A new article has been published in the BMJ exploring whether the four day working week could be a viable and cost-effective response to the NHS’s ongoing workforce challenges.
The analysis discusses persistent issues such as recruitment difficulties, high staff turnover, absenteeism and low morale, and examines how a four day week, understood as a reduction in working time combined with internal work reorganisation, could help improve staff retention and well-being without compromising productivity or quality of care.
✍️ Authors: Pedro Gomes, Rita Fontinha, Brendan Burchell, Amelie Morin, Jolene Skordis, Pedro Pita Barros, and Sotiris Vandoros
🔍 Key messages:
• A four day week could improve staff retention and reduce absenteeism without compromising productivity or quality of care
• Evidence from other sectors and countries suggests potential benefits, but healthcare presents unique organisational and operational complexities
• Existing healthcare pilots have been limited in scale or methodological rigor
• The authors argue there is now sufficient evidence and uncertainty (equipoise) to justify a rigorous NHS evaluation, ideally using a realist evaluation approach to understand what works, for whom, and under which conditions
🎯 Bottom line: The four day week should be considered not as a simplistic reduction in hours, but as an organisational reform combining working-time reduction with work reorganisation—potentially offering a pragmatic tool to strengthen NHS workforce sustainability.
🔗 Read the full article here:
https://www.bmj.com/content/391/bmj-2025-085261
BMJ (Analysis), 2025; 391: e085261
Published 13 October 2025
DOI: https://doi.org/10.1136/bmj-2025-085261