International recruitment is where employers seek to employ people from outside the UK to supplement their traditional workforce resourcing policies.
International recruitment of healthcare workers takes place in three main ways.
Active recruitment: by employers or recruitment agencies. This usually involves advertising UK employment opportunities in the target country, holding interviews there and processing applications for successful candidates.
Passive recruitment: this is where overseas or European workers individually pursue career options, often after moving voluntarily to the UK.
Refugee entrants: initiatives are starting to facilitate the employment of refugee doctors and nurses.
International recruitment is necessary in healthcare because of staff shortages in NHS Trusts and some parts of the wider NHS, eg in general practice. In an economy currently close to full employment, there are recruitment difficulties and skill shortages across the public sector. International recruitment is a relatively speedy solution to skill gaps, since training home-grown workers can take up to three years or longer depending on the job role. It is now an in-built part of Trust resourcing strategies, and the Department of Health has supported international recruitment through a number of specific routes, such as the international fellowship scheme for consultants.
There are particular NHS staff shortages in London, where vacancy rates are higher than the rest of the UK. London also has a higher proportion of internationally qualified nurses — 14% compared with the UK as a whole (source: Royal College of Nursing Annual Members Survey 2003), contributing to a highly mobile workforce. Most nurses come from six countries: the Philippines, South Africa, Australia, New Zealand, Nigeria and Ghana.
In the summer of 2010, the then UK Government announced a limit on the number of non-EU migrants allowed to work in the UK, as part of a wider review of numbers in the longer terms. There are now limits on tiers 1 and 2 applications and NHS Employers have produced a set of Frequently Asked Questions to help employers understand the changes and the longer term implications.
In July 2014, NHS Employers updated its UK Code of Practice (CoP) map for international recruitment, which includes all the commercial recruitment agencies who adhere to the CoP. Employers are encouraged to adhere to the list when choosing to work with international recruitment agencies.
The UK CoP sets out the principles and the benchmarks laid down in the World Health Organisation (WHO) CoP, which encourages voluntary principles and practices in the ethical recruitment of international healthcare professionals within Member States of the European community.
On 30 September 2020, the Home Office launched a new campaign to guide employers in navigating the new points-based immigration system due to be introduced on 1 January 2021.
Resources are available at https://pbisemployers.campaign.gov.uk — the information includes details on hiring from the European Union (EU) from 1 January as well as details on how to register as a sponsor for employers who have not already done so.
In early 2021 NHS Employers updated it’s International Recruitment Toolkit to reflect the many changes in the current employment context, including:
information regarding the radiologist Global Learners programme and other international recruitment frameworks
new best practice for maintaining international recruitment during the Covid-19 pandemic and specific resources for overseas nurses, including links to additional Diaspora groups
changes to the new points-based immigration system
a new section developed by NHS England & Improvement on pastoral self-assessment for overseas nurse recruitment, designed to help employers reach the gold standard.
A further update to the International Recruitment Toolkit was published on 31 March 2022 including additional updates:
a new section to support the international recruitment of community nurses developed in partnership with the Queen’s Nursing Institute, NHS England, NHS Improvement, and representation from the national patient and community advocates forum (PCAF)
top tips on booking OSCEs and information on the new test centres
additional retention messages throughout
information on the nursing associate test of competence.
Also, in early 2021 the British National (Overseas) (BN(O)) Visa opened for applications. This route is unique to people from Hong Kong and now offers those with BN (O) status and their family members the opportunity to come to the UK to live, study and work. NHS Employers provides guidance for employers including information regarding professional registration requirements.
NHS Employers has also created a web section specifically for NHS organisations to be found on the international recruitment pages of the NHS Employers website.
As from 1 July 2021 statutory changes took place to the way that EEA nationals and their family members must prove their right to work and to the way that identity and criminal records checks are to be carried out.
EEA nationals will need to demonstrate their right to work either by proving their pre-settled status or settled status, or with a visa under the points-based immigration system.
International recruitment has been successful in meeting NHS staff shortages, but now targets have been almost met it will be important for maintaining workforce levels in some jobs and geographical areas. NHS HR Strategy Contexts
Criticism of NHS employers poaching key workers from developing countries has led to revised policy on fair employment practices in international recruitment. Ethical International Recruitment
Most international recruitment in the NHS is now routed through websites (such as NHS Careers and NHS Jobs) and local employers. Summary of Current Initiatives for Different Healthcare Professionals
Most nurse recruitment is from India and the Philippines. International Nurses
Trade unions are concerned that internationally-recruited healthcare workers progress within the career structure and receive professional development. Trade Union Perspectives
There are alternative although longer-term solutions to workforce gaps other than active international recruitment. What HR Managers Must Consider before Recruiting Employees from Overseas
International recruitment of junior doctors will be restricted by the abolition of permit-free training arrangements. Changes Affecting Doctors in Training
Interviews should be structured and include objective and fair language competency assessment. Recruitment Process: What to Consider
Trust policy should include a planned process to familiarise internationally-recruited staff with local clinical practice and procedures. After Recruitment: Processes for Induction and Supervision