The first 90 days in the NHS: what new starters told us.

Between December 2024 and December 2025 we surveyed new starters across acute, mental health and community trusts during their first months in post. The headline is positive but uneven: nearly three-quarters are engaged, yet one in five is already at risk – a profile that matters because early risk is strongly associated with resignation inside the first twelve to eighteen months.

Recruitment is a strength. Protecting it is the problem.

Most candidates describe a process that was fair (94%), respectful (97%) and professional, and 84% rate the experience good or excellent. Where it frays is not speed but predictability: 17% had a poor experience of being kept informed about timing, and 13% were unclear where they stood or what came next. Candidates tolerate long timelines if expectations are set. The fix is communication, not pace.

That goodwill is created centrally and then handed to local teams – and that is where it is not always protected.

Where the first weeks break down

Induction itself is rated well: excellent is the most common answer (42%), good the next (41%). The problems are in the day-one essentials that either unblock work or quietly slow everything down. New starters who were dissatisfied with:

• A third: the expenses process
• A fifth: how ordering systems were explained
• 18%: IT registration and access
• 17%: the phone system

None of these is dramatic. Together they are the difference between a confident first month and one spent asking colleagues how things work.

The three things that decide who stays engaged

The gap between engaged and at-risk starters is not motivation or capability. Both groups want to do well. What separates them is whether the early environment gives them enough clarity and reinforcement to feel they can succeed:

Put the two journeys side by side and the pattern is stark:

Not all staff groups start equal

At-risk rates vary by staff group. The highest:

• 33% of qualified nursing and midwifery starters
• 29% of additional professional, scientific and technical staff

Comparing each group against administrative and clerical staff, one item dominates the gaps: regular feedback from the line manager. Eight of the ten largest negative gaps are that single item, widest in medical and dental training grades.

What this points to

Three things in the first ninety days, none of them expensive:

• A day-one essentials standard – systems access, expenses, ordering, phones – owned centrally rather than left to tribal knowledge.
• A simple manager rhythm: a week-one check-in, a 30-day conversation about what good looks like, a 60-day development discussion.
• A short, plain-language guide to how success is measured for each role family.

The 32% who do not yet know how long they will stay are the prize. Their next few months will decide the answer, and a consistently good early experience is the cheapest retention intervention a trust has.

Go further: for a line manager’s week-by-week version of that rhythm, see What NHS line managers can do in a new starter’s first 12 weeks. For which starters are most at risk, and when, see The early-leaver window in the NHS. For new starters across all sectors, see The first months of a new job: UK new-starter data 2026.