00 · Evidence

The 232-doctor study

Independent survey of 232 NHS doctors across diverse specialties confirmed the Safety → Quality → Efficiency hierarchy and modelled the harm caused by understaffing.

What we asked

We asked 232 doctors working across NHS specialties:

1. Whether they prioritised Safety first, then Quality, then Efficiency in their work.
2. Their estimate of the Relative Risk a patient is exposed to in different staffing categories, against an Optimal-staffing baseline.
3. The frequency of each Service Quality state in their current job.

What we found

• 232 of 233 (99.6%) agreed with the Safety → Quality → Efficiency prioritisation.
• 177 of 232 (76%) reported working any Unsafe services.
• Of those, 158 of 177 (89%) also reported working any Overstaffed services in the same period, danger and waste, in the same teams.

What it means for clinical risk

If services were worked at 100% Optimal staffing, the modelled clinical risk to patients would fall by ~42%. A typical Directorate, after Nexin Allocation, sees a modelled ~19% reduction in Total Clinical Risk.

A full methodology note and the underlying graphs are available on request.

Last reviewed: 2026-05-06