A new analysis collating dropout rates among clinical degree students in England revealed how significant numbers never make it into the NHS as full-time doctors, nurses, and other health professionals – or leave early in their careers.
The study by the Nuffield Trust showed that for every two GP training places filled, only one person joined the GP workforce full-time.
It also found the proportion of doctors who take a break after foundation years doubled from 34% to 70% between 2011 and 2021 and around one in six of them don't return to finish their training.
The think tank's analysis of early careers found that fewer than three in five doctors in core training remain in the NHS in England 8 years later, with half of the dropout occurring in the first two years.
Help With Student Debt
The study showed a similar situation in nursing, with one in eight students dropping out during training and 18% of nurses leaving the NHS within the first two years of employment.
The situation was contributing to strain on the NHS and unnecessary expense to the taxpayer, the Nuffield Trust highlighted. It suggested that dropout rates might be cut — and retention rates boosted — if student loans for nurses, midwives, and allied health professionals were written off under a "loans forgiveness" scheme for those who stayed employed in the NHS for 10 years.
In the case of doctors and dentists, a formula for delaying paying off loans without accruing interest might be investigated.
The researchers looked at data on more than 190,000 student records to establish rates of attrition during university studies. They also examined 100,000 staff records to try to understand early careers retention. Searches of available literature were conducted to try to explain the UK's high dropout rates and what other countries were doing to address the issue.
Current Situation Damaging for the NHS
One of the report's authors, Dr Billy Palmer, a senior fellow at the Trust, said: "These high dropout rates are in nobody's interest. They're wasteful for the taxpayer, often distressing for the students and staff who leave, stressful for the staff left behind, and ultimately erode the NHS's ability to deliver high-quality care."
The British Medical Association (BMA) said the cost of studying to be a doctor was "saddling medical students with crippling debt, in some cases over £100,000", and that rising student loan repayment costs would add to the burden. BMA medical students committee co-chairs Chinelo Nnadi and Shivani Ganesh said in an emailed statement: "Such high costs will deter a future generation of capable and talented medics, particularly those from an economically disadvantaged background or those studying medicine as a second degree, at a time when we need to widen participation in medicine."
The Royal College of GPs (RCGP) welcomed the Nuffield Trust's analysis. In an emailed response to Medscape News UK, its vice chair for external affairs, Dr Victoria Tzortziou Brown, said: "There may be many reasons for GP trainees choosing to work part-time, or even leaving the profession, after qualifying, but we are extremely concerned that this is happening due to unsustainable workload pressures – and need urgent action to halt this."
A serious workload and workforce crisis existed, with demand for services ever rising but without the supply of GPs to cope, she commented. "The sad fact is that the job of a 'full time' GP is now largely unmanageable, and even working 'part time' in general practice often means working what would normally be considered 'full-time', or longer," she added.
Dr Tzortziou Brown called for a fully funded national retention scheme and measures to cut the amount of time GPs spend on bureaucracy instead of caring for patients.
Government Says Current System "Strikes Right Balance"
Reacting to the Trust's analysis and call for a student loan forgiveness scheme, the Government said it had made significant progress in growing the workforce, resulting in record numbers of staff working in the NHS.
A Department of Health and Social Care spokesperson said, "The current student finance system strikes the right balance between the interests of students and of taxpayers. We are working closely with NHS England to reduce student attrition rates and ensure they are supported whilst in training.
This includes a training grant for eligible nursing, midwifery and allied health profession students of at least £5000 a year, alongside support for childcare and certain expenses."
This article was updated on 29 September 2023 to include comments received from the British Medical Association