The cost to taxpayers of losing doctors early from the NHS at the current rate is as high as £2.4bn a year – and could rise to as much as £5bn a year if more is not done to retain doctors in the UK – a BMA report warns today.

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 estimates that the cost of replacing them and their expertise would be between £1.6bn and £2.4bn. Moreover, with rising numbers of doctors indicating they are taking steps to leave the profession, the BMA warns this figure could rise even further - underlining not just the huge loss of medical expertise in terms of NHS capacity and patient care, but also the vast expense to the public purse if action is not taken.

In “When a doctor leaves: tackling the cost of attrition in the UK’s health services”, the BMA outlines four key areas where urgent action is needed to retain doctors in the UK, protect services and patients, and save public money:

• Pay and debt. Reversing years of real-terms pay erosion is the first step in rebuilding good faith, showing doctors they are valued and retaining them. A failure to do so will mean that doctors will continue to leave for better paid jobs elsewhere. Furthermore, writing off student debt while doctors work within the NHS will provide added incentive to stay.
• Working conditions. Working conditions need to make doctors want to stay, not push them out of the door, but too frequently they are uncaring, uncomfortable and unsafe. 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.
• Diversity and inclusion. The NHS is fortunate to have a workforce that has become more diverse over time. To keep this diverse workforce, action needs to be taken to end discrimination and support those with additional needs to contribute to their potential.
• Development and support. In the context of relentlessly pressured environments, staff are afforded less and less time for learning and development. To better retain staff, employers need to ensure that doctors are able to practise in roles that make the most of their skills and experience, with the support to develop and progress personally and professionally.

Dr Latifa Patel, BMA representative body chair and workforce lead, said:

“It’s no secret that the NHS does not have enough doctors to meet our patients’ needs, and the ones that we do have are increasingly saying they do not want to stay.
“The negative effects are there for all to see – near-record waiting lists for treatments, overwhelmed services consistently missing A&E and cancer targets, exhausted staff working themselves to the point of burnout just to plug the gaps. 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.

“In a year where strikes have already estimated to have cost £1.2bn, when you add the cost of losing more doctors, the Government’s argument that it is unaffordable to properly value and support doctors falls completely flat.

“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. 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.

“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.”

Case study

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.”

Ends

Notes to editors

The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.

1. Full report can be read at bma.org.uk/attrition-costs