Meeting the NHS workforce retention challenge

A key moment in 2026 will be the publication of a new long-term workforce plan for the NHS. The plan, due this spring, will be the first under the current Labour government and is expected to set out how the workforce will be developed to underpin the 10-Year Health Plan.

Improving NHS staff retention will be central to delivering on the government’s ambitions for the NHS. The 10-year plan recognises the need to boost staff retention, identifying key actions around investment, reducing burnout and modernising roles to keep skilled staff from leaving. But achieving an effective and sustainable response to retention will require NHS managers and policymakers to develop a better-informed understanding of the root causes of workforce retention problems. 

Some progress but retention remains a challenge

The NHS has made some progress on improving retention in recent years. Last year, NHS England reported that the staff leaving rate in the NHS was its lowest for more than a decade. But this doesn’t mean that staff shortages have gone away or that retention is no longer a problem.

The most common measure of staff retention is the ‘leaver’ (or turnover) rate. This can be a blunt, potentially misleading indicator – if taken at face value and aggregate level. A reduction in all-staff turnover rates does not necessarily mean a happier, committed workforce. It can reflect demographic change, such as proportionately more staff reaching retirement age; an absence of alternative job options; or the impact of funding constraints and reduced job vacancies. Notably, in recent months there have been increasing reports of local NHS recruitment freezes and of newly qualified nurses not finding jobs. The national turnover rate also masks significant variations in leaver rates by region, organisation and occupation. 

The new workforce plan will have to look beyond national headline trends on leavers and focus on targeted, tailored and sustainable solutions for workforce retention. Too often, the focus on NHS staff retention has been based on incomplete evidence about why staff have left, rather than why they stay. The new workforce plan must take this more positive perspective, building on an improved understanding of the dynamics of NHS staff retention. A coherent set of policy recommendations is required based on a clear diagnosis of what is and isn’t currently working when it comes to retaining NHS staff. 

Three main benefits of improving retention

There are multiple benefits to the NHS of achieving improved retention. A recent series of studies on NHS staffing, supported by the Health Foundation, and other evidence, point to at least three main benefits that should drive policy improvement. 

1. Impact on care

The most obvious and important benefit of improved retention is the potential to improve care. Reduced turnover and improved workforce stability may contribute to better care through more effective teamwork, and staff having greater familiarity with systems, procedures and patient/client needs. 

Poor staff retention can lead to workforce shortages, increasing workload and additional pressure on remaining staff; higher use of stop-gap temporary staff; and reduced quality of care or unmet care.

One recent study on NHS nurse and doctor turnover across 148 NHS trusts (using yearly records on 236,000 nurses, 41,800 senior doctors and 8.1 million patients) reported lower turnover rates for nurses and senior doctors at hospital level were associated with better health outcomes for patients with emergency hospital admissions. Another study, of 626,313 patient admissions in four NHS trusts in England, reported a statistically significant increase in the risk of death among patients exposed to days of low nurse staffing or high proportions of temporary staff.

2. Impact on remaining staff

In organisations where retention is poor, remaining staff are likely to have to take on additional work and may experience increased work-related stress or burnout. These factors can impact on the ability to deliver safe care and, in turn, may encourage the ‘stayers’ to consider becoming leavers. 

It is also important to keep in mind that it is not sufficient just to have staff ‘present’ at the workplace. They must be supported to be fully engaged to achieve the optimum benefits of retention. 

The NHS staff survey provides one standardised source of system-wide data on retention factors and trends. The proportion of staff responding to the 2024 survey ‘who often think about leaving their organisation’ was reported to be 28.83%, marking a continued marginal improvement since a recent peak in 2022 (2023: 29.14%; 2022: 32.42%; 2021: 31.28%; 2020: 26.61%). With the survey cited as being the largest in the world, there is scope to make much more use of its findings – such as a deeper dive analysis to pinpoint differences in the reported experiences and intentions of staff in different locations, occupations and age groups.

3. Impact on costs and productivity

The organisational costs of staff turnover have been estimated using a range of different methods. The cost estimates are usually significant. One US study estimated that the average cost of turnover for a bedside registered nurse was $61,110 in 2024, an 8.6% increase on the previous year, resulting in the average hospital losing between $3.9m and $5.7m. The report estimated that each percent change in nurse turnover will cost/save the average hospital an additional $289,000 a year. An NHS analysis estimated that the total financial impact of 10% nurse turnover on a large hospital employing over 3,000 nurses equated to a ‘minimum spend of £3.6m every year’. Another study estimated that the overall cost impact of poor NHS staff health and wellbeing, including staff absence and turnover, as being in excess of £12bn per year in 2022. 

These examples of significant costs suggest improved retention could have a positive impact on NHS productivity, both by directly reducing some staffing input costs and by contributing to improved workforce stability.

The role of evidence in meeting the challenge

Retaining the health workforce is a common policy challenge around the world. The UK is also not alone in that much of the ‘evidence’ of what works used in the debate is opinion based, small scale and descriptive. 

Effective policy interventions will require consistent data and analysis to support them. This should include differentiating between voluntary and involuntary turnover (eg ill heath, retirement) and delineating internal and external destinations of leavers. The new workforce plan should envision NHS trusts working with real-time live dashboards that cover staff absence (and the types of absence); turnover (reasons and destinations); and give NHS trust boards a regularly updated unit-by-unit measure of staff stability. Alongside this, the pace of reform and planned improvement in the 10-Year Health Plan is such that workforce impact assessments should be carried out periodically to check that motivation and retention are improving. 

Getting these measures in place will go a long way to deepening understanding of retention issues, supporting the NHS to build a sustainable and motivated workforce.