OBJECTIVES: High staff turnover poses a major threat to the NHS and directly impacts the quality of care delivered. Understanding drivers of turnover is important for improving staff retention. This study assessed the drivers of and geographic variation in turnover intention in the NHS acute sector using results from the 2022 NHS Staff Survey.

METHODS: Along with other indicators of staff satisfaction, the NHS Staff Survey reports the percentage of staff at each trust in England intending to leave their organization in the next year. Univariable analysis was used to examine the association between 21 staff satisfaction indicators and intention to leave. Twelve indicators moderately or highly associated with the outcome were carried forward to the modelling stage. Given the high collinearity between indicators, relative weights analysis was used to estimate the relative importance of each indicator in contributing to intention to leave, adjusting for the other indicators. Moran’s I statistics were calculated to assess the extent of spatial clustering among trusts with respect to intention to leave.

RESULTS: The relative weights model with the 12 indicators explained nearly 85% of the variation in intention to leave across acute trusts. The largest share (approximately 30%) of the explained variance was attributable to the Diversity and Equality indicator, which captures employees’ perceptions of fairness in career progression and experiences of discrimination. Based on the global Moran’s I value (0.41, pseudo p-value < 0.001), there was strong evidence of spatial clustering, with hotspots of trusts with high percentages of staff intending to leave found in London and in the East of England.

CONCLUSIONS: Concerns about workplace discrimination and fairness are an important contributor to turnover intention in the NHS. This research suggests that the NHS should be taking action to promote diversity and equality and eliminate workplace discrimination to improve staff retention.