Nearly a quarter of NHS staff are from ethnic minority groups, yet these workers are leaving the health service at higher rates than their white British colleagues, and the reasons remain poorly understood. This project aims to find out which minoritised groups are most at risk of leaving, and why. The NHS faces a severe workforce crisis, worsened by the pandemic. While 24% of staff are from ethnic minority backgrounds—including 42% of doctors and 90% of nurses in the lowest grade—there is little post-pandemic evidence on which groups are leaving fastest or what drives them out. Without this knowledge, retention policies may miss their targets. The research will analyse NHS staff records from 2009 to 2025, survey data from 18,000 healthcare workers, and conduct interviews with staff and managers. It will then co-design a suite of practical retention interventions with NHS policymakers, staff, and patients. If successful, the project will give NHS organisations clear, evidence-based tools to keep a diverse workforce. Retaining more staff from minoritised groups would relieve workload pressures across the board, improve patient experience, and advance health equity in a service that depends on its diverse employees to function.
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Research question: In which contexts and why are staff from minoritised groups more likely to leave or stay within the NHS workforce post-pandemic compared to white British groups? Aims: Improve retention of NHS staff from ethnic minority groups and/or who have migrated to the UK (“minoritised groups”) by improving understanding of how and why NHS policies and practices (“interventions”) lead to attrition/retention in these groups and developing with NHS policy-makers, staff and patients, a suite of theory-informed retention interventions. Background: The NHS is in a workforce crisis compounded by post-pandemic pressures. Nearly a quarter (24%) of staff are from ethnic minority groups (including 42% of doctors and 90% of nurses in the lowest grade) but we lack post-pandemic evidence about which groups are at greatest risk of attrition and why, and how the NHS can retain them. Key outputs: A programme theory underpinning the co-design (with diverse healthcare workers, patients and stakeholders) of a suite of acceptable policy retention interventions for NHS organisations according to their contexts. Methods: Mixed-methods study comprising five interlinked work packages (WP). WP1: Qualitative framework analysis and mapping, with stakeholders, of current and planned NHS retention interventions relevant to minoritised groups. Identification of gaps in which to place interventions. Months(M)1-6, updated M20. WP2: Retrospective cohort analysis of human resource record data for all NHS staff in England 2009-2025 and Trust-level NHS Staff Survey indicators to identify which minoritised groups are at greatest risk of leaving and which factors increase their risk post-pandemic versus pre-pandemic. M1-27. WP3: Statistical analysis of six waves of longitudinal questionnaire data collected 2020-2024 (including a wave collected in study year 1) from the UK-REACH cohort study of UK healthcare workers (n~18,000 at baseline) to examine the extent to which attrition intentions and sickness absence are mediated by job and wellbeing factors among staff from minoritised groups compared to white British groups. M1-24. WP4: Qualitative analysis of interviews and focus groups with staff and NHS managers, sampled from Trusts with poor staff retention and average to high proportions of staff from minoritised groups, to explore findings from WPs1-3 about how, why and in which contexts retention interventions are or are not effective for staff from minoritised groups. M12-36. WP5: Involvement and co-design workshops with PPI and stakeholder groups to develop and refine a programme theory with synthesised research findings, co-design and explore the acceptability of a suite of theory-based policy interventions. M1-36. Dissemination: PPI and stakeholder groups are key to our dissemination and impact strategy, which targets outputs at health policy-makers and commissioners, healthcare workers and their representative organisations, practitioners, patients, the wider public, and researchers in various health and related disciplines. Impact: Improved knowledge and understanding of the drivers of retention in minoritised groups among policy-makers, practitioners and researchers. As interventions are implemented, improved retention of diverse NHS staff, relieving workload pressures more widely with knock-on effects on productivity and patient experience, and advancing health equity.
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