Doctor exodus costs the NHS up to £2.4bn a year, BMA warns

Doctors leaving the NHS prematurely currently cost the taxpayer up to £2.4bn a year, according to calculations by the BMA.

A new report, published today, said the cost of an individual doctor leaving ‘varies significantly’ depending on specialty and can be up to £365,000.

Based on the 15,000 to 23,000 doctors estimated to have left the NHS prematurely in England between September 2022 and September 2023, the BMA estimated that the cost of replacing them and their expertise would be between £1.6bn and £2.4bn.

It used case studies to calculate how much it would cost to replace doctors in different parts of the NHS, showing that the ‘minimum replacement cost’ for a salaried GP would be £295,000.

The report said: ‘The actual cost of replacing an individual doctor varies significantly, and can be higher than the minimum costs set out above.

‘To demonstrate the wide range of costs, we have set out and costed three possible scenarios: a senior obstetrician who resigns early, a salaried GP who resigns to move abroad, and a first-year Specialty Registrar in Psychiatry who leaves their training programme.’   

The BMA warned that the calculated costs could rise even further, to as much as £5bn a year, underlining not just the loss of medical expertise in terms of NHS capacity and patient care, but also the expense to the public purse ‘if action is not taken’.

The report also offered recommendations on how to retain doctors going forward, including writing off student debt for those remaining within the NHS and cover the cost of mandatory examinations.

General practice should also ‘be supported to move away from a system of uncapped demand’ in which clinicians are ‘expected’ to maintain ‘unsafe’ levels of patient contacts per day to a waiting list system based on clinical need.

It also suggested upgrading security measures in GP practices where appropriate, as the NHS should ‘take a zero-tolerance approach’ to harassment and bullying.

The BMA also argued that a reform of employer referral and fitness-to-practise processes is needed so that they are ‘fair, timely and proportionate’ and to reduce the ‘personal impact’ on doctors.

The recommendations also mention reducing pressure from operational failings, including ‘poor IT’ and ensuring IMG doctors get ‘comprehensive inductions, mentoring and ongoing support’.

The report concluded: ‘We cannot afford to lose more doctors. 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. It will also cost dearly.’

BMA representative body chair and workforce lead Dr Latifa Patel said that it is ‘not enough’ for the Government to focus ‘exclusively’ on recruitment.

She said: ‘If this has so far not been enough for the Government or policymakers to take the issue of retention seriously, then we hope seeing the staggering sums of public money needed to replace doctors who leave early will make them sit up and listen.

‘It is not enough to focus exclusively on recruitment. It takes a long time to train a doctor and there is a risk that we’re training more doctors only for them to leave. There’s no point turning on the taps to fill a bath if there’s no plug in the drain.

‘There are simple solutions, starting with reversing real-terms pay cuts and making good on pledges to overhaul the way doctors’ pay is set.

‘We need to end the ongoing pay disputes with doctors across the UK and prevent further disputes in future.’

NHS Providers deputy chief executive Saffron Cordery said: ‘Relentless demand continues to outstrip available staff and resources as overstretched teams and services work flat out to treat patients, many with more complex conditions, as quickly as possible.

‘We need the Government to tackle longstanding challenges throughout the health and care system, including more action to recruit and retain staff backed by appropriate training and support.

‘Patient care will suffer if we keep losing NHS staff due to burnout, stress and excessive workloads.’

Earlier this month, a GMC survey on doctors moving abroad found that GPs are the most likely to experience ‘deep discontent’ practising medicine in the UK.

And a major Pulse investigation last year looked at workforce issues in general practice, uncovering the reasons why GPs are looking to move abroad, reduce hours or take other routes out of the profession.