Recruiting and retaining doctors-a wicked problem needing complex solutions.

Abstract

Recruiting and retaining healthcare professionals, particularly doctors, remains a critical challenge for the National Health Service (NHS), exacerbated by an ageing population, geographical disparities, and persistent workforce shortages. Traditional linear solutions fail to address the complexity of these interconnected issues, necessitating a multidimensional approach rooted in complexity science. This article frames the recruitment and retention of doctors as a wicked problem, characterized by interdependencies, dynamic interactions, and context-specific nuances. Using the Anglia Ruskin University School of Medicine in Essex as a case study, we explore a locally contextualized strategy within the national 'train, retain, reform' framework. Initiatives include the innovative Medical Degree Doctor Apprenticeship, targeted outreach programmes, and collaboration with NHS England to prioritize local foundation training posts for graduates. These strategies are designed to address workforce disparities in socioeconomically disadvantaged regions whilst fostering local retention. Our findings highlight the need for adaptive, non-linear solutions that integrate national policies with local innovations to address workforce inequalities effectively. We argue that sustainable improvements require distributed control, interdependent systemic interventions, and stakeholder collaboration. This approach not only addresses local recruitment challenges but also contributes to reducing health inequalities, emphasizing the importance of local agency within a national framework.