Nearly a third of managers are considering leaving the NHS, and a disproportionately large number of them are senior leaders or have highly valued skills, according to HSJ’s biggest ever survey.

The findings, from nearly 2,000 respondents, suggest the NHS faces a “brain drain”, losing many of its best leaders as it tackles the daunting task of saving £20bn.

A fifth of PCT managers strongly agreed with the statement: “I hope to find a new job as soon as possible”

The survey results are being blamed on looming public spending cuts, imminent restructuring and uncertainty about the direction of health policy.

Overall, 29 per cent of survey respondents were considering leaving the health service, but this jumped to 40 per cent among executive directors.

Nearly a quarter of respondents thought they would be able to take early retirement or redundancy by 2012, when an independent board will replace strategic health authorities and primary care trusts are likely to lose most of their commissioning responsibilities.

Even among executive directors not already considering leaving the NHS, nearly half said they might if offered redundancy. This compares with a quarter of chief executives, 45 per cent of senior managers and 43 per cent of clinical managers.

Half the chief executives who were not already planning to leave said a pay cut might persuade them to and 53 per cent said they would consider a move if their pension scheme was devalued. This comes as chancellor George Osborne is expected to target public sector pensions as an area for big savings in next week’s Budget.

However, NHS Ealing chief executive Robert Creighton believed the majority of leaders would stay to oversee the challenges ahead. He said: “I’m sure that people in leadership positions throughout the NHS will continue to show that leadership.”

The findings also show only 11 per cent of chief executives and executive directors said an increased workload would prompt them to go, compared with 37 per cent of clinical managers, who were also most likely to say they would consider leaving if there were service cuts.

Carmel Gibbons, head of the healthcare practice at recruitment firm Odgers, said many managers at primary care trusts and non-foundation trusts were looking for jobs.

A fifth of PCT managers strongly agreed with the statement: “I hope to find a new job as soon as possible”, compared with 14 per cent of those at acute foundations. Although most thought they would still be in a commissioning role in 2012, only 5 per cent expected to work for a practice based commissioning consortium.

Ms Gibbons said: “There are some excellent people in the NHS. These must be kept and retained because of the scale of the challenge. The NHS needs to think about training people, helping them recognise where they might be transferring into. It has to let people know that it wants them to stay.”

Managers were more likely to be thinking about leaving if they had skills and experiences that are in high demand.

For example, only 22 per cent of those with no experience in procurement or commercial roles said they were thinking about leaving, compared with 28 per cent of those who had previously held positions in these fields.

Among those who had never worked outside the NHS, 22 per cent thought they might leave, but for those who had experienced other sectors the figure was 27 per cent.

Mark Turner, senior partner at recruitment consultancy Gatenby Sanderson, said policy uncertainties and the impending funding squeeze made the private sector attractive, especially for those with specialist skills in IT, human resources and finance.

Efforts to recruit trust board directors with private sector experience would be hampered by moves to hold down public sector pay and review pension schemes, he said.

“It’ll be much harder to get the kind of people the public sector needs to tackle the challenges ahead. People are going to be very wary about coming to leadership posts - there’s no prospect of pay going up, no pension protection in the way there used to be,” Mr Turner said.

“We’ve had several years of attracting people into the public sector from outside because they’ve seen the reward is getting to be more competitive. I think that will be reversed.”

NHS facing brain drain as leaders look for exit