One in three allied health professionals (AHPs) reports symptoms of burnout, and 5.7% of new registrants leave the profession within four years. This matters because 185,000 AHPs—physiotherapists, radiographers, podiatrists, and others—work in the NHS, yet five of the 14 AHP professions are on the Shortage Occupation List. Existing retention studies have excluded most UK-recognised AHP roles, leaving workforce leaders without evidence on who is leaving, why, and what might keep them. The research team will interrogate NHS England’s workforce database to identify high-risk professions, grades, and settings, then survey staff in those contexts to pinpoint organisational factors driving departures. Focus groups with regional and integrated care system leads will then map current retention projects and recommend interventions for future testing. If successful, this work could give NHS managers concrete, profession-specific tools to reduce turnover—particularly among early-career staff and in smaller professions like arts therapies and podiatry. That would stabilise a workforce that underpins everything from cancer diagnosis to community rehabilitation, without requiring dramatic new investment.
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Background and justification: Currently 252,309 AHPs are registered in 14 unique professions, with 185,000 (73%) working in the NHS. Investment in this workforce has failed to keep pace with rising demand; five AHP professions are listed on the Shortage Occupation List. Retention of this workforce is arguably the greatest challenge affecting workforce stability. AHP leaving rates are rising, particularly in podiatry, occupational therapy, arts therapies and diagnostic radiography. Early career retention is concerning; 5.7% of all new registrants deregister within four years, with smaller professions worst affected. Of AHP leavers in the first five years of their career, 44% quit the NHS and 45% change post within it. Work-related stress affects retention; 35% of AHPs report symptoms of burnout; pay disputes, bullying, harassment, and discrimination all factors in decisions to leave. A rapid review of AHP factors associated with intention to leave was published in Feb 2024, but this Swiss study excluded 8 out of the 14 AHP professions recognised in the UK. This Phase 1 study is designed as a sequential explanatory mixed methods study with each phase informing subsequent data collection. It will build on the findings of an ‘in progress’ NHS England funded workforce study led by our co-applicants Grafton, Fowler-Davis and Gussy, undertaking an international and domestic review of solutions to maintain, build and train the rural and coastal AHP workforce at pre-registration and post registration levels. It will also build on learning from previous nursing-focused retention studies undertaken by our research team member Senek . Following exploration of retention interventions in published literature, we will undertake a ‘deep dive’ into existing national workforce data to better understand AHP retention challenges at both national level and across our differing geographical settings. We will interrogate the NHS England eProduct Workforce Intelligence Portal, which draws workforce data from the NHS Electronic Staff Record. We will use eProduct to identify high-risk contexts (e.g. professions, roles/grades, settings, demographics) where retention appears to be challenging. Working with our partners, we will deploy a survey in these high-risk contexts to identify organisational factors which may influence staff decisions to leave or remain. The findings will be presented to workforce leaders for review, enabling exploration of any current retention projects and seeking recommendations for future potential interventions which may be taken forwards in later stages of the Partnership. The four phases of this research are: i) Evidence synthesis of systematic reviews using umbrella review methodology related to the effectiveness of retention interventions in the health and social care professions, to ascertain if there may be any transferable learning for the AHP workforce. Since initial grant submission, a review of interventions has been completed by Senek as part of another funded project that overlaps with the aims of this review. Therefore, we will update this review and select reviews of interventions that include AHPs as well as those that focus on AHPs-only. We will also extend the search strategy to include searches for individual AHP professions (using a range of recognised professional terms). This will allow us to map AHP-specific effective intervention components and measured outcomes. ii) Interrogation of AHP leaver data (NHS England Workforce Intelligence Portal – eProduct) to investigate who is leaving, when, why, where they are going, and which settings, grades and professional groups are worst affected. In consultation with NHS England and regional partners, we will narrow down the range of AHP professions reviewed in this and subsequent stages to focus on under-researched professions and/or those raising significant concerns. iii) Questionnaire survey adapted from Senek’s previous work with purposive sampling of specific AHP professions and staff working in selected ‘high risk of leaving’ contexts within the Partnership test bed settings to identify factors which may influence those stating intention to leave, and the positive influences affecting those stating intention to remain. iv) Focus groups drawn from NHSe AHP Regional Leads (n=7) and ICS AHP Workforce Leads (n=42) to discuss findings from #1-3, explore deployment / evaluation of current interventions, identify interventions for scoping in Phase 2, liaise with NHS England for implementation / policy impact.
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