Retaining doctors in late stage career guidance

In this foreword Em Wilkinson-Brice, NHS England’s National Director for People, Celia Ingham Clark, NHS England’s Medical Director for Professional Leadership and Clinical Effectiveness and Alastair Henderson, Outgoing Chief Executive, Academy of Medical Royal Colleges explain how this guide will support our people, particularly those in late stage career, to stay in the NHS and stay well.


This guidance provides suggestions for systems and employers about the strategies that could help to retain experienced doctors in late stage career.

Around 30 per cent of our NHS workforce are aged 50 and over and whilst this guidance is focused on doctors in late stage career, many of the principles and recommendations will be applicable to the wider NHS workforce. You can find out more about the support available for those in late stage career and access a variety of tools, resources and case studies on NHS England’s retention hub.

Why does this matter?

As recognised in the NHS people plan, to ensure the NHS has the staff it needs, we need to retain our existing workforce. Those in late stage career have a wealth of skills and expertise that is critical in ensuring the delivery of high-quality, safe services for patients. At a time of workforce shortage across the health and social care sector, it is important to consider strategies that can be implemented to increase the number of doctors seeking to continue working during the later stages of their career, including through flexible options to continue to work in the NHS after partial retirement.

Removal of the default retirement age in 2011 made it unlawful to retire someone based on age and aimed to provide greater opportunities for people to participate in the labour market beyond the age of 65. Most doctors over the age of 50 will be in the 1995 Section of the NHS Pension Scheme, so their normal retirement age is 60. However, despite these changes to policy, many doctors in late stage career, are making the decision to retire due to a variety of personal, organisational and systemic factors.

NHS workforce data demonstrates that the profile of the medical workforce is ageing, with approximately 22% of medical staff aged 50 and over and 12% over the age of 55.

Consultant grade doctors are mostly aged between 45 and 54 years, with 42% of consultants falling in this age bracket. Almost a third of consultants are aged between 35 and 44, and a further 21% are aged between 55 to 64 years. Speciality and associate specialist doctors show a similar picture, with 62% of these doctors falling between the ages of 35 to 54 [Electronic Staff Records data processed by NHS England].

When compared with the average retirement age across the UK economy, which currently stands at 65.4 years for men and 64.3 years for women, doctors are seen to retire from the NHS workforce much earlier, with data from March 2022 showing an average retirement age of 61.9 years for male doctors and 61 years for female doctors. Taken together with the age profile of the medical workforce, these data suggest that targeted focus is needed to create the conditions to enable doctors in late stage career to have satisfying and fulfilling careers that support retention of this valued and highly skilled cohort of staff and to encourage them to extend their careers.

The NHS Staff survey 2021 shows that 25.5% of medical and dental staff answered ‘agree’ or ‘strongly agree’ when asked if they often think about leaving their organisation, a proportion that has increased over the last three years, from 21.4% in 2020 and 22.5% in 2019. Furthermore, data from the 2021 NHS Staff Survey also indicate that a third of the medical and dental workforce ‘often’ or ‘always’ felt burnt out because of their work.

This data from the NHS Staff survey underscores the pressures faced by the medical and dental workforce and a need for action to address these challenges if we are to improve retention outcomes. For 2021, the NHS Staff survey underwent redevelopment to align with the elements that comprise the NHS people promise, the themes and words of which have come directly from those who work in the NHS. It is through a focus on translating the themes that make up the NHS people promise into tangible actions that we will improve the experience of those working across the NHS. The recommendations contained within this guidance have been aligned to the various elements of the NHS people promise, emphasising the relevance of this framework in supporting retention of doctors in late stage career.

Benefits of an older workforce

Older workers have a wealth of skills, experience and knowledge, which can be of huge value to their organisation and patients, often with the benefit of flexibility and local insight. Retention of doctors in late stage career is beneficial for many reasons, for example, existing staff have developed relationships and networks, which are important in delivering patient care, particularly when their needs are complex.

Doctors in late stage career have an important role to play in the education, supervision and mentoring of doctors in training. They act as role models for the wider workforce and, in respect of mentoring, doctors in late stage career can be hugely beneficial in passing on knowledge and experience to the next generation of doctors.

Having a multigenerational workforce provides a diversity of perspectives and lived experiences which can improve organisational decision making. Retaining more experienced workers also ensures that the NHS is more representative of the communities it serves, particularly as the population grows and ages, which can help to improve outcomes for patients.

Supporting doctors to continue to work for longer also brings benefits to individuals, such as increased physical and psychological wellbeing from maintaining professional identities, which can result in wider societal gains, reflecting the role of the NHS as an anchor institution.

Why do doctors retire?

Across the National Retention Programme, we have engaged with doctors and their representatives, in addition to numerous stakeholders and partners, which has highlighted some reasons that doctors choose to retire, including:

  • Health and wellbeing concerns, including those related to the development of long-term conditions or disability, which are likely to increase due to the normal ageing process.
  • Work-life balance/inflexible job plans (requirements for shift work, being on call and out-of-hours commitments).
  • Caring responsibilities, which often increase as an individual gets older, with the need to provide care for ageing parents and grandchildren.
  • Increased bureaucracy, unsustainable workloads, and burnout, with the effects of working in a system under pressure bearing a cost to staff.
  • Concerns about pensions – some doctors may be concerned about breaching the annual allowance and worry that the subsequent tax charge means it is not worthwhile for them to continue to provide the same amount of service to the NHS.
  • Concerns about performance competency due to the decline in physiological and cognitive abilities brought on by the ageing process, which can make certain aspects of medical jobs more challenging (i.e., requirements to be on call/technical procedures requiring high levels of dexterity).
  • Poor team culture and low morale.
  • Not feeling valued.

As identified in the Completing the picture report by the General Medical Council, modelling demonstrates that retiring from the profession represents a major emotional and psychological threshold for doctors, and that, once the decision has been made to retire and relinquish professional identity, it is not an easy thing to come back.

What motivates doctors to stay working?

Experience from the National Retention Programme shows that what doctors want from their careers may change over time, with a variety of common factors motivating doctors in late stage career to stay working, including:

  • Flexible working patterns, including the ability to work less than full time, reduction in out-of-hours work, having reduced or no on-call responsibilities and opportunities to explore annualised hours, career breaks, and portfolio careers.
  • Adjusting clinical responsibilities or the working environment to compensate for physical changes brought on by the ageing process.
  • Feeling supported, respected, and valued by their employer and wider system and included in decision-making processes.
  • Having job satisfaction – the ability to continue to do interesting work and have a certain level of influence over one’s work, aligned to the core need for autonomy and/or control, identified by Professor Michael West and Dame Denise Coia in Caring for doctors, caring for patients as fundamental to doctors’ wellbeing.
  • The ability to continue learning and a breath of opportunity to pursue new roles. This may include access to sabbatical leave, which can provide doctors in late stage career with the opportunity to take time away from their day-to-day role, with the added benefit of bringing new knowledge and skills back to the workplace upon their return.
  • Ability to reduce impact of pensions taxation.

Ten recommendations for systems and employers

The below recommendations are amongst those that you may wish to consider implementing to support the retention of doctors in late stage career:

1. Workforce planning

Workforce planning for doctors should be informed by an analysis of the age profile of the medical workforce, broken down by specialism/department to allow trusts to assess where the biggest challenges may sit, any variation across specialities, and permit succession planning.

Before deciding on where best to target activity to support the retention of doctors in late stage career, it will be useful to capture a range of quantitative and qualitative baseline data such as turnover, leaver rate (those leaving the NHS completely), sickness absence, vacancy rate, NHS Staff survey and NHS People Pulse survey data, and exit interview data, alongside information provided through engagement with employees through surveys or focus groups.

Model Health System data can provide some of the key retention metrics outlined above. Electronic Staff Record exit interviews are a good way to capture consistent exit data about why staff leave. Furthermore, NHS Staff survey data and NHS People Pulse survey data provide staff satisfaction metrics, which can be broken down by staff group against each element of the NHS people promise.

It may also be helpful to access NHS Employers’ working longer resources, including this handy age profiling tool, which allows you to profile your workforce by age, helping you predict trends and identify areas with a higher likelihood of retirement requests in the future.

Other bodies, including the British Medical Association, the General Medical Council and the medical royal colleges and faculties, also hold valuable data that may help employers and systems develop retention strategies for doctors in late stage career. Links to useful reports and surveys from these organisations and others are available in the further reading section of this guidance.

To ensure equality and inclusion are at the heart of all retention strategies, it is important to gather and analyse data on specialist roles, gender, ethnicity, and country of origin, to identify issues relevant to particular sub-sections of the workforce, including those recruited internationally.

2. Retirement conversations

It’s important to have retirement conversations early enough to help older doctors to plan and consider their options around retirement.

Retirement conversations could be standalone conversations or could be included as part of appraisals and yearly reviews of job plans but should ideally happen before a staff member has begun to consider or started preparing to leave, and the opportunity to retain them may already have been lost.

As shown in the below tables, medical and dental staff with a length of service of between 21-30 years comprised the highest proportion of those leaving the NHS due to retirement. However, given that this cohort comprises only 3.8% of medical and dental staff in post, these data suggest that instigating retirement conversations earlier with colleagues with a shorter length of service may have a bigger impact on overall retention.

Medical and dental staff retirees by length of service – March 2022

Length of service (LoS)

Whole Time Equivalent (WTE)

LoS WTE as a % of total

0 – 5 years



6 – 10 years



11 – 20 years



21 – 30 years



31 – 40 years



Over 40 years



Medical and dental staff in post by length of service as % of all staff in post

Length of service

March 2022

0 – 5 years


6 – 10 years


11 – 20 years


21 – 30 years


31 – 40 years


41 – 50 years


Over 50 years


It is important to recognise that everyone’s circumstances are different, so whilst it can be beneficial to highlight a range of options for those approaching retirement, employers should not make assumptions about how doctors’ preferences change with age. Engaging with individuals is essential to allow flexibility and choice in exploring options that are mutually beneficial for both doctors and their employers.

These retirement conversations should be targeted appropriately to help identify doctors at risk of leaving, enabling a range of options to be explored between the individual, team, and employer as to changes that could be accommodated to support retention.

Leicestershire Partnership NHS Trust has been having conversations with doctors in late stage career about what matters most to them and intend to use the information gathered to improve their ways of working. While having these conversations can be time consuming for colleagues in medical workforce and human resources, the trust considers this to be time well spent, as it helps to make colleagues feel valued by the organisation and can support retention.

Employers should also send clear, trust-wide communications about the value and respect they have for those approaching the end of their careers. Without this clear signal, it can be easy for individuals to plan and make decisions regarding retirement, without realising that their employer is keen to actively retain them and willing to make adjustments and create options to do so.

It is important to consider how your organisation can maintain contact with doctors who retire and don’t immediately want to return but may be interested in returning to work in the future. A complete severance of communications and loss of IT support can precipitate or perpetuate disengagement, which can be difficult to win back.

For instances where doctors choose to retire but then later return following a period of absence, thought should be given to offering return to work support. The Royal College of Obstetricians and Gynaecologists Return to work toolkit is a good example of measures designed to support doctors back into the workplace after a period of absence and the Return to practice guidance, issued by the Academy of Medical Royal Colleges, provides useful information for returning doctors and their employers.

3. Flexible working

Promote and support the various options for flexible working, encouraging a collaborative and team-based approach and having clear policies and processes for doctors.

Flexible working is becoming more commonplace across the medical workforce. However, within the speciality and associate specialist grade, where there are often greater demands in the delivery of direct clinical care and within certain other specialities, particularly those which have historically been more male dominated, there may still be cultural and management barriers in embracing options to work flexibility. Tailored strategies may be needed to address these barriers and shift the perceptions of how doctors are deployed in the workforce.

Flexibility should include consideration of the timing of work commitments, type of work scheduled and total volume of work. There are a range of flexible working options which may be appealing to doctors in late stage career, including:

  • less than full-time working
  • reduced or no on-call/out-of-hours responsibilities
  • job sharing
  • annualised hours contract
  • remote working.  

Full consideration should be given to how these options can benefit individuals and the wider organisation, with a range of potential options likely to succeed more than a single offer. In the case of remote working, it is also important that the necessary IT hardware, software and training is in place to enable effective remote working, building on the many successful innovations that have emerged throughout the pandemic.

“We have been recruiting doctors to do virtual work, such as image reporting and consultations, and this is working well in helping to manage the delivery of services”. Deputy Medical Director, Royal Cornwall Hospitals NHS Trust

Before advertising a post, employers should embrace creative job planning and consider whether roles could be filled by someone who wishes to work part-time or whether they would consider someone who wants to work flexibly. This may improve recruitment across the NHS more broadly but will also help to retain older doctors who wish to remain working but with a more flexible pattern.

“It has been a relief feeling able to drop other professional activities to free up my non-working days, as these really are now non-working days. I enjoy having the fixed two days when I normally work but am also able to do clinical work at other times that suit me (mostly in school holidays as promised)”. Consultant in late stage career who has been supported to work more flexibly 
How team job planning and creating job share arrangements supported a pathologist and clinical director to work flexibly in the lead up to retirement 

  • The shift to flexible working happened after a period of illness in their sixties. Originally the pathologist returned part-time, with the aim of returning to full-time but it became apparent that they could retire from full-time work and resume on a fixed-term, part-time basis. This arrangement was financially attractive and in keeping with their wish to step down towards retirement, rather than stopping work entirely.
  • The medical director was very supportive and helped change their contract. As another consultant colleague in the speciality made similar working arrangements at the same time, the outcome was equivalent to sharing a single whole-time equivalent job.
  • Another colleague was appointed to the pathologist’s clinical director role and another new appointee took on their head of department role, freeing up the pathologist to focus on direct patient care and medical education.
  • After retiring fully from NHS employment, the pathologist took up part-time volunteering activities for organisations such as the Royal College of Pathologists, the mental health charity MIND, Rare Disease UK, and the local hospital public and patient involvement panel.
“We need to have more honest conversations with people about their roles and how they could change throughout their career. For example, doctors in training may be required to focus more on service delivery in the early years, with opportunities for getting involved in education and research opening up more as they progress in their careers. This would help to address some of the challenges in filling rota gaps and offer greater flexibility to those in late stage career.” Chief Medical Officer, Northern Care Alliance

While it is important to consider the options for doctors approaching retirement, it is equally important not to place additional burdens on the rest of the workforce. Taking a team-based approach to job planning and considering the implications of intended strategies across the wider workforce will help to ensure roles are complementary. In increasing opportunities for doctors to work more flexibly, it is important to consider skill mix across the broader multi-disciplinary team, including how to make the best use of new roles such as physicians associates.

Doctors in late stage career may still be able to contribute to out-of-hours work, even where this work is no longer on-call. Many departments run evening and weekend elective clinical sessions and staff might be offered the opportunity to take up some of that work on a regular basis, in exchange for relinquishing their on-call commitment. This may help demonstrate to colleagues the value of a flexible approach to role distribution, particularly to those who may need similar consideration now or later in their working lives.

Norfolk and Norwich University Hospitals NHS Foundation Trust offer flexible working patterns to doctors in late stage career, such as annualised hours and taking people off on call rotas. These arrangements allow them to deliver 7-day services while supporting other colleagues to balance needs around childcare. Pensions webinars have proven popular in supporting staff to navigate the complexities of the NHS Pension Scheme and stay interviews are used routinely, working in partnership with human resources, to find out what matters most to staff and what can be done to improve retention outcomes.
How one large teaching hospital trust used team-based job planning to retain a consultant approaching retirement 

Consultant Anaesthetist Dr Smith, aged 59, is a highly experienced practitioner and trainer, loves her clinical activity and special interest lists, is highly regarded as a safe and productive anaesthetist and is well-respected by colleagues. She wants to keep working but no longer wishes to undertake out of hours on the general on-call rota.

Dr Smith was part of a team of consultants whose job plans all included 1 programmed activity (PA) for out of hours on-call duties. Dr Smith and her clinical director agree that they reduce her hours from 12 PAs to 8 PAs and, for parity with the team, she will maintain 1 PA of the 8 PAs as out-of-hours activity. Instead of doing onerous on-call, she will instead use that 1 PA to undertake an all-day trauma list every third Saturday (= 3 PAs = 9 hours ‘premium time’ activity).

This was a ‘win-win’ for everyone:
  • Patient care was enhanced.
  • Dr Smith was happy to maintain her clinical activity and support the service with some weekend working.
  • The directorate management had a reliable, productive weekend list that was job-planned.
The rest of Dr Smith’s team appreciated her presence, her commitment to the team, and were content to support her dropping her on-call because she was visibly supporting their out-of-hours weekend service.

NHS England has created two flexible working guides, in collaboration with Timewise and the NHS Staff Council. The guide for individuals will help prepare staff for positive conversations to make requests about flexible working and equip staff to help them to come to an agreement that works for them, their teams, and their organisations. The line manager guide offers support in how to lead a flexible team, helping managers to put structures and processes in place to support and encourage flexible working for all.

Working flexibly: a toolkit, developed by the Royal College of Physicians, also discusses the opportunities for physicians to work flexibly as an alternative to leaving the NHS and provides examples of flexible ways of working, as well as giving tips for doctors at different stages of their careers.

4. Flexible retirement

Have a clear and accessible policy on flexible retirement and use the full range of options to support flexible retirement.

Ensure that offers of support for those approaching retirement are communicated to staff and are equitable, being applied fairly across the medical workforce, regardless of department or speciality, encompassing consultant, speciality and associate specialist, and locally employed doctors.

Providing clear flexible retirement policies and promotional material can help organisations convey how they support employees to continue working beyond retirement and that they actively invite employees to have conversations about flexible retirement. This clear messaging not only raises awareness about options that employees can consider but also gives the ‘permission to ask’ and have the conversation about what is possible.

Recent reforms to the 1995 Section of NHS Pension Scheme are designed to give staff more choice about flexible retirement and incentivise them to prolong their working lives, helping to maintain/increase capacity.

For example, from 1 April 2023, members of the 1995 Section who retire and return to the NHS can join the 2015 Scheme and build more pension savings.

From 1 October 2023, members of the 1995 Section, in discussion with their employer, can apply to take between 20% and 100% of their pension and carry on working, keeping pay and pension. To do this, members must reduce pensionable pay by 10%.

You can support your employees to reduce pensionable pay by 10%, without reducing hours/programmed activities, by identifying pensionable pay which does not need to count towards pension savings. NHS Employers describe how this can be achieved in their guidance – Using flexible retirement to support retention. Further information is also available on the NHS Business Services Authority website.

Importantly, partial retirement means employees do not need to take a break in their employment, with their employer’s agreement they can continue in their current role. 

Manchester University NHS Foundation Trust’s policy states: “If you are considering retirement, you should be aware of the many opportunities that exist to stay on in employment with the trust, or to draw your NHS pension and continue to be employed. The trust does not operate a mandatory retirement age, so the decision about whether to retire is up to you. The trust recognises and values the significant contribution you have made and the skills and experience you will have developed over the length of your employment”.

NHS England’s retention hub shows how different flexible working options can allow individuals to continue using their skills and experience and the impact they could have on pensions benefits in the NHS Pension Scheme. In addition, NHS Employers have produced this quick reference flexible retirement poster, that can be used to support local conversations and promotion of flexible retirement options and how these are supported by the NHS Pension Scheme.

“Through retire and return I have fully achieved my aim of a gradual transition from full-on work to full-on retirement. Now I love the new work life balance, both sides are improved; I have taken up new activities outside of work and love not having time pressure for leisure activities, and enjoy my work days for the camaraderie and sense of worth/achievement that our role involves.” Consultant who has recently retired and returned

Ensure there are adequate IT and human resources systems in place to support easy transition of those who choose to retire and return, to avoid time wasted due to loss of access to systems and information. In addition, it is important that consideration is given to managing retire and return job moves to ensure there is minimal need to repeat pre-employment checks or mandatory training.

Cambridge University Hospitals NHS Foundation Trust has around 750 consultants and has a retire and return rate of 60% for those consultants who have retired in the past five years. The trust ensures that there is an agreed job plan for those returning, which provides certainty for the individual, service and the trust on the activity which will be delivered. The specific job plan agreed is decided on a case-by-case basis, dependent on both the preferences of the individual and the needs of the service. The trust takes a team-based approach to job planning, to explore what reassignment of duties and/or modification to roles can be supported and co-ordinated across the team.

Dr Ashley Shaw, Medical Director at Cambridge University Hospitals NHS Foundation Trust, is very supportive of the benefits of retire and return, commenting that “Senior consultants have a huge amount to offer the hospital, colleagues, and patients. We look to work flexibly and constructively with individuals and teams to enable a positive outcome for all”.

Organisations may wish to review contracts and job titles offered to those doctors who retire and return to ensure they are attractive and offer fair renumeration. Short fixed-term contacts, or contracts which don’t take account of years of experience or level of skill, may seem unattractive and discourage doctors from re-entering the workforce on retirement.

When reviewing employment offers and contracts for supporting the retire and return of doctors, consideration should be given to engagement with other employers across integrated care systems to avoid the potential for competition between neighbouring organisations. Engagement across systems can also support the exchange of learning between providers on the best ways to create the conditions to support the retention of doctors in late stage career. In addition, it can highlight opportunities for secondments, which may be attractive to those seeking to retire and return and utilise their skills in a different way.

“This a system-wide issue, and we need to work collectively and across boundaries and consider how integrated care systems can play an integral role in organisations supporting each other”. Chief Medical Officer, Northern Care Alliance
Leeds Teaching Hospitals NHS Trust use retire and return for doctors across all specialities, with many of those returning doing so on 5-6 programmed activities, which includes a mix of direct clinical care and supporting programmed activities. Early retirement planning conversations help to design job plans that strike a balance between the needs of the service and the specific interests of those doctors seeking to retire and return.

“The Retire and Return Scheme provides a mechanism where Leeds Teaching Hospitals can retain the great wealth of experience and skill that individuals have built up over their career. It also helps bridge the gap when an individual decides to retire. This can often be a destabilising time for a team and retire and return allows this period to be more of a transitional one”. General Medicine Consultant, Leeds Teaching Hospitals NHS Trust

The benefits of retire and return are well regarded amongst those doctors that have chosen this option at the end of their working lives:

“Easing, rather than jumping into retirement is a much better approach in my opinion”.
“I am enjoying the work life balance very much”.
“Locally, for me, there has been very little to complain about and I would heartily recommend this as a career progression at the end of a busy working life”.

5. Create compassionate inclusive cultures

Embed a culture of compassionate leadership, with leaders visibly modelling the desired behaviours and being open to creating listening and psychologically safe cultures.

Complementing our NHS people promise, Our leadership way formalises the approach our NHS leaders should take. Our leadership way sets out the compassionate and inclusive behaviours we want leaders at all levels to show towards us as individuals and colleagues. It introduces how leaders at every level across the NHS can help raise leadership standards by committing to compassionate and inclusive leadership supported by a culture of lifelong learning and development. It describes how we can operate at our best and is a tool for leaders to use to consider how their behaviour impacts the cultures they create.

Leadership commitment is essential in tackling the recognised bias and discrimination across the system, which places those with certain protected characteristics at a disadvantage; this will ensure that all doctors in Iate stage career have equal access to opportunities and the ability to fulfil their potential.

Organisations should appreciate and recognise the physiological changes that happen as part of the normal ageing process and create cultures that embrace equality and diversity and are free from stigma, to allow these changes to be discussed freely and openly, without fear of repercussions or judgement. Focus on what people can do, rather than what they can’t, being open to alternative ways of working to support the retention of those in late stage career.

It is also important to consider the demographic of the medical workforce in late stage career and reflect on the higher proportion of women and those who identify as Black, Asian and minority ethnic in the speciality and associate specialist workforce compared with the consultant grade. It is important to consider how these demographics may have bearing on supporting people to work more flexibly. For example, women may be more likely to have constraints due to caring responsibilities.

6. Support health and wellbeing

Ensure adequate access and signposting to health and wellbeing resources and occupational health services, and human resources teams and line managers have support for accommodating reasonable adjustments.

Some staff may develop long-term medical conditions or disabilities because of the normal ageing process, and it is important that individuals are supported to remain in work when able to do so. Furthermore, it should be recognised that capacity to cope with the additional pressures of working on-call, and/or night-time working may be impacted by age, and flexibility may be needed to maximise opportunities to retain doctors in late stage career, whist at the same time supporting optimal health and wellbeing.

Somerset NHS Foundation Trust are proud of their wellbeing offer, which has included the use of Schwartz Rounds. As a mental health trust, they benefitted from clinical input and championing to shape their wellbeing offer and messaging that ‘it’s ok to be vulnerable and reach out for help’. The trust has done focused work on civility, which has helped to ease tensions across teams and work through multi-disciplinary team issues.

Although not exclusive to those in late stage career, we know that at this stage, many women will be affected by menopause. There is much evidence highlighting that menopause can have a big impact on the daily lives of employees but there is more that needs to be done to raise awareness and break the stigma and taboo surrounding menopause at work.

The British Medical Association has published a useful report, based on the findings from a menopause survey, which provides insight into the challenges faced by doctors working through menopause and the changes needed to make it easier to manage their symptoms at work. Such changes might include allowing doctors experiencing the symptoms of menopause to work more flexibly and placing equal importance on managing the mental and physical symptoms of menopause.

NHS England has published menopause guidance, which helps NHS organisations, line managers and those working in the NHS to understand more about menopause, how they can support colleagues at work and those experiencing menopause symptoms. NHS Employers have also published information on how menopause can affect people at work and provides practical guidance for employers on how to improve workplace environments.

7. New ways of working

Consider opportunities for doctors in late stage career to make use of their skills in other ways away from the clinical setting (i.e., mentoring of trainees or newly appointed doctors, research, teaching, management, and leadership). The opportunity to develop professionally and work in different ways ensures staff continue to enjoy their roles and increases motivation to stay.

“As a speciality and associate specialist doctor, diversification of my career has benefitted both my professional and personal life, as well as the departmental clinical services and the patients these serve. Working a registrar-equivalent, on-call shift rota is very demanding in mid to late stage career and was affecting the quality of my non-working life. I was in my mid-40s when I relinquished this element of my job plan and it allowed me to undertake more elective clinical activities (surgery and outpatient reviews), thereby reducing waiting times. It also enabled me to input into service redesign by setting up a joint thyroid clinic with the endocrinology team, streamlining both the operational pathway and patient journey. Further adjustment of my job plan enabled me to take on educational and leadership roles, both regionally and nationally, thereby supporting non-clinical professional development. Diversifying my role has improved the balance between my career and non-working, family life, in addition to facilitating exploration of other avenues within the profession”. Experience of a speciality and associate specialist doctor in late stage career 

NHS England has developed a range of resources to support organisations to implement and employ legacy mentors. Legacy mentors are experienced professionals, usually in late stage career, who provide coaching, mentoring and pastoral support to our NHS people who are at the start of their careers, or who are newly appointed to the NHS. Legacy mentors provide essential professional advice, education and guidance and pass on a ‘legacy’ to the next generation. They are crucial in supporting staff health and wellbeing and career progression. Appointing legacy mentors ensures that we do not lose the valuable experience of colleagues in late stage career and provides a rewarding career opportunity which celebrates our experienced colleague’s contributions to the NHS and provides vital support to those at an early stage of their NHS careers.

SAS workforce and mentorship, published by the Academy of Medical Royal Colleges, references how acquiring formal mentoring skills could be a welcome development at a later stage in a speciality and associate specialist doctor’s career. The benefits include improving their own job satisfaction by helping them use their own experience for the benefit of more junior colleagues, a ‘win-win’ for both speciality and associate specialist doctors and the employing trust.

Given that the COVID-19 pandemic has disrupted many training programmes, mentoring may also assist in providing trainees or recently appointed consultants the opportunity to be further supported in the development of practical skills. Furthermore, mentoring can also form a valuable component of an organisation’s health and wellbeing offer, with peer-to-peer models providing psychologically safe spaces to reflect and process difficult experiences.

Bradford Teaching Hospitals NHS Foundation Trust identified in early 2021 that the pandemic had resulted in negative impacts on the consultant workforce, including increased sickness absence and, tragically, deaths within this group. The need for an intervention was agreed and consequently the peer-led Consultant Mentoring Programme was established. Strategic promotion of the programme addressed historical perceived stigma associated with the concept; this was achieved through showcasing benefits and sharing lived experiences. Ray Smith, Chief Medical Officer said: “At the most challenging time for healthcare we have seen, consideration of wellbeing has never been more important. The peer support offered by our Consultant Mentoring Scheme supplements the other wellbeing opportunities available in the trust. Safe, meaningful conversation with someone who really understands the challenge and who has received specific relevant training is proving invaluable to our consultant body”.

There are also many positive examples of how mentoring has been used to good effect across primary care and the benefits that such an approach can bring to both parties. The Supporting Mentors Scheme has enabled systems and their primary care networks to upskill their experienced GPs and provide a portfolio working opportunity, whilst also supporting newly qualified GPs to embed into their new roles.

Mentoring can lead to transformational change “What stands out is the ability to discuss topics that matter to the mentee but also resonate with me as well. One colleague reached out asking to be mentored while at a difficult crossroads in their life and the positive impact that just two sessions have had has made me realise how powerful mentoring can be. The satisfaction that helping a peer brings is hard to describe until it’s witnessed personally.” NHS Leadership Academy South West – Mentoring by Cynergy – Flipsnack

When considering new ways of working and the constantly evolving nature of healthcare, which the pandemic has further accelerated, the valuable contribution that doctors in late stage career make to systems redesign and transformation should not be overlooked. After many years in the workforce, doctors in late stage career will likely have experienced several iterations of service and systems redesign and will possess valuable skills and insights that can be used to shape future transformation activities.

8. Recognition

Review organisational approach to recognition to ensure that various schemes (i.e., long service awards, thank you cards, employee of the month, annual awards ceremonies) recognise and celebrate the skills of doctors in late stage career.

To gain insights into doctors’ current levels of satisfaction with organisational approaches to recognition, a helpful starting point may be to examine data from the NHS Staff survey, which allows users to view results by staff group against individual elements of the NHS people promise. Obtaining this baseline data will help to identify where there might be areas for improvement, helping to inform future action plans.

Recognising the achievements of staff can be a useful tool in improving staff engagement and promoting the retention of staff. Understanding how staff like to be recognised will ensure that any organisational approach to recognition can be aligned to what staff value.

Cambridgeshire Community Services NHS Trust have used the GREAT-ix initiative to allow NHS staff to say thank you to each other and help make colleagues feel valued and appreciated. The tool was co-produced by doctors and was found to contribute to a positive working environment and be a powerful mechanism for staff to learn from excellence. This factsheet provides a summary of the work undertaken by the trust to date, the benefits of the approach, and plans for the future.

Whilst formal recognition schemes have an important place, a simple thank you for day-to-day work can often go a long way in helping staff to feel valued and appreciated.

9. Advice on pensions

Signpost doctors in late stage career to financial advice and provide access to information to help raise awareness of pensions taxation and the options that exist for colleagues worried about its impact.

Changes to pension tax regulations set out in the Spring 2023 Budget, effective from April 2023, abolished the lifetime allowance for tax free pension savings and increased the annual allowance from £40,000 to £60,000 from the tax year 2023/2024. These changes mean that for most NHS staff, pension tax charges will no longer apply. However, for those with pensionable pay over around £202,500 they may have pension growth of over £60,000. For staff still affected by pensions tax, and for whom opting out of the NHS Pension Scheme may be a sound financial decision, NHS Employers published guidance about the Spring 2023 budget which explain how staff could be retained through, for example, recycling employer pension contributions into pay, helping to keep the staff you need to support the recovery of core services.

10. Getting the basics right

Focus on getting the basics right, with access to adequate IT systems, nutritious food and drink out-of-hours, rest facilities and ability to leave work on time.

The NHS England national Civility and Respect Programme supports cultures of civility and respect in the NHS, creating positive working environments that are kind, compassionate and inclusive for all.

Whilst these things are important to all staff groups, not just doctors in late stage career, it is important not to underestimate the importance of these elements as push/pull factors and the influence they have over job satisfaction and decisions to remain working in the NHS. The British Medical Association Fatigue and facilities charter outlines simple steps that can be taken by trusts to improve facilities and reduce fatigue.


As organisations navigate the ongoing impact of the COVID-19 pandemic, we must all work together to strengthen the supply of our medical workforce and ensure that doctors are supported and encouraged to stay and stay well in the NHS workforce.

This guidance has provided an overview of the reasons why doctors choose to retire and ten recommendations for employers and systems, aligned to the elements of the NHS people promise, to support the retention of doctors in late stage career. Whilst these recommendations are known enablers to retention, it should be recognised that there is no single solution to improving retention. As retention is an outcome of good employment practice, it is important that a bundle approach of interventions is implemented to ensure doctors in late stage career have a positive experience in the workplace.

To ensure equity across the multi-disciplinary teams that form the cornerstone of the delivery of high-quality services, it is important to consider how similar strategies can be implemented to retain all staff in late stage career across the health and care sector.

Alongside this guidance, you may also find it helpful to take a look at Improving staff retention: a guide for line managers and employers, which has been jointly developed between NHS England and NHS Employers, and includes a specific chapter on supporting staff in late career, with top tips, tools and case studies applicable to the wider workforce.

Further reading

Below are links to further sources of information relating to the retention of doctors in late stage career that you may find helpful:

  • Caring for doctors caring for patients – This report discusses how to transform UK healthcare environments to support doctors and medical students to care for patients.
  • Challenging the culture on menopause for working doctors – This report from the British Medical Association looks at the experiences of doctors during menopause and areas of action which could support doctors during this time.
  • Completing the picture report – This research provides insight into doctors who were previously practising in the UK but who are not currently doing so in terms of their characteristics/motivations and their likelihood to return to clinical practice in the UK.
  • Consultant workforce shortages and solutions: now and in the future -This document from the British Medical Association is aimed at the government, employers and arms-length bodies, and details how we can protect patients, consultants, and the NHS from an emerging workforce shortage of consultants.
  • Flexible careers – This webpage provides an overview of the work of the Academy of Medical Royal Colleges in supporting flexible working and signposts to several useful websites and reports.
  • Later career and retirement report – This report from the Royal College of Obstetricians and Gynaecologists provides a summary of the factors influencing retirement plans; what can be done to support doctors who want to remain in the NHS workforce for longer and how to make the later career stage as attractive as possible to all.
  • Later careers: stemming the drain of expertise and skills from the profession – This report from the Royal College of Physicians will help doctors, NHS leadership and policy makers stem the drain of expertise and skills from the profession.
  • Medical careers: a flexible approach in later years– This report from the Academy of Medical Royal Colleges provides a comprehensive picture from across the medical and dental workforce and sets out their views on how they would like to structure their later careers.
  • RCP view on the NHS workforce: short- and medium-terms solutions – This paper from the Royal College of Physicians sets out recommendations for short and medium-term measures that should be taken to help address the workforce challenges facing the NHS.
  • Respected valued retained: working together to improve retention in anaethesia – This report from the Royal College of Anaesthetists uses findings gathered from a membership survey and a rapid evidence review about the factors affecting retention in anaesthesia to make recommendations which employees, employers, anaesthetic departments, government and NHS leaders can use to shape the local policies required to make a long-term career in anaesthesia fulfilling and sustainable.
  • Retirement in the south west division: a guide for members and employer organisations – This guide from the Royal College of Psychiatrists is intended for retired doctors, doctors approaching retirement, and their employers.
  • Return to practice guidance – This guidance from the Academy of Medical Royal Colleges highlights the importance of a good procedure for doctors returning to practice and provides practical advice.
  • Return to work toolkit – This toolkit from the Royal College of Obstetricians and Gynaecologists provides a framework for supporting all doctors planning and returning from an absence from work.
  • SAS workforce and mentorship – This statement from the Academy of Medical Royal Colleges outlines how opportunities for speciality and associate specialist doctors to be mentored and act as mentors could be improved at national and local level.
  • SAS workforce: later careers and retirement – This paper from the Academy of Medical Royal Colleges makes the case for an improved model of working that enables a rewarding career and satisfactory work-life balance for the speciality and associate specialist workforce prior to retirement.
  • Supporting an ageing medical workforce – This report from the British Medical Association explores the unique pressures facing older doctors to identify how best the NHS can support its ageing workforce.
  • Working in the peri-retirement period; possible changes to working practices including retire and return– This guidance from the British Medical Association focuses on consultants and sets out the ways that employers can retain them, in addition to factors consultants should consider when considering retirement and returning to the NHS.
  • Valuing consultants – the consultant charter – This guide provides an overview of the standards NHS consultants in England should expect employers to meet.


Em Wilkinson-Brice, National Director for People, NHS England:

In the NHS people plan we set out a key ambition; to have more people, working differently, in a compassionate and inclusive culture. This ambition is at the forefront of all our work across NHS England’s Workforce, Training and Education Function, and our National Retention Programme, launched in April 2020.

Retaining our colleagues in late stage career is important, particularly as a third of our workforce are aged 50 and over. This guidance focuses on how we can best support doctors in late stage careers, however, aspects of the recommendations are also applicable to all our NHS people. We have worked with the Academy of Medical Royal Colleges and representatives from a number of medical Royal Colleges and Faculties to develop and publish this resource.

The guidance aims to support systems and employers to implement strategies to better support and retain doctors in late stage careers, aligned to the themes in our NHS people promise. We know that great work is already happening across the system and the recommendations in this guidance are based on insights from across the service that you have told us have made the biggest difference to doctors.

This guidance is aimed at human resources professionals and medical workforce teams across our NHS, and I hope you will find it useful in supporting our NHS people, and particularly those in late stage career, to stay and stay well.

Celia Ingham Clark, Medical Director for Professional Leadership and Clinical Effectiveness, NHS England:

I appreciate the pressure that colleagues have felt over the past couple of years. As a doctor, I also know that it is the contribution of the whole team that delivers the very best patient outcomes and provides the support for us all to continue to be the best we can be.

Having a multigenerational workforce provides a diversity of perspectives and lived experiences, which can improve organisational decision making. Retaining older workers also ensures that the NHS is more representative of the communities it serves, particularly as the population grows and ages, which can help to improve outcomes for patients.

Older workers have a wealth of skills, experience and knowledge which can be of huge value, often with the benefit of flexibility and local insight. Doctors in late stage careers also have an important role to play in education, supervision and mentoring of doctors in training and act as role models for the wider workforce.

We hope this resource will inspire you to help doctors in late stage careers to feel happy and fulfilled at work and supported to achieve their individual ambitions, whilst delivering the highest levels of care to patients.

Alastair Henderson, Outgoing Chief Executive, Academy of Medical Royal Colleges:

It has been, and continues to be, an exceptionally challenging time in the NHS. Now more than ever, it is vital that we retain and value our people. As organisations navigate the ongoing impact of the COVID-19 pandemic, we must focus on strengthening the supply of our medical workforce and ensure that staff are supported and encouraged to remain in your teams.

The Academy of Medical Royal Colleges has been delighted to work together with NHS England to contribute to shaping this guidance and fully endorses all the recommendations contained within it.

Ensuring we take positive action to retain our talented and skilled medical workforce in late stage careers will remain a priority for individual employers and local systems and learning from each other’s experiences is a key part of that endeavour.

We would like to say thank you to everyone who helped to shape this guidance, provided case study examples, and willingly shared their insights. Your expertise has been invaluable to the development of this guidance and recommendations. We strongly encourage you to share this guidance within your own networks, so that together we can support the retention of our highly skilled, talented, and valued medical workforce in late stage careers.

Publication reference: PR00081_i