The reality of working in the NHS

A tough world of rota gaps, overwork, burnout and reduced patient care.

Headline news

I’ve been reading the latest ‘GMC Staff and National Training Survey’. It paints a complex picture of the realities facing NHS doctors in 2025, when taken alongside other NHS Data. The headline news is that an astonishing 1 in 5 doctors (20%) are considering leaving the NHS altogether.

What are the headlines?

Doctors say that persistent rota gaps result in ever increasing high workloads and ‘enormous pressure’. 26% of trainees and 29% of trainers say that these gaps have a negative effect affect on training. Ironically, the same staff shortages are accompanied by severe competition for training posts, with many doctors finding themselves in limbo, working yet unable to progress, despite the shortages in the system. We are creating gaps in the system whislt we have doctors willing to be trained to fill them.

An astonishing  61% of trainees and 47% of trainers are measured to be at moderate or high risk of burnout. Some specialties face even higher risk. Half of all trainee physicians reported work as causing a high level of emotional exhaustion.

Over half (53%) reported that fatigue was affecting their concentration. 22% of doctors said they were sleep deprived on a daily basis. Fatigue reduces empathy, leads to medication and other errors, and reduces staff wellbeing. These consequences of fatigue have a negative impact on patient safety.

Emotional exhaustion, low morale, stress, and anxiety are major themes, all intensified by long hours, under-staffing, and high expectations. Around 1 in 5 feel that their only option is to cut their hours. The GMC Chief Executive, Charlie Massey, stated that ‘Doctors protecting their wellbeing is essential, but they shouldn’t feel their only option is to reduce their working hours’. Nevertheless despite recognising their stresses, reducing hours or refusing to take on extra work, many still experience burnout and are forced to quit the NHS as the heavy workloads take their toll.

What pressures affect Doctors?

Doctors frequently feel unsupported. 21% of trainees saying that they were hesitant about escalating patient care issues to a senior colleague. In A&E this rises to 26%, to 27% in Obstetrics and Gynaecology and 29% in Surgery - all areas with a high potential for clinical errors and expensive litigation. If a trainee doctor is working in a culture where they feel psychologically unsafe to raise concerns, this not only impact the doctor negatively but will also endanger patient care.

A significant number of doctors experience discrimination, with 34% of UK graduates from an ethnic minority background reporting poor behaviour - including microaggressions from colleagues - compared to 25% of their white colleagues. 39% of gay and 45% of bisexual trainees had experienced discriminatory comments. In addition, 17% of female trainees said they were ignored or sidelined, compared to 13% of male trainees.

Trainers are unable to train, with only half of them able to use their allocated training time. Workload is prioritised over education, with a third of trainers agreeing that rota gaps harm training quality. Doctors just keep working, but feel they cannot progress.

Why are Doctors leaving the NHS

Burnout is a leading reason for both GPs and hospital doctors leaving the NHS. More than 40% of GPs who have left cited burnout, and overall, 42% of NHS medical and dental staff report work-related stress.

Personal health, wellbeing, poor work-life balance, and excessive workloads lead to 38% of doctors indicating that they feel unable to cope at least weekly, and 65% regularly working beyond their agreed hours.

Pay remains an issue with only 32% of NHS staff satisfied with their pay, and less than half feel valued by their organizations. Pay alone, however, is considered a modest factor relative to stress and workload intensity.

Career Progression is poor, with a lack of training posts and senior support also drive some Doctors to seek opportunities abroad or outside medicine altogether.

Emigration is becoming more popular, with one in eight doctors considering a move overseas. The incentives are mainly “being treated better” and higher pay. Nearly one in five are considering leaving the UK profession altogether. The UK has fewer doctors per person than most other OECD countries (2.8 per 1000 population compared to 4.1 in Germany and 5.1 in Austria for example). Just increasing training places by a few percent when doctors are haemorrhaging from the NHS will not fulfil the government’s ambitions to reduce waiting times.

BMJ - see reference.

What does this mean for the NHS?

The GMC’s recent survey should be a wake up call, not just to the Department of Health and NHS Managers, but to colleagues in the NHS. The figures are alarming and demonstrate that while clinical supervision and training quality are generally rated highly, workplace pressures, including burnout, fatigue, discriminatory environments, and lack of support, are massively undermining staff retention and morale.

The result is that as many as 1 in 5 Doctors are considering leaving the NHS for better opportunities abroad, or quitting the NHS altogether. This loss of talent has implications for the NHS’s sustainability and ability to improve, and continuing negative effects on patient care.

Many Doctors remain absolutely committed to working in and improving the NHS. If you are affected by any of these issues raised in this article, and feel that work is negatively affecting your personal wellbeing and work-life balance, or if you are frustrated by the lack of future opportunities in the NHS, you could speak to an Executive Coach who can help you navigate thought these issues.

You can book a free no obligation 30 minute on-line conversation with me here. If I am not the right Coach for you, I will recommend somebody else who might be.

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