
Some 67% of consultants reported always or frequently working beyond their contracted hours and 42% of respondents did not take their annual leave entitlements in the past year.
The impact of these pressures is also revealed in the report as 50% of respondents across all career grades indicated that they considered leaving the workforce in the past year.
And 64% of the 55-64 age group of consultant surgeons plan to retire in the next four years.
The report was based on a survey of the whole surgical workforce that aimed to identify the key challenges facing surgical teams and inform workforce planning.
There were 6,348 responses to the census survey from different members of the surgical team, which is approximately 25% of the current workforce. Of the respondents, 54% were consultants, 25% were trainees, 10% were SAS surgeons, 5% were LEDs in surgery and 6% were part of the extended surgical team.
Led by the RCS England, it was supported by the Royal College of Physicians and Surgeons of Glasgow, Royal College of Surgeons of Edinburgh and the Federation of the Surgical Speciality Associations.
The report sets out three recommendations from the surgical Royal Colleges focusing on improving productivity, capacity and efficiency; ensuring sustainability within the workforce by focusing on wellbeing; and overhauling the surgical team structure with further integration of associate specialist and specialty (SAS) surgeons and locally employed doctors in surgery (LEDs).
It is hoped these recommendations will provide a basis for future comparative work to support the work of surgeons and the wider surgical team across the UK and help to reduce waiting lists.
Tim Mitchell, president of the Royal College of Surgeons of England, said: ‘At a time when record waiting lists persist across the UK, it is deeply concerning that NHS productivity has decreased. The reasons for this are multifactorial, but access to operating theatres and staff wellbeing certainly play a major part. If surgical teams cannot get into operating theatres, patients will continue to endure unacceptably long waits for surgery.’
Commenting on the retirement data in particular, Mr Mitchell said: ‘This will create a significant loss of experienced surgeons who are key to helping bring NHS waiting times down and training our future surgeons.
‘Tackling the challenges health services face hinges on having a happy and fulfilled workforce. We should not be losing any talented surgeons or surgeons in training because they do not feel valued, or they are denied the flexibility in their careers they require.
‘There is an urgent need to increase theatre capacity and ensure existing theatre spaces are used to maximum capacity. There is also a lot of work to be done to retain staff at all levels by reducing burnout and improving morale.’
Mike McKirdy, president of the Royal College of Physicians and Surgeons of Glasgow, added: ‘The findings of this important report underline the intense challenges being felt by surgical teams across the UK.
‘In addition to increasing theatre spaces and staff to help drive down waiting lists, we must ensure that we protect training time for all members of the surgical team: without quality, ‘on-the-job’ training, we simply won’t have the surgical workforce we need for the future.
‘With alarming levels of burnout, it is also vital that we have a national focus on improving the wellbeing of our dedicated surgical teams.
‘The UK’s surgical Royal Colleges have a long history of working together to inform workforce planning. We are ready to work with the wider health system to drive positive change.’
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.
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