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The employee turnover and retention Challenges in the NHS, England

Introduction: The employee turnover and retention Challenges in the NHS, England

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This report aims to highlight the current scenario in the healthcare sector regarding nursing shortage and staff turnover. The sudden outbreak of the COVID-19 pandemic has highlighted several pitfalls or loopholes within the healthcare sectors of most countries across the world. Quek et al., (2021) has mentioned that the healthcare sector is one of the most important industries on which the health and well-being of an entire society depend extensively. Though with time, the nursing shortage and employee turnover are becoming major issues, and this turnover intention has increased significantly during the COVID-19 pandemic. Quek et al., (2021) has mentioned that this high staff turnover might result from growing stresses and work pressures, handling a huge number of patients and delivering the best possible treatment, mental stress and anxiety among the nurses. According to Costelloet al., (2020), these factors can be considered the main contributing predictors of turnover decisions. Though, a recent survey mentioned that nurses or healthcare workers who are quitting their workplace do not necessarily take a permanent leave from their profession. A study showed that approximately 89 per cent of the registered nurses or RNs in the UK remain in their profession after leaving their hospital jobs. The same study also revealed that an increased population of the RNs or registered nurses leave their workplaces, including hospitals, to work for others as healthcare providers. Besides the COVID-19 outbreak, there are other important factors which can contribute to the high nursing turnover; and that factor is leadership. There are several studies which indicate that the leadership approach of nursing managers within a healthcare sector can accelerate the cause of turnover intention among the nurses or healthcare providers in hospitals. On the other hand, it is also true that healthcare leadership at the current time is facing several challenges or obstacles to cope with the high employee turnover and employee retention factor (Chiou, 2021). Starting from the reimbursement issues to developing and implementing healthcare policies and dealing with their complaint from healthcare workers to mitigate the gap- the issues are several with which a healthcare leader or manager has to deal with. 

Aim and objective of the report 

The primary aim of this business report is to explore the current situation being faced by healthcare managers in the healthcare sector or industry of the United Kingdom. In this report, the focus will also be given to major challenges being faced by healthcare leaders in terms of employee retention and delivery of the best quality healthcare services to the patients and community people.

Therefore, the objectives of this report are:

  • To highlight the major challenges being faced by healthcare workers from the perspective of leadership in the healthcare setup
  • To identify the issues healthcare leaders are facing regarding employee retention and staff turnover in the healthcare sector of the UK.
  • To develop possible recommendations about the best possible way to tackle the issues and implement the changes.

Case study analysis 

As per the data published in BMA.org.uk, it was seen that the NHS UK are facing severe problem of challenges related to the workforce, specifically since the outbreak of the COVID-19 pandemic. According to the review, the NHS is experiencing severe pressure in its prior 60 years of history. According to (), the pandemic scenario is the tip of the iceberg. The real problem that the entire healthcare sector of the UK and England is facing is related to inadequate planning and under-resourcing. As per a news article published in “Independent”, the majority of the junior doctors have already left NHS, UK, last year. According to this news article, a survey was conducted by BMA or the British Medical Association, which showed that 4000 of the junior doctors in November and 80 per cent of the doctors in December are planning to leave the NHS to protest against the equal or fair pay-roll policies. In the NHS, junior doctors get 2 per cent of the rise every year as a part of the agreement in 2019 in England, whereas separate deals have been found in Scotland, Wales, and Northern Ireland. According to the RCN general secretary Pat Cullen, “the government has the opportunity to solve this issue before Christmas, but the government has chosen to push the healthcare workers and nursing staff out into the cold” (Kline, 2019). The survey by the BMA or British Medical Association, staff shortage is growing every day in the NHS, UK. the major contributory factors to this fact are inadequate planning for workforce management, insufficient and lack of accountability by the government, which also include the insufficient policy framework, funding and grant, lack of infrastructure. This same survey or study also reveals that chronic understaffing is a cause of increased workload and work pressure, and bureaucracy, which has made the NHS UK as a "leaky bucket". On the other hand, years-old demoralising pay-roll or erosion, punitive pension, and taxation policies made it harder for the nursing and healthcare staff to retain in NHS over a longer time.

Literature Review 

Major challenges faced by the healthcare workers from leadership practice within the healthcare sector 

According to Edwards et al., (2018), a business used to flourish with the help of a good leader. Within the healthcare sector, a skilled leader is essential for motivating the staff to work at their highest potential and deliver the best healthcare service to the patient. The term leadership in the healthcare industry is often used alternatively with “management”. However, both the management and leadership play a critical role in healthcare setup, including planning, implementation of policies in real-time, control, organising, budgeting and analysis. The importance of effective leadership is related to the implementation of reform and shaping the corporate culture within the healthcare industry and among workforces who are related to this specific sector. Monkhouse et al., (2018) has mentioned that the main role or responsibility of a leader in a healthcare setup is to coordinate the workers and staff, oversee the payroll and complaints, motivate the nurses and other healthcare providers to deliver the best healthcare services to the patients along supervise whether all the needs or requirements of the care-workers are being fulfilled or not. 

Considering the case scenario, it can be seen that after the outbreak of the COVID-19 pandemic, the healthcare staff are facing major challenges in their workplace setup. The increasing rate of workload and rising bureaucracy are making the NHS a leaky bucket or a challenging workplace setup for the care providers. Additionally, unequal wages rate, year-old demoralising pay erosion, pension rules and taxation policies for the nursing staff made it harder for them to stay at the workplace (Anderson, 2018). For example, in the UK, the major challenges faced by the staff from the perspective of leadership approaches are as follows:

  1. Hospital backlog: once the COVID-19 pandemic is finally extinguished, a major stumbling block is creating a crisis in the staffing scenario. Lack of infrastructure, autocratic leadership approach at healthcare setup, lobbying and rising of bureaucracy is the main constraint or challenges that, in recent time, healthcare workers are facing. 
  2. Morale on the frontline:bouncing back is a tough job without having a ready workforce”. COVID-19 has put the healthcare workers in the NHS under pressure and work strain. For this reason, doctors and healthcare workers are getting exhausted and burnout, which in turn impacts mental health and well-being. There is no doubt that the medical professionals across the UK and in NHS have served an extraordinary level of commitment at the time of the pandemic. Still, as per the majority of the professionals, they are not getting paid fairly. Payroll check is one of the major duty of the leader, and unfair wages rate and excessive work burden can be detrimental to the personal health of the nurses and care workers; and when they are working without any protection. 

Another important role or responsibility of the leader in the healthcare sector is to check the mental health and well-being of the healthcare workers or nursing staff (Anandaciva et al., 2018). Though, the lack of proper infrastructure, healthcare policies and shortage of staff create mental stress on the existing healthcare workers.

  1.  Leadership gap: healthcare leaders have the daunting task of managing teams and facilities in a high-stake industry. The role or responsibilities of a leader in the healthcare sector is to oversee the expenditure, and job vacancies and monitor uncertainty within the workplace setup. However, most healthcare leaders in NHS do not have formal or adequate training in leadership. Additionally, busy schedules do not allow leaders to get time to pursue leadership training. In NHS, in most of, the cases traditional leadership approach. Though, in NHS, it is often seen that the professional development program and traditional leadership approach do not address the unique challenges within the healthcare industry (Anandaciva et al., 2018). Additionally, there is a huge gap in the leadership skills and training program. Therefore, healthcare workers do not get minimal support from the leadership perspective regarding a payroll check or equal pay.
  2. Insufficient: Funding can also be related to the current healthcare worker turnover rate or the current strict and tendency to quit the NHS among junior doctors and healthcare workers in the UK. Lack of negotiation skills, empathy and skill to develop contingency plans among the healthcare leaders lead the workers to get less payment in comparison to their wages rate. Additionally, healthcare workers were forced to deal with COVID-19 with limited funding, and as a result, they could not meet the needs of the NHS in managing the pandemic. On the other hand, improper leadership approaches and management facilities have made the growth of the GP workforce stagnation. In the UK, the average number of patients per FTE or full-time equivalent GP has been increased by 20 per cent since 2016 (Swanwick and Varnam, 2019). This, in turn, has input much clinical and administrative burden on the general practitioners and health care staff. 

Highlight and address the challenges related to employee retention in the healthcare sector

According to a report published by the NNHS. UK:

  1. The cost of replacing a fully-trained and skilled Nurse is equivalent to 12,000 euros
  2. The investment or spending on trust to replace nurses in NHS is equivalent to 3.6 million euros
  3. The total burden of failing to address staff retention in NHS (MSI/HWF) is approximately 21.8 billion euros
  4. The cost of recruiting a skilled nurse from outsourcing and overseas is approximately 6,000 euros
  5. The burden of NHS on the absence of staff due to poor health every year is approximately 2.4 billion euros.

These facts indicate the cost burden on the NHS related to staff turnover and retention. Staffing is one of the major concerns in NHS as well as the healthcare leaders and managers. Considering the case scenario, it can be seen that 4,500 of the junior doctors in the NHS are planning to leave the NHS and the country. The walkout by the nurses and healthcare workers, along with the junior doctors in England, Wales and Northern Ireland in terms of strike for two days in December, indicates the incapabilities of healthcare leaders to manage the workers in NHS in a proper way. According to the case study, the strike in January might take place among the NHS employers in England, which will increase from 45 to 55 trusts. This high turnover rate can cause difficulties in meeting the staffing needs of the NHS and assurance to offer adequate services to the patients and society (Chiou, 2021). In response to this statement, it can be stated that management used to play a major role when it came to keeping the employees engaged and motivated with their roles in the workplace setup. Some studies suggest that in any sector, the main source of employee motivation is associated with the managers. Though, considering the current scenario, it can be stated that several challenges or issues are being faced by the leaders while there is a high employee turnover rate (Costello et al., 2020). In healthcare, employee turnover can cause the following challenges for leaders:

  1. Improve care service: when the leadership approach is not on the right track, it may not be possible for the organisation to deploy the human resources rightfully and optimally. Additionally, an inadequate leadership or traditional autocratic leadership approach can fail to meet the basic needs of healthcare workers. One of the major needs is the mental health and well-being of nurses and general practitioners. In the NHS, when there is a high employee turnover rate, leaders fail to retain the existing skilled nurses. Therefore, it has increased the work pressure on existing workers and led them towards declining health and well-being. 
  2. Poor service: on the other hand, poor mental health and well-being among the general practitioners and healthcare nurses can increase the scope of poor healthcare service delivery, which in turn can restrict the NHS from fulfilling the needs of patients and the community and can increase the disease burden, overhead cost of the organisation to a considerable extent.
  3. Inadequate space and deteriorating estate: poor workforce management, high employee turnover rate along with declining revenue of the NHS can be considered as the consequence of the deterioration of NHS estate, which is increasingly unfit for the purpose (Marufu et al., 2021). The cost of maintaining the deteriorating asset and transforming that into a suitable working format or the cost to mitigate the maintenance backlog is rising each year. But the fundamental problem healthcare leaders are currently facing with employee retention is getting sufficient space and skilled expertise to train new doctors. This is preventing staff from delivering the care they would like to.
  4. Outdated and insufficient : IT provision is another challenging scenario for leaders, which is directly associated with employee retention and turnover. Outdated and insufficient IT provision across the NHS can cause a delay in delivering necessary healthcare services to the patients and waste valuable staff time. Above all the issues related to lack of interoperability in terms of maintaining the confidentiality of patient data and information, sharing of patient records can also be considered as another leadership issue or challenge in the NHS. This can create blockages and duplication of the work and give rise to fraudulent activities. 

According to (), there are several ways in which the staffing problem can be addressed. First, the NHS should put staff retention at the heart of any healthcare policy and decision. There are several straightforward ways in which NHS can increase pay across the board. The NHS can implement Governmental grants to increase the funds and ensure the paying to the staff on time. Maintaining and implementing flexible working hours and timing in healthcare setup can also be considered as one of the major ways to deal with staff turnover.

Additionally, it is also important for the leaders and managers of the NHS to seek tools for delivering consistent and regular recognition and rewarding the staff for going the extra mile. Non-financial and financial incentives and proper appraisals can help the workers to be motivated and committed towards their role, which in turn can help the NHS and its leader to manage employee retention and performance efficacy. At the same time, it comes to delivering the best healthcare services. Additionally, a healthcare leader can supervise the set-up and implementation of policies and regulations in such a way with which the current level of workforce dissatisfaction can be monitored and mitigated.

Secondly, to make the best use of the capacity within the already existing system, leaders can implement a flexible working environment which will free up all additional capacity or workload on the healthcare workers. The leaders can also stress the equal wages rate and increase the organisational funding and infrastructures so that every healthcare practitioner and nurse can do their duties and responsibilities properly and effectively. In NHS, 78 per cent of the nurse or healthcare practitioners are women. Therefore the implementation of the strict rule against discrimination, rules for equal payroll and the development of a flexible working environment can offer benefits to the nurses and help them to maintain a proper work-personal life balance (Marufu et al., 2021). This, in turn, can reduce the anxiety and mental stress among the workers and help them to be motivated towards delivering the best healthcare services as per the necessity. This approach not only can help NHS to tackle the employee turnover rate but also strengthen employee retention and performance efficacy by reducing the overhead cost.

Adaptation of changes by the leader to deliver the best possible healthcare services

The quick and simple way to implement these changes is through technology. The use of robotics and AI in the recruitment and hiring process can help NHS to get the best and most skill staff for the healthcare service provider. Moreover, with the adaptation and rollout of the right technology, the NHS can become self-sufficient and regain control of staffing issues by reducing expenditure on agency fees. 

Best possible recommendation to tackle the challenges and deliver quality healthcare services 

Organisations with robust onboarding processes can help NHS or any healthcare industry to improve employee retention by 82 per cent. With the change of time, the work stress in the healthcare sector is increasing day by day, along with the demand rate among healthcare workers. Nowadays, one of the best ways to retain workers and reduce staff turnover is to give them flexible working hours and a work environment. A good onboarding process can help the workers to feel safe, valued, and in control of the working environment without sacrificing the company's cost efficiency and data management process.

Practice management software is another innovative approach to dealing with the em[ployee turnover rate and staff retention. When it comes to controlling patient and staff workflows, healthcare practitioners are well aware that they shouldn't rely on conventional concepts. Practice management software is now necessary for doctors and hospitals to implement in order to delegate work, improve collaboration, and provide secure access to sensitive data as the demand for high-quality healthcare keeps rising (Cheng et al., 2020).

As staff retention largely depends on the presence of good infrastructure, practice management software can help NHS to bring potentiality from the healthcare workers; this system enables the organisation of patient information and set up of schedules in the appropriate way by improving the documentation process. 

Telehealth and telemedicine platform is another innovative approach with which staff retention can be managed along with increasing organisational performance efficacy. Modernising the healthcare practice refers to incorporating telehealth and telemedicine technology. This can help the healthcare workers to engage the patient in practice remotely. Above all, with telemedicine, NHS can also boost employee retention by ensuring flexible working hours and limiting the workload even during the pandemic scenario. For starters, telemedicine can lessen the symptoms of burnout among primary care staff members who are susceptible to demanding on-site work environments. In addition, telehealth enables practitioners and nurses with comorbidities or other problems to work flexibly (Andersson, 2015). Despite the distances, you can keep healthcare professionals close by using telehealth, which is growing more and more common.

Human resource solutions can be another innovative approach to tackle employee turnover and staff retention and mitigate the leadership challenges in NHS. Along with the practice management software, the NHS needs to equip the workplace and human resource department with the right tools. These tools can enable management and engage the healthcare staff with the practice (Moscelli et al., 2022). The NHS can implement a real-time feedback process instead of waiting for an annual review, and it helps to develop an engaged and high-performing workforce and workplace. Strong staff management software may assist HR in making quicker decisions when it comes to processing leaves, managing payroll-related activities, enhancing internal communications, and planning upskilling sessions. On-site nurses or virtual medical assistants.


To conclude this report, it can be stated that NHS is going through several employee-related and leadership challenges. In this report, the focus has been given on a recent newspaper article, where the focus has been given on the high turnover rate of junior doctors and nurses in England, Wales and Ireland. Insufficient facilities, improve leadership management, unfair payroll and wages rate along with high workload are the main reasons for high employee turnover in the NHS. Though in this report, an in-depth analysis of how these challenges can be overcome has been assessed and evaluated. In this report, the primary focus has been given to implementing technologies as the foremost way to mitigate employee retention and turnover issues at NHS.


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