Workplace experiences 2024

Executive summary

The executive summary outlines the findings in this year’s report. It shows how we’ll work with healthcare organisations to maintain high standards of patient care in the face of ongoing pressures.

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Foreword

UK health services are in a critical state and those who work within them are at breaking point.

Workloads are high and professional satisfaction is low. A third of doctors are struggling and feel unable to cope. 41% report having seen patient safety compromised.

Seeking to protect their wellbeing, doctors are taking matters into their own hands. Many are reducing their hours and declining additional work. A concerning proportion are taking time off due to stress. This further constrains capacity, increasing the pressure on those who remain.

While these issues are present among the whole doctor population, they are particularly acute among certain cohorts. Doctors in training are now more likely to be at high risk of burnout than any other group. They are also among the most likely to be considering leaving the UK. Issues around rotas and frequent placement changes are disrupting family life and undermining the sense of belonging needed for a long, happy career. If we fail to recognise the significance of these factors, we risk demoralising the newest generation of doctors when they’ve scarcely even begun.

Meanwhile, trainers report being more dissatisfied than non-trainers. Without their experience and enthusiasm, efforts to increase the number of doctors in training will fall flat. Making the role of trainer attractive to senior practitioners is therefore vital if we’re to build a strong pipeline of future talent.

Results from primary care are also particularly concerning. Of all doctor groups, GPs continue to be the least likely to be satisfied and the most likely to be struggling with their workload. Support for their wellbeing is vital. But so, too, is a fresh approach to the delivery of services. Developing the multi-disciplinary team in general practice will be crucial in freeing up doctors’ time to do what only they can do.

Intelligently using the skills mix of the health workforce is key to increasing productivity and improving patient outcomes. Locally employed doctors are the fastest growing of all doctor groups but have often found support for their learning and development to be lacking. Helping these doctors grow their skills and deploying them more widely could make a real difference, both to them and to the patients in need of care.

Doctors’ experiences of UK practice vary greatly across different groups. For the fifth year in a row, our data raise flags around the poor experiences of disabled doctors, who are worse off than non-disabled doctors across multiple measures.

This is not only incredibly harmful to those doctors, it is also incredibly short-sighted. Without a sustained focus on compassionate culture and inclusive leadership, more damage will be done to doctors’ wellbeing, and more doctors will consider leaving.

Across the profession, workload pressures are draining morale. Combating the negative trends we’re seeing is mission critical. Part of this comes down to having enough healthcare professionals to serve the needs of our changing society. But that’s not the whole story.

Our data show that while overall workforce numbers have increased in recent years, this has not led to improvements in doctors’ experiences. It is not enough to simply grow the workforce if large numbers of staff within it remain demoralised. And if workplace pressures cause experienced staff to leave, the arrival of new staff alone will not plug the gap. Retention is the route to more stability in UK health services and the government cannot achieve its ambitions without it.

Good patient care is impossible without a motivated workforce to deliver it. Health services rise and fall on the strength of their teams. And right now, they are struggling. Putting UK healthcare on a sustainable footing means putting the fundamentals of compassion, empathy, and fairness at its heart. To deliver better outcomes in the system, we must focus on fixing the foundations.

Chapter 1: The state of the profession: An imperative to act now

This report, which draws on evidence from the Barometer survey, highlights a concerning picture of the medical workforce in 2023. After successive years of declining wellbeing indicators, the vicious cycle of workload pressures, low satisfaction, risk of burnout, and desire to leave UK practice or reduce working hours has not improved.

A worrying proportion (33%) of doctors were ‘struggling’. This meant they were regularly working beyond their rostered hours and not feeling able to cope with their workload. High proportions of doctors ‘struggling’ presents risks to patients and the workforce. Employers and arm’s-length bodies need to be aware of where doctors are experiencing these pressures and address them. Planning for this will need to include action that focuses on developing more compassionate leadership; creating more supportive and inclusive environments; demonstrating that doctors and other healthcare professionals are properly valued; and ensuring doctors feel empowered and listened to.

Doctors are taking steps to deal with these pressures themselves. For two years in a row, high proportions of doctors have reduced their hours (19% in 2023) and refused to take on additional work (41%) in response to pressure on workload and capacity. For individual doctors, this is often the only responsible course to enable them to deliver safe care. But taking these steps further reduces the capacity of the health service and is not a good basis on which to build the sector’s future.

In 2023, 48% of general practitioners (GPs) were struggling, a higher proportion than that of other groups of doctors. That GPs have worse experiences than other groups of doctors has been a persistent pattern since 2019.

Both doctors in training and trainers were more likely than average to be under pressure. A quarter of doctors in training (24%) were at high risk of burnout in 2023 (a higher proportion than all other doctor groups). 44% of trainers were dissatisfied, compared with 37% of non-trainers. We will scrutinise this issue and act in line with our regulatory remit, but it’s crucial that employers play their part in ensuring capacity and support are available: it is vital that time for training is protected, both for trainers and doctors in training. This will become even more important as governments across the UK act to increase numbers in training over the next decade.

Locally employed (LE) doctors, though a diverse group, had worse experiences than other doctors in some metrics. A relatively low proportion felt part of a supportive team (66%) and a relatively high proportion had taken hard steps to leave (20%), compared with other doctor groups. The experiences of LE doctors vary depending on their age and where they gained their medical qualification. LE doctors are the fastest growing doctor group and have been overlooked in the past. Some employers are now considering their needs more carefully, and it is important that this spreads across the system. In particular, the learning, development, and progression opportunities for LE doctors must be strengthened.

Disabled doctors have worse experiences than non-disabled doctors. In 2023, 44% of disabled doctors struggled with their workload, and 52% found it difficult to provide sufficient care to patients at least once a week, compared with 32% and 42% respectively of non-disabled doctors. Making sure that reasonable adjustments are quickly implemented in working environments is vital. Ensuring that good working practices are followed across the board will positively affect all doctors, and disabled doctors in particular.

Chapter 2: Doctors’ workplace experiences in 2023

In 2023, 53% of doctors reported being satisfied with their day-to-day work. This is similar to 2022 (50%), but remains lower than previous years, after a sharp fall from 70% in 2021.

Though doctors’ workloads remained high, there were small reductions in the proportions of doctors who worked beyond their rostered hours, found it difficult to take breaks, and felt unable to cope with their workload. A third of doctors (33%) were categorised as struggling with their workload, down from 38% in 2022 but still higher than the 2021 level (26%).

Doctors continued to feel supported by their immediate colleagues: 85% said they felt supported by their colleagues in 2023, similar to 2022 (82%) and 2021 (84%). However, levels of feeling supported by senior medical staff (61%) and by nonclinical management (41%) remained lower than 2021 (66% and 50% respectively).

43% of doctors reported finding it difficult to provide their patients with the sufficient level of care needed at least once a week, in line with 2022 (44%) but much higher than in 2021 (25%). Difficulty providing adequate patient care was associated with struggling with their workload, high risk of burnout, experiencing a lack of support, and reporting insufficient autonomy.

Doctors were more likely than ever to report having taken hard steps to leave the UK medical profession. In 2023, 16% said they had done so, compared with 15% in 2022 and notably higher than 7% in 2021.

Groups of doctors who were more likely to have taken hard steps to leave included doctors who were not part of a supportive team (30%), those dissatisfied with their day-to-day work (27%), and those struggling with their workload (23%).

Chapter 3: Workplace experiences by UK country

The broad trends across the four countries were similar in 2023. As noted in previous chapters, there has been a pause in deterioration since 2022 across the UK.

In 2023, doctors in Scotland reported slightly more positive experiences than the average across the UK. This included a higher level of satisfaction in their day-to-day work as a doctor (59% compared with 53% of UK doctors) and feeling they had enough autonomy in their role (68% compared with 60% of UK doctors). A lower-than-average proportion of doctors in Scotland were at high risk of burnout (14% compared with 21% of UK doctors).

Doctors in Northern Ireland generally reported more negative experiences than the UK average, including a higher level of dissatisfaction in their work. 48% were dissatisfied, compared with 39% of UK doctors.).

A higher-than-average proportion of doctors in Northern Ireland found it difficult to provide sufficient patient care at least once a week (55% compared with 43% of UK doctors) and had witnessed patient safety being compromised at least once a week (52% compared with 41% of UK doctors). A lower-than-average proportion felt supported by non-clinical managers (30% compared with 41% of UK doctors) and senior medical staff (49% compared with 61% of UK doctors

Doctors in England had workplace experiences that were generally in line with the UK average, as this group comprised most of the total sample.

Doctors in Wales had experiences that were generally very similar to those of all UK doctors. They were more likely than the UK average to identify patient flow or bed pressures as a barrier to providing good patient care (68% compared with 57% of UK doctors).

Chapter 4: Variation of experiences across the workforce.

In 2023, out of the main doctor groups, general practitioners (GPs) were the least likely to be satisfied (42% compared with 53% of all doctors) and the most likely to be struggling with their workload (48% compared with 33% of all doctors). This is broadly in line with previous years, although GPs saw some small improvements in the period 2022 to 2023.

Doctors in training had the largest proportion of doctors at high risk of burnout (24%) compared with other doctor groups. 21% of all doctors were at high risk of burnout. Trainers were more likely than non-trainers to be struggling with workload (36% compared with 31%).

Specialty and specialist (SAS) doctors reported the most positive experiences compared with other doctor groups while locally employed (LE) doctors’ experiences were more mixed. LE doctors, especially those who graduated in the UK, were the most likely to have taken hard steps to leave the UK profession. 20% of all LE doctors had done so, while 37% of LE doctors who were UK graduates had taken hard steps to leave (compared with 16% of all doctors).

LE doctors and doctors in training had similarly negative experiences in certain areas. Both groups had a lower-than-average proportion of doctors who felt they had enough autonomy in their role. 52% of doctors in training said they had enough autonomy, as did half of LE doctors (50%), compared with 60% of all doctors.

Doctors working in paediatrics and anaesthetics had the most positive experiences. Surgeons, those working in emergency medicine, and GPs had the most negative experiences.

As in previous years, non-UK graduates tended to report more positive experiences than UK graduates. This was especially true of doctors who gained their primary medical qualification (PMQ) from outside the European Economic Area (EEA). 62% of graduates who graduated outside the UK and EEA were satisfied, compared with 49% of UK graduates.

Among UK graduates, ethnic minority doctors generally reported poorer experiences than white doctors. 25% of ethnic minority doctors were at high risk of burnout compared with 20% of white doctors. Ethnic minority doctors were more likely than white doctors to have taken hard steps to leave (23% compared with 14%). Among non-UK graduates, the experiences of white and ethnic minority doctors were broadly similar.

Disabled doctors reported higher dissatisfaction (44%) and were more likely to feel unable to cope with their workload at least once a week (49%) than their non-disabled colleagues (38% and 37% respectively).

Female doctors were more likely than male doctors to report that they have been struggling with their workload (36% compared with 29%).