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Stress and high workload main reasons staff leave NHS, finds study

Stress and high workload main reasons staff leave NHS, finds study

Pay increases alone will only have ‘a modest impact’ on NHS staff retention because the main problems are stress and high workload.

This was the findings of a survey of 1,958 NHS health professionals from across the UK, which 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 by:

  • 227 doctors
  • 687 nurses
  • 384 healthcare assistants and other nursing support staff
  • 417 allied health professionals
  • 243 paramedics from acute, mental health, community, and ambulance services

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
  • 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.

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

The researchers 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.

‘Many GPs are experiencing huge workloads, resulting in burnout, low morale and a sense of moral distress.

‘We know that when GPs do leave the profession earlier than planned, it is often due to the pressures of the role which have worsened in recent years.

‘In many instances, when a practice loses a member of staff, it is really difficult to find an equivalent replacement, intensifying the pressures on those remaining.

‘College surveys have shown that this cycle is likely to get worse, with many of our fully-qualified GPs considering leaving general practice in the next five years.’

Pulse’s recent investigation on GP workforce found that burnout, stress and unachievable demands are pushing GP trainees, as well as older GPs, out of the profession – but the biggest and most worrying haemorrhage involves fully trained GPs at the height of their careers.


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