The early-leaver window: which NHS new starters are at risk, and when.
New starters form a view within weeks of whether the job matches the promise. NHS new-starter data shows where that view is most fragile, and for whom.
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Risk is highest among qualified nursing and midwifery, scientific and technical, and disabled starters; feedback and a development plan are the clearest fixes.
Our headline piece on the first 90 days in the NHS covered recruitment, induction and the three things that separate engaged from at-risk starters. This piece goes further into the detail of the same dataset: who joins and why, how long they intend to stay, and which groups are most exposed in the window when early doubts turn into resignations.
That window is wide. Report 2 notes that early risk is strongly associated with resignations within the first 12 to 18 months. Our earlier NHS leaver benchmark (June 2020, 5,993 leavers) gives a sense of scale: 9% of leavers had less than six months’ service and a further 14% between six and twelve months – almost a quarter of all leavers gone inside their first year.
They came for development
The strongest pull into an NHS trust is growth. Opportunities for learning and development was the most common main attractor (35%), well ahead of the nature of the work itself (14%), work–life balance (11%) and being local to home (8%). Employer reputation and the people who work for the trust each sat at 5%. Over half found their role through NHS Jobs and 15% through the trust’s own careers site.
Set that against what happens after they start. Only 65% have an agreed development plan, and 76% understand how their performance is measured. When development is the most common reason people join, more than a third without a plan is a broken promise in the making – and a cheap one to fix.
How long they mean to stay
Nearly half expect to stay three years or more, and 27% already see themselves there in ten years. But the single largest answer is don’t know: 32%. These are people whose next few months will decide the answer. Two groups stand apart. Medical and dental starters show much higher short-stay intent – 24% expect to stay less than a year, partly reflecting training rotations. Additional clinical services starters show the opposite: a strongly anchored profile, with a majority expecting to stay three years or more.
Fit matters as well as intent. 71% say the organisation closely matches what they were led to expect, and 68% say the same of their role. Around one in five describe only an “okay fit” for each. Report 2 calls this the most strategically important group: a short, early conversation about role scope and what good looks like can often turn an okay fit into a close one before uncertainty sets in.
Who is most at risk
About one in five new starters is already at risk. The groups that stand out:
| New starters | At risk |
|---|---|
| Nursing and Midwifery Qualified | 33% |
| Starters reporting a disability | 33% |
| Additional professional, scientific and technical | 29% |
| Starters not reporting a disability | 21% |
| All NHS new starters | about one in five |
Larger groups – administrative and clerical, allied health professionals and registered nursing and midwifery – sit closer to the average. When each group is compared with administrative and clerical starters, one item dominates the gaps: regular feedback from the line manager accounts for eight of the ten largest, widest in medical and dental training grades, qualified nursing and midwifery, and other medical and dental staff.
Disability, and what it does to confidence
Disability is the other clear divide in the table above, and the gap is not in the induction programme. It is in manager interaction and clarity: disabled starters are 5.5 percentage points less likely to receive regular feedback and 7.4 points less likely to be clear how their performance is measured.
The difference all this makes to confidence is large. Among engaged starters, 94% believe they will be successful in the role; among those at risk, 57%. When belief is that low, small frustrations are enough to start a job search.
What this points to
Report 2 recommends targeted support where risk is higher – buddying, more frequent check-ins and early well-being touchpoints – on top of a standard rhythm for everyone: a week-one check-in, a 30-day conversation about how performance is measured and a 60-day development discussion. Given what people joined for, we would make the development plan the non-negotiable output of that 60-day conversation, and check by staff group and disability that it is happening. A manager’s week-by-week version is in What NHS line managers can do in a new starter’s first 12 weeks.
Source: great{with}talent, Understanding the New Starter Experience in NHS Trusts, NHS Workforce Intelligence Series Report 2 of 4, including Appendices 1 (staff group) and 2 (disability status, with suppression and disclosure safeguards). New-starter questionnaires collected through OnBoarder across NHS trusts in acute, mental health and community settings, December 2024 – December 2025. Leaver tenure figures from the great{with}talent LastOpinion NHS leaver benchmark, June 2020 (5,993 leavers; an aggregated report compiled for participating trusts), a separate and older dataset. Figures are aggregated and rounded to whole numbers; staff-group names follow the report. Our rolling new-starter benchmark (each trust’s latest twelve months, five NHS trusts) uses a different period and mix of trusts, so its NHS figures differ.
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