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NHS reality check: Update 2018

NHS reality check: Update 2018 returns to last year's key report and once again gives over 1,500 doctors working in the NHS the chance to discuss their experiences of delivering care in the UK health service. The key finding for the 2018 update was that conditions had got worse and NHS staff, who have benefited from some of the best medical education in the world, were not able to provide the standard of care they have been trained to deliver.

Key recommendations

Our recommendations for reducing pressure on doctors:

  • We need to make the UK more accessible and attractive to doctors from other countries. The government must relax visa restrictions for the healthcare workforce and build on successful schemes such as the Medical Training Initiative.
  • Government, NHS organisations, royal colleges, professions, trade unions, regulators, higher education institutions and think tanks need to work together to make sure the NHS has the workforce and resources it needs. 
  • Funding for health and social care must match growing patient need, and there must be more investment in public health initiatives that reduce that need.

Our recommendations for retaining doctors in the NHS:

  • Improve morale by reducing the pressure. 
  • Recruit more doctors from outside the UK and develop a robust plan for the future.
  • Make sure the environment in which doctors work is supportive and enables them to meet and retain professional standards. 
  • Ensure a medical career is attractive and fulfilling, with time for supporting professional activities. 


Repeating the questions they were asked last year, the latest data clearly shows the pressure has increased over the past 12 months. Overall, the picture painted by respondees shows doctors struggling against rising demand, the impact of an ageing population with increasingly complex medical needs, and the difficulties of maintaining morale when the NHS is underfunded, underdoctored and overstretched.

Key data findings show:

  • 64% of doctors believe that patient safety has deteriorated over the past year – 10% higher than last year.
  • 93% experienced staff shortages across the team – 9% higher than last year.
  • 84% believe that the workforce is demoralised – 2% higher than last year.
  • 85% cite rising demand for their service over the past year – 7% higher than last year.
  • 47% cite lower-quality care over the past year – 10% higher than last year.
  • 80% are worried about the ability of their service to deliver safe patient care in the next 12 months – 6% higher than last year.