NHS facing £5bn bill to replace doctors leaving workforce early

It costs taxpayers more than £2.4bn a year to replace doctors who leave the workforce before retirement age, a figure that could rise to £5bn a year, according to a new report from the British Medical Association (BMA).

The report, “When a doctor leaves: tackling the cost of attrition in the UK’s health services”, found that between September 2022 and September 2023, 15,000 – 23,000 doctors left the NHS prematurely in England alone. It estimates that the minimum cost to NHS employers and the public purse of replacing those doctors lies between £1.6 and £2.4 billion.

In addition, for every doctor that leaves, pressures worsen for those who stay, increasing the likelihood that they too will leave the profession.

The report outlines key areas where urgent action is needed to retain doctors in the UK, protect services and patients, and save public money. The first is reversing years of real-terms pay erosion so that doctors do not leave for better paid jobs elsewhere. Furthermore, writing off student debt while doctors work within the NHS will provide added incentive to stay.

It also says that governments, health systems and employers must act to reduce workload pressures, improve work-life balance, expand access to basic facilities and services and stamp out harassment and abuse. Action also needs to be taken to end discrimination and support those with additional needs to contribute to their potential.

Small changes could help retain doctors in UK

Dr Latifa Patel, BMA representative body chair and workforce lead, said it was no secret that the NHS does not have enough doctors to meet patients’ needs, and the ones that we do have are increasingly saying they do not want to stay, but only by valuing doctors appropriately in the UK can we hope to prevent them from leaving for more competitive roles abroad or outside the NHS.

“At a local level there are so many small changes that would make a real difference every day – from improving painfully and sometimes dangerously slow IT systems to making sure doctors have somewhere to rest, to get a hot meal on a night shift, park their car or even just perform administrative duties,” she added.

“Doctors believe in the NHS and most would rather stay to ensure that it works for everyone. But everyone’s goodwill runs dry eventually and they cannot be expected to continue to give every day to a service that so often leaves them undervalued, under-supported and unable to care for themselves or their patients.”

A doctor’s view on leaving the NHS

Dr Phil Colwell, originally from Northern Ireland, left the UK for Australia in 2017 after working for three years as a doctor in England and Scotland. He recently qualified as an Emergency Medicine consultant and works in Adelaide.

He said: “When I started working as a doctor in England I believed that my hard work, in stressful and demanding conditions, would be rewarded by the NHS. I saw it as a part of a social contract and would give extra time and effort for that reward. Over time I realised that the other side of that contract wasn’t being honoured and my hard work and sacrifice wasn’t appreciated. The pay and conditions were simply not worth breaking myself for and I increasingly felt burnt out and used.

“South Australia supported me with much better pay and fewer hours with more flexibility. There is a positive and supportive medical culture and we are proactively offered training opportunities to progress to be the best doctor we can be

“Of course, one big thing is pay. As a consultant I can earn three times what I would in the UK. But there’s also work-life balance, career development and working in a supportive system where there are enough staff to meet patients’ needs without driving ourselves to burnout.

“I’m a big supporter of the foundational ideals of the NHS and I miss my family back in the UK. There’s a lot of guilt that comes with being a 30-hour flight away. But to tempt me back the UK would need to show it valued me and my colleagues: through significantly better pay, better work-life balance and better workplace culture.

“UK doctors make up a significant proportion of the workforce in my, and many other, Emergency Departments in Australia and those numbers are rapidly rising and from a much broader range of seniorities. This trend will only continue unless the Governments and health services back home start to value, support and care for doctors properly.”