The number of NHS staff who left their jobs last year is “quite worrying”, an MP said, as a committee was told the health service has seen “record levels of pressure”.

About 9% of NHS workers quit between 2022-23, a figure that Commons Public Accounts Committee member Mark Francois said was “quite worrying” and compared it with the Ministry of Defence, which was about 6%.

But Amanda Pritchard, chief executive at NHS England, told the cross-party committee that hidden in that figure are people being promoted or going to other roles within the NHS.

She added that “record levels of pressure on the NHS” have been seen over the pandemic but also in the time since.

Asked why with investment going in there is a drop in productivity on a long-term trend, Ms Pritchard said: “We’ve seen one of certainly by far and away the worst winters that I can recollect in 25 years working for the NHS, but certainly that hasn’t stopped with winter, so we’ve just had the busiest May for A&E attendances ever, and we continue to see pressure not just on urgent emergency care in hospitals, but in GPs as well.

“So, we’ve just completed 12 months where we’ve seen 30 million more appointments in primary care than pre-pandemic so that’s just another indication of the level of demand that there is in the system at the moment. So levels of demand outstripping anything we’ve had before.”

The population is “older, more complex and generally sicker”, which has impacted the length of time people are in hospital, Ms Pritchard added.

And she said Covid has not ended, with 1,000 patients in hospital with it now, and staff sickness higher currently than before the pandemic.

Ms Pritchard said there are “three big reasons” why workers are off sick: muscular skeletal issues, respiratory conditions and mental health.

Asked by Mr Francois what percentage of staff left the NHS in 2022-23, Ms Pritchard said she did not have the exact figure to hand, but it was about 9%.

The MP said it was “quite worrying”.

“So coming on for one in 10,” he said.

“The Ministry of Defence (MoD) by contrast, they’re under a great deal of pressure, in the last year, just ended financial year, their outflow was about 6%, so that you’re one-and-a-half times higher than the armed forces.

“And the MoD have a system whereby they survey all armed forces personnel, it’s a voluntary survey and they can reply confidentially, they call it the armed forces continuous attitude survey (AFCAS) and AFCAS, you know, from our previous discussions I’m not a great one for bureaucracy, but I can see the value of asking people what they think about the organisation they work for. Does the NHS have any pan NHS system like AFCAS?”

Ms Pritchard said they have an annual staff survey and other surveys which pick up what the drivers are for people to leave.

She also said within that figure are people being promoted or going to other roles within the NHS.

Asked how they will persuade staff not to leave their current roles within the NHS, Ms Pritchard said there are a range of measures focused on “flexibility”.

She added: “There are things that are outside our control, so pay is one of them.

“Workload is another issue and we know that really matters, so if you don’t feel you can do your best work that really affects people’s desire to continue to work in the NHS, therefore all the things that we’re describing today, all of those things are hugely important in retention as well as making sure that we’re doing the absolute best we can for our patients.

“But in terms of the specific offers that we’ll be making as part of the long-term workforce plan, there are a range of measures particularly focused on flexibility and I’ve talked about career end but it’s you know, from day one, flexibility that works for patients, flexibility that works for our staff, as well as continuous career development and that is that package of things that we know works because of the 23 trusts that are already piloting that range of things and have been over the course of this year, the rate of improvement that they have seen in retention has been twice that.”

Concerns about the upcoming winter were also discussed and Sarah-Jane Marsh, national director of urgent and emergency care and deputy chief operating officer at NHS England, said “we know we’re going to face risks” and there are “early indications from the southern hemisphere that it might be a challenging flu season”.

She added: “We’ve also potentially got industrial action which brings with it some uncertainty.”

Ms Marsh said: “There’s an awful lot of challenge this winter, but I think, you know the commitment is there to absolutely be focused.”

Professor Sir Stephen Powis, national medical director at NHS England, said this year they have started preparations for winter “earlier than ever before”.

He said: “So we actually started I think, you know, January in February. So we are well ahead in our thinking and I think importantly systems are well ahead in their thinking as well.

“So we’re really focused on getting things in place as much as possible by September, October, rather than a last-minute dash to do it as we go into winter. I think we are doing the right things.”

He added that despite the preparations, winter will be “challenging”.