A shortage of 1,400 NHS anaesthetists already means that more than one million surgical procedures are delayed every year

Published: 30/09/2021

One-in-four anaesthetists plan to leave the NHS in the next five years

Up to one million operations1 may be delayed every year because of a shortage of 1,400 anaesthetists – and the situation will get worse, as one in four working anaesthetists plans to leave the NHS in the next five years.

Retaining more anaesthetists within the workforce would provide part of the solution to surgical waiting lists2 and would give more time to make up for a shortage of newly-qualified anaesthetists caused by pauses to training during the pandemic and a shortage of training posts.

However, to do so will require prompt action. Working patterns should be adjusted to accommodate the changes of ageing, adjustments should be made to pension and tax arrangements to address the financial pressures that force doctors to retire, returning to work after retirement should not involve loss of status, pay and rights, and employers should focus on supporting those in later stages of their careers. Not feeling valued or supported is cited by anaesthetists as their main reason for wanting to leave. This needs to be addressed as a matter of urgency.

The findings are set out in the ‘Respected, valued, retained’ report and survey data3 published today by the Royal College of Anaesthetists.

The current shortage of 1,400 NHS anaesthetists4 was compounded during the pandemic by more than 500 anaesthetists in training not being able to secure a national anaesthetic registrar training place5.

The RCoA is assembling health leaders from across medical specialities to consider and debate the issues arising from the report. This is a chance to explore what individuals, managers, employers and systems can do to improve retention in anaesthesia.

Anaesthesia is the single largest hospital specialty. Anaesthetists are skilled and experienced doctors delivering highly specialised care to more than two-thirds of all NHS hospital patients and over three million patients6 each year. Anaesthetists continue to be front-and-centre of the NHS’s response to the COVID-19 pandemic by working alongside their intensive care colleagues to treat the sickest of patients.

As the average age of the anaesthetic workforce keeps rising7, it is struggling to train and retain enough ‘next generation’ anaesthetists to meet increasing patient demand. Today’s data add to existing concerns that the NHS will struggle not only to address the millions of patients on waiting lists following the COVID-19 pandemic, but also to cope with the increasing long-term demands of an ageing population.

Key findings:

  • 25% of consultants and 29% of anaesthetists in training plan to leave the NHS within five years
  • 42% of anaesthetists who have left or retired from the NHS cite not feeling valued or well supported as their main reason for leaving
  • over one third (35%) cite bureaucracy and leadership issues as the reason they left the NHS.

Reasons for leaving:

  • not feeling valued or supported (42%)
  • concerns about taxes or pensions (36%)
  • bureaucracy and leadership issues (35%)
  • improving mental wellbeing, reducing stress or burnout (25%)
  • could not sustain workload or being on-call (25%)
  • lack of flexibility, reduced hours, breaks or leave (19%)
  • lack of autonomy and respect (16%).

Dr Fiona Donald, President of the Royal College of Anaesthetists said:

“Staffing is fast becoming the key issue for the NHS as it rebuilds after the pandemic.

“Successive governments have failed to invest in anaesthesia, while we have been speaking about the very personal impact of staff burnout for years8. The pressures are now unsustainable, and many of these vital doctors – whom the NHS cannot afford to lose – are now choosing to leave the NHS entirely.

“It is critical that the government, managers and NHS employers work together to retain highly skilled and dedicated anaesthetic doctors within the NHS. This will require a culture shift to encourage respect, compassion and dialogue. If the pandemic has taught us anything, it is that the people within the NHS are flexible and dedicated, so I truly believe that this can be achieved.

“There is no quick fix to retaining staff, as the reasons that people stay or go are complex and personal. However, this report clearly shows that flexible working and making staff feel valued can have a lasting positive impact. By putting staff welfare and wellbeing at the heart of the NHS workforce strategy, we can make a positive difference to the retention of employees, the capacity of employers and the lives of NHS patients.”


The Royal College of Anaesthetists ran this survey on retention between 16 and 30 June 2021. A total of 817 members from anaesthetists in training, consultants, SAS grade and retired anaesthetists contributed.


  1. Over one million patients at risk of not receiving treatment every year due to anaesthetic workforce shortages, November 2020
  2. We need more anaesthetists to tackle the backlog in elective surgery, June 2021
  3. Respected, valued, retained – working together to improve retention in anaesthesia, September 2021
  4. Despite additional funding, workforce shortages will limit the recovery of the NHS, September 2021
  5. Joint statement on anaesthetics recruitment, May 2021
  6. British Journal of Anaesthesia, Frequency of surgical treatment and related hospital procedures in the UK, July 2017
  7. Age and the Anaesthetist, August 2016
  8. A report on the welfare, morale and experiences of anaesthetists in training: the need to listen, December 2017