Understanding how unprofessional behaviour in English NHS Trusts can be prevented and reduced: a mixed-methods study

Why this research is important: Unprofessional behaviour among NHS staff—such as incivility, bullying, and harassment—is widespread. Almost all NHS staff experience incivility, and around a quarter report bullying or harassment each year. Women, disabled staff, and those from ethnic minority backgrounds are disproportionately affected. These behaviours harm staff wellbeing, undermine patient safety, and cost the NHS an estimated £2 billion annually. While the NHS Long Term Workforce Plan recognises the issue, it lacks a clear strategy—highlighting the need for evidence-based solutions. What we plan to do: Our aim is to help prevent and reduce unprofessional behaviour in the NHS. In 2022, we developed a framework and guidance describing how and why such behaviours occur between staff, and how strategies might prevent them. This study will test that framework in practice. We’ll work with NHS staff to see whether our ideas reflect reality—through interviews, observations, and analysis of national NHS Staff and Patient Survey data. We'll compare trusts on measures of unprofessional behaviour and select two high-performing and two lower-performing trusts for in-depth study. We’ll also study four additional trusts that have adopted interventions, exploring how these work in practice. Findings will help refine and update our framework. How this research will help: We’ll produce practical, co-designed resources with NHS staff, experts by experience, and our PPIE colleagues. These will be shared via national networks, leadership programmes, and workshops. Our research will support trusts to reduce unprofessional behaviour and address inequalities in its impact. Ultimately, this will lead to improvements in staff wellbeing, retention, patient safety, and NHS costs.