Every day, I open my phone to see new LinkedIn notifications asking me to congratulate former colleagues on their new jobs, more often than not outside the NHS. Not just moving to Australia or New Zealand, as is widely reported, but often into consulting posts for various private corporations.
This isn’t happening for no reason – it is common knowledge at this point that conditions and pay in the NHS are not up to par. Across the board, nurses, doctors, porters, cleaners and, actually, the vast majority of the public sector have had their pay decimated by the legacy of David Cameron and George Osborne’s austerity. Job security is also no longer a guarantee, with many staff facing unemployment due to training bottlenecks.
Those of my colleagues who have made the move to Australia report how much better the pay, working conditions and lifestyle are there. This is enticing other doctors to follow suit and is creating our own “brain drain” effect in the UK. It’s hard not to feel the gravitation towards a better life.
While it’s difficult to know exactly how many doctors are planning to leave the UK, a 2024 survey of 4,700 doctors showed that around 34 per cent were considering doing so. Seven hundred respondents had taken so-called “hard steps” to leave, such as applying for jobs abroad, but more worryingly, also applying for non-medical jobs. Over the last few years, migration of workers to the UK has once again steadied the ship, as is ever the case in the NHS.
We can’t do much to compete with Australian weather, and the salary is obviously enticing at almost double for GPs, but many of these doctors end up returning to the UK anyway after a gap year in the sun. What is of concern is the increasing number of medical professionals who are being courted by private corporations. I cannot name the number of times I have been told anecdotally how over half of someone’s cohort from medical school has gone to work in the private sector, or have seen an update from a doctor getting a job at McKinsey or GSK. There are various platforms now designed specifically to find posts for doctors outside of healthcare.
I can’t help but feel this is a waste of medical talent. Not least because it costs the taxpayer £175,000 to train a doctor, but even if pay restoration is achieved (by some miracle), public sector pay is never going to compete with the salaries offered by firms like these. Colleagues also report the benefits which come with working in the private sector aren’t just financial – it’s also the lifestyle or company perks. This is why alternative ways need to be found to make life in our health service more attractive for doctors. My fear is, there are just too many doctors who do not like working in the NHS.
In hidden conversations, it is becoming a “flex” to find a job in the private sector. The end goal for many staff, the dream even, is to leave the NHS. I find the thought frustrating, but many colleagues believe that their talent is above public sector work.
This couldn’t be more timely – Wes Streeting and Labour rightly point to concerns that Reform UK will put the NHS’s existence on the line. The rhetoric around insurance-based models should harrow the public. Despite Reform now backtracking, claiming the NHS will remain free at the point of use, Nigel Farage has been on record as saying the UK will move to an insurance-based model. It’s quite clear this is his subliminal intention.
Nigel Lawson once described the NHS as the closest thing the English have to a “national religion.” Maybe it is, but parts of the public, and the staff who work in it, are certainly starting to lose their religion. It is going to need doctors to want to work in the system in order for it to survive. It is not an insurmountable task to fix a health service which has previously been deemed “high performing”. This cannot happen, however, unless some staff can let go of their pride and compromise on what a publicly funded health system can offer its workforce.
The British Medical Association needs to work with the government to find a suitable and sustainable way to do this. Whether it is student loan forgiveness, covering the cost of membership exams and fees, or a change in the structure of the terrible working hours, something needs to be done. The NHS may not have all the perks of working for a big financial firm, but when it works, it is like nothing else. Lives are saved, and no British citizen takes home a bill or receipt. If that means having a worse salary than the private sector or not having a swanky office, so be it.
