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Original research
Relationship between labour force satisfaction, wages and retention within the UK National Health Service: a systematic review of the literature
  1. Kweku Andrew Ampadu Bimpong1,
  2. Ausaf Khan1,
  3. Robert Slight2,
  4. Clare L Tolley1,3,
  5. Sarah P Slight1,3
  1. 1School of Pharmacy, Newcastle University, Newcastle upon Tyne, England, UK
  2. 2Department of Cardiothoracic Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, England, UK
  3. 3Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, England, UK
  1. Correspondence to Kweku Andrew Ampadu Bimpong; k.a.a.bimpong2{at}; Dr Sarah P Slight; sarah.slight{at}


Objectives A systematic review was undertaken to understand the nature of the relationship between the UK National Health Service (NHS) labour force and satisfaction, retention and wages.

Design Narrative systematic review.

Data sources The literature was searched using seven databases in January 2020: MEDLINE (1996–present), the Cumulative Index to Nursing and Allied Health Literature (CINAHL via EBSCO) (1984–present), Embase (1996–present), PsycINFO (1987–present), ProQuest (1996–present), Scopus (all years) and Cochrane library (all years). We used medical subject headings and key words relating to ‘retention’, ‘satisfaction’ and ‘wages’.

Eligibility criteria for selecting studies Primary research studies or reviews that focused on the following relationships within the NHS workforce: wages and job satisfaction, job satisfaction and retention or wages and retention.

Data extraction and synthesis Two independent reviewers screened all titles, abstracts and full texts, with arbitration by a third reviewer.

Results 27 803 articles were identified and after removing duplicates (n=17 156), articles were removed at the title (n=10 421), abstract (n=150) and full-text (n=45) stages. A total of 31 full-text articles were included. They identified three broad themes, low job satisfaction impacting negatively on job retention, poor pay impacting negatively on staff satisfaction and the limitations of increasing pay as a means of improving staff retention. Several factors affected these relationships, including the environment, discrimination, flexibility, autonomy, training and staffing levels.

Conclusions This review highlighted how multiple factors influence NHS labour force retention. Pay was found to influence satisfaction, which in turn affected retention. An increase in wages alone is unlikely to be sufficient to ameliorate the concerns of NHS workers. More research is needed to identify the role of autonomy on retention. A system leadership approach underpinned by data is required to implement bespoke job satisfaction improvement strategies to improve retention and achieve the goals of the NHS Long Term Plan.

  • health policy
  • health services administration & management
  • quality in health care
  • human resource management

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  • Twitter @kwekubimpong

  • Contributors SPS and RS conceived this review. KAAB and AK conducted the literature search and extracted the data. KAAB led the writing of this manuscript, with all other co-authors (SPS, RS, CLT and AK) commenting on subsequent drafts. All authors gave their approval for the final version to be published.

  • Funding This project has received funding from the European Union’s Horizon 2020 research and innovation program MedEye under grant agreement No. 730731.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.