The study of medical graduates in the North West of England found almost a fifth had become disillusioned and left the service over a ten-year period.

When questioned by a team of researchers, the leaving doctors also cited the attractiveness of career opportunities being offered abroad.

Medical graduates

The NHS Executive is funding the investigation into wastage, recruitment and retention of doctors in the region.

The Don't Waste Doctors project followed the career paths of more than 3,000 graduates from the Liverpool and Manchester medical schools. From the results of a questionnaire, it estimated 18% of the doctors did not have a substantive contract with the NHS.

But Dr Jane Harvey, from the research team, said it was still possible to bring the "wasted doctors" back into the NHS.

"Many of the doctors who had returned or intended to return said factors such as improved working patterns would have helped them to return earlier. Many of those doctors who did not intend returning had found better working conditions abroad."

Flexible employment

She called for a more flexible approach to employment practice with more part-time posts made available. More than half the women doctors with children who had left the NHS told the survey that they could work part-time if suitable jobs were available.

The project has linked with hospital trusts in the North West to establish a number of less-than-full-time jobs.

Researcher Dr Helen Davison said these had shown the way ahead: "The trusts have been delighted with the calibre of the recruits. A database has been set up which now has over 160 doctors who are interested in less than full-time work and to whom we send a newsletter, information and regular mail outs."

The project team also said junior doctors' hours must continue to fall with a 48-hour week the eventual goal. They called on NHS trusts to commit themselves to practical family friendly policies such as providing on-site childcare and promoting flexitime and job-sharing.

Improved training

The NHS Confederation, which represents health authorities and trusts, welcomed the report which it said adds weight to previous research.

It said that work was already under way in NHS trusts to reduce doctors' hours and improve facilities, improve training and support and offer more flexible working patterns.