Improving retention in anaesthesia

Respected, Valued, Retained – working together to improve retention in anaesthesia


Anaesthesia is facing a perfect storm of workforce shortages, low morale and an ageing workforce. 

Our latest Census 2020 reveals a gap of 1400 anaesthetists currently.

The average anaesthetist across all grades treats 750 patients per year, therefore the current shortfall in anaesthetic cover could result in over 1 million procedures being delayed a year, compounding further the current waiting lists and patient experience.

Our members have suffered and continue to suffer high levels of fatigue and burn-out as a result of the pressures of managing COVID-19 patients while still maintaining emergency services and supporting the elective backlog recovery.

The 50 years + age group is now 39% of the workforce meaning that this group will be expected to retire in the next 5-10 years.

While we wait from the Government for long-term and sustainable investment in the NHS workforce, we all must do what we can to retain existing talent and improve the working lives of anaesthetists across all grades and nations.

Our report Respected, valued, retained - working together to improve retention in anaesthesia, warns that one-in-four anaesthetists plan to leave the NHS in the next five years and goes on to investigate the factors affecting retention in anaesthesia and possible solutions to improve retention at individual, employers and systems level.  

The factors affecting retention in anaesthesia

The factors affecting retention are complex and multifaceted and our report shows that a collaborative approach with flexibilities from all sides is essential, alongside the steps that Government and healthcare leaders need to take to remove the barriers preventing valuable and experienced staff from staying in work. 

The report, which contains survey data from anaesthetists in training to retired anaesthetists, paints a
concerning picture of a workplace culture which does not always facilitate career progression and flexible working, leading valuable and experienced staff to leave often out of frustration with unsustainable workloads and lack of the adjustments required to keep them in work.
Work-life balance and the need for flexibility (or lack of) emerge as two key factors affecting career decisions in anaesthesia.

The report also finds that conversations between staff and managers about career progression and retirement to support succession planning in departments do not happen consistently, leading to cliff edge situations where too little time is left to offer flexibilities required for those who would like to continue to contribute. This is further compounded by perverse pension taxation incentives which essentially encourage doctors to retire, rather than continue to work. 

The findings also tell us that decisions about flexibilities cannot be taken in isolation and that tailored solutions need to be discussed across teams to ensure that everyone can benefit from the same flexible approach thus fostering a culture of support and collaboration between those who require adjustments and those who require fewer, if any.

It’s also important for individuals to recognise any changes in cognitive and physical abilities and for staff to be able to have honest conversations with managers about any adjustments that might be required without fear of repercussion on their careers.

The issue of chronic excessive workload is of particular concern and the report makes recommendations for Government and NHS leaders to address this urgently. In the long term this can only be resolved by investing in the expansion of the anaesthetic workforce to fill existing gaps and to ensure it can meet the demands for anaesthetic services driven by population needs. In the short term by ensuring all targets for reducing the waiting lists allow time for staff to recuperate from the effects of the pandemic.

Summary of recommendations for improving retention of staff in anaesthesia

What individuals can do
  • Individuals should make use of available resources and take annual leave and time they need to look after themselves and recuperate.
  • Individuals requesting flexible working and adjustments should be mindful of the impact of these requests on other team members and should be open to discussing options and solutions with managers and colleagues which work for the whole team.
  • Individuals should recognise and be honest about physiological changes that might affect their ability to sustain current job plans and should seek help early.
  • SAS and Trust Grade Anaesthetists should proactively use appraisals and yearly reviews of job plans to discuss career progression and agree Personal Development Plans with their appraisers and employers.
  • Retired anaesthetists wishing to return should show flexibility and negotiate job plans that work for them, but also benefit the department and colleagues.
and teams
can do
  • Managers at all levels, including senior, should show compassionate leadership and foster a culture where staff are enabled and encouraged to seek help and the time off they require to improve their wellbeing.
  • Managers should consider and support requests for flexible working and LTFT working to improve the work-life balance of staff and have clear policies about flexibilities and retirement options available to staff.
  • Anaesthetic departments should actively support the professional development of SAS and Trust Grade Anaesthetists, using appraisals and yearly reviews of job plans to discuss opportunities for career progression available to them, for example the new specialist grade contracts or the Certificate of Eligibility for Specialist Registration.
  • Policies for dropping on-call should be equitable for all non-training grade doctors, with due consideration of the intensity of resident on-call requirements.
  • Employers should offer regular and tailored conversations about retirement and career plans as part of yearly reviews of job plans, including training for managers to have these conversations.
  • Employers should allow changes to working environments and job plans to support employees’ changing physical needs, with support from occupational health services if required.
  • Clinical Directors and Managers should regularly and proactively look at the age profile of their anaesthetic workforce to quantify and identify staff approaching retirement and initiate early conversations about retirement plans with these individuals.
  • Managers and employers should foster a culture of respect towards senior anaesthetists and encourage a collaborative and team-based approach to flexible working.
can do
  • Government and NHS Leaders should safeguard the mental and physical wellbeing of NHS staff by setting realistic targets for reducing the waiting lists which allow burnt out staff to recuperate from the effects of the pandemic and enable them to access the resources and time off they need.
  • Government should urgently invest in the expansion of the anaesthetic workforce and support an amendment to the Health and Care Bill from MPs which places a stronger duty on the Secretary of State for Health and Social Care to commission regular workforce projections and to act on them.
  • NHS Leaders should standardise retention policies across providers, and these should be aimed at encouraging staff to stay in work as long and as healthily as possible and at making all NHS employers equally competitive and attractive places to work.
  • Government and NHS Leaders should review how legislation to prevent discrimination on the grounds of age (The Equality Act 2010) applies to NHS employers, so that managers can have conversations around retirement and coming off on-call/overnight rotas without fear of employees raising formal grievances and to facilitate succession planning and retention strategies in departments.
  • NHS employers and regulators should strive to remove barriers to retire and return, simplifying the administrative burden and issuing guidance at national level to support the safe return of retired doctors to practice.
  • NHS leaders and government should strive to remove perverse pension taxation incentives which essentially encourage doctors to retire, rather than continue to work.

Watch the virtual roundtable - Addressing the retention challenge in anaesthesia

This roundtable was an opportunity to explore what individuals, managers, employers and systems can do to improve retention in anaesthesia and to hear from newly elected RCoA President, Dr Fiona Donald, about the findings from our project on retention as part of our Anaesthesia - fit for the future campaign. 


Chair: Dr William Harrop-Griffiths, RCoA Vice President
Dr Fiona Donald, RCoA President
Angela Walsh OBE, Head Agenda for Change and NHS Reward, NHS England
Chris Dzikiti, National Retention Programme Lead, NHS England and NHS Improvement
Danny Mortimer, Chief Executive, NHS Employers
Dr Vishal Sharma, Chair of the Consultant Committee, British Medical Association