Context and System Signals

The NHS faces no greater long-term threat than the loss of its people. While pressures on beds, flow, and digital systems attract headlines, a quieter and potentially more destabilising issue is unfolding: rising staff resignations, early retirements, and a sharp increase in professionals leaving the register altogether.

The headlines from the May NHS England Board Report focused on recovery, performance gains, and system reform, yet beneath this sits a growing capacity gap. One not driven by vacancies alone, but by disillusionment, fatigue, and unsustainable strain. The impact is not just numerical, it is cultural, operational, and strategic.

This piece takes a closer look at the scale of workforce exits, what they mean for planning, and how partners like ProMedical can support system resilience.

The Scale of the Leak: What the Numbers Tell Us

 The May 2025 Board Report noted a year-on-year decline in the NHS’s total pay bill, a signal of reduced temporary staffing spend and tighter budget discipline. However, behind this sits a deeper tension: the system is shrinking its cost base even as it experiences sustained demand and attrition.

Consider these data points:

• Over 170,000 NHS staff voluntarily resigned in the year to September 2023, an increase of 28% over five years
• The Nursing and Midwifery Council (NMC) reported that over 27,000 professionals left the register in 2022–23, the highest figure in recent memory
• One in three GPs say they plan to retire within the next five years
• The GMC’s State of Medical Education & Practice shows that workload pressure and wellbeing remain leading factors for doctors leaving or considering exit, around 4% leave the GMC register each year

This is not just about retirements. It’s about system exit, highly skilled people, many in their prime, stepping away from practice altogether. When that happens, re-entry becomes exponentially harder, and the loss of accumulated expertise, especially in specialist or leadership roles is profound.

Strategic Implications: Risk to Capacity and Planning Credibility

The implications are multi-layered:

• System flow and elective recovery depend on having sufficient trained clinicians, but if workforce assumptions ignore attrition, they become unreliable.
• Integrated care strategies rely on a flexible, well-distributed workforce, yet community and mental health providers report the highest turnover rates.
• Financial planning assumes efficiencies through digital innovation and pathway redesign, but every innovation needs people to embed and deliver it and the cost to train new healthcare professionals is significant.

“Jim Mackey, incoming NHS England CEO, recently described parts of the NHS as becoming “fossilised,” with a culture that sometimes sees patients as an inconvenience, not from malice, but from deep-rooted exhaustion and systemic overload.”

That comment was provocative, but it speaks to something real: when professionals are operating under chronic pressure, system compassion and loyalty erodes fast. Leavers are not just a risk to numbers, they are a red flag to the very culture the NHS is built on.

Why They Leave: Beyond Pay and Perks

It’s tempting to frame workforce exits around pay, working hours, or competition from other sectors. But the evidence, including the Health Foundation’s 2024 workforce analysis points to deeper causes:

• Lack of voice in decisions
• Poor local leadership and autonomy
• Inefficient rosters and unsafe staffing levels
• Lack of access to development or career pathways
• A culture of transactional scheduling over human-centred management

For example, over 70% of NHS leavers surveyed by the NMC said they did so not because of pay, but because “the role no longer felt sustainable.” That is a signal not of rebellion, but of exhaustion.

Supporting Retention Through System-Aware Partnerships

The system cannot retain staff through words alone, nor through more regulation, more long term plans, digital dashboards, or central targets. What’s needed is:

1. Smarter workforce planning that builds in attrition data and life-cycle modelling
2. Retention-focused rostering and job design, particularly in under-pressure specialties
3. Strengthening ‘trust owned and managed’ internal staff banks as a flexible alternative to external high cost bank solutions or agency dependence
4. Safe temporary staffing partners that understand the system, not just the shifts

At ProMedical, we believe recruitment is no longer just about filling posts, it’s about aligning to long term system resilience to deliver safe patient care and make workload sustainable to currently stretched NHS staff. That means:

• Providing advisory input on workforce redesign, especially for high-risk specialties
• Offering data-backed insight into leaver trends, risk hotspots, and cost effective flexible workforce solutions

A Final Word from Altin Biba, MBA,  AMBA Chief Executive of ProMedical

Workforce is not just a cost line, it is the infrastructure of the NHS. When professionals leave, we lose more than capacity. We lose continuity, culture, and the human scaffolding that enables safe care to patients.

This is not about blame, it’s about focus. The NHS has made significant gains in recent months. But any performance recovery that ignores the human drivers of system stability is temporary.

At ProMedical, we are committed to understanding these patterns, not only because it shapes our service offering, but because we know real impact comes from working with the system, not around it.

If this month’s Brief resonates with your own local experience, we’d welcome a quiet, strategic conversation.

References

1. NHS Digital – NHS Workforce Statistics (2023)
2. NMC – Annual Data Report (2023)
3. King’s Fund – Workforce Trends in General Practice (2024)
4. GMC – The State of Medical Education and Practice (2024)
5. Health Service Journal (HSJ) – Jim Mackey Interview, June 2025
6. Health Foundation – Retention in the NHS: What the Evidence Tells Us (2024)