View more on the general practice workforce.
Last updated: 30 November 2023
The most valuable resource the health service has is its staff. Yet the NHS is in the midst of a chronic workforce crisis, driven by years of insufficient investment in training new staff, inadequate workforce planning, and lack of government accountability.
The result is a vicious cycle of mounting pressures, declining staff wellbeing and poor retention.
FTE / headcount
NHS Digital publishes workforce data as both headcount and FTE (full time equivalent).
Headcount refers to the number of individual doctors, while FTE is the proportion of full-time contracted hours that the post holder is contracted to work. 1 FTE would indicate they work a full set of hours, 0.5 that they worked half time.
As FTE reflects the true number of clinical hours the NHS has at its disposal, we usually find FTE to be more meaningful than headcount. FTE is used throughout this page.
Full-time here is taken to be 37.5 hours - the FTE definition used by NHS Digital. This calculation is for illustrative purposes only, as we recognise employed doctor contracts can be 40 hours.
OECD (Organisation for Economic Co-operation and Development) comparisons.
For international comparisons we use OECD data. However, this should be interpreted with caution due to international differences in how doctors are defined and differences between definitions, such as 'practising' and 'professionally active', that may create variation across countries.
We have calculated the doctor to population ratio for England ourselves (as OECD only supply this figure for the United Kingdom, not its constituent countries) using NHS Digital general practice and secondary care workforce statistics and mid-2020 ONS population estimates.
England has a shortage of doctors
In comparison to other nations, England has a very low proportion of doctors relative to the population. The average number of doctors per 1,000 people in OECD EU nations is 3.7, but England has just 2.9. Germany, by comparison, has 4.3.
England needs nearly 50,000 additional FTE doctors simply to put us on an equivalent standard with today’s OECD EU average of 3.7 doctors per 1,000 people.
Uneven regional distribution of doctors
Not a single region in the country meets the OECD EU nation average of 3.7 doctors per 1,000 people. Excluding London, regions of the country with a large population also do not have a proportionate number of doctors: 3.5 million more people live in the Midlands than the North West, but they have 4,000 fewer doctors to treat them.
The NHS has long carried a stubbornly high number of unfilled vacancies, a problem that far predates the pandemic.
As of September 2023, there were 121,070 vacancies in secondary care in England. Of these, 8,858 vacancies were medical, amounting to 5.9% of all medical posts. This vacancy rate is similar to the one seen a year ago (6%). The greatest proportion of all secondary care vacancies remains in nursing, with 42,306 unfilled posts (10.3% of all nursing posts). Care is delivered by multi-disciplinary teams, so nursing shortages directly impact the medical workforce who must take on a greater burden of work as a result.
High vacancy rates create a vicious cycle: shortages produce environments of chronic stress, which increases pressure on existing staff, and in turn encourages higher turnover and absence.
Insufficient growth in the medical workforce
In primary care, the overall number of GPs has seen little growth since 2015, with the number of GP partners experiencing significant decline over that time. Full detail can be found on our pressures in general practice analysis page.
The latest data shows that, over the last year, from August 2022 and August 2023, the NHS gained the equivalent of 6,814 full-time secondary care doctors. This amounts to an annual increase of around 5%, which is higher than the previous year (3% between August 2021 and August 2022). Though this increase is encouraging, it remains to be seen whether this rate of growth is sufficient to cope with rising demand and work through backlogs of care.
Staff are suffering rising stress and declining wellbeing
The workforce crisis both causes and worsens rising stress, fatigue and burnout among NHS staff, as well as poor wellbeing and mental health – all of which impact retention.
Mental health issues are the highest reported cause of sickness absence in secondary care. We know that COVID-19 is having lasting effects on the mental health of doctors. BMA surveys have consistently shown that since the start of the pandemic, doctors have been left feeling increasingly depressed, anxious, stressed or burnt out as a result of their work or study.
Violence and abuse directed at NHS staff is also a growing issue. In 2022, more than half of UK doctors experienced or witnessed verbal or physical abuse.
The medical workforce is ageing
Like the general population, the workforce is ageing. 13% of secondary care doctors and 18% of GPs will be reaching minimum retirement age in the next one to 10 years. This could mean a loss of over 25,000 doctors through retirement alone.
Doctors are retiring early
In addition, the number of doctors taking early retirement from the NHS has more than trebled over the past 13 years. Early indicators suggest the stress of working in the NHS through a pandemic may cause this to rise even further.
43% of respondents to a BMA survey in September 2021 agreed with the statement 'I plan to retire early', while 50% agreed with the statement 'I plan to work fewer hours after the pandemic'.
The GMC reports that between May 2021 to May 2022, 40% of doctors with a primary medical qualification (PMQ) from the UK cited ‘retirement’ as their main reason for leaving UK practice,
What the BMA is calling for
The publication in July 2023 of a long-term strategy based on supply and demand modelling – which the BMA has lobbied for alongside a wider coalition of stakeholders – is a major step forward. To ensure the plan achieves what it set out to, it must be backed-up with the necessary funding and commitments must be extended to include all aspects of the medical training pipeline.
For more information on the BMA’s view on the Long-Term Workforce plan, see our briefing.
Given the time it takes to train a doctor, it is imperative that the NHS and Government takes immediate action to retain those currently working and ensure they are valued.
The BMA is calling on the government to fairly restore doctors’ pay and properly value the contribution of doctors. Find more information on our current pay campaigns.
Health and wellbeing initiatives
The BMA is advocating for better working conditions and work-life balance to protect staff health and wellbeing. This includes flexible working options for all staff, and retention strategies across all grades of doctor as outlined in our Rest, recover and restore report, Mental Wellbeing Charter and Good Rostering Guide.
The BMA is working in partnership through the social partnership forum to address the escalation of violence and abuse against healthcare workers. Read more in our violence against doctors briefing.