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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.

  1. 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.

  2. Passive recruitment: this is where overseas or European workers individually pursue career options, often after moving voluntarily to the UK.

  3. 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.

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 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 — 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 its 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 such as:

  • 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.

Again, in December 2022, the International Recruitment Toolkit was amended with the following updates.

  • An updated case study on collaboration.

  • A new link to the Code of Practice FAQs.

  • Access to the pregnancy toolkit produced by NHS England.

  • Updated weblinks to resources throughout the toolkit.

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.

Standstill provisions were originally put in place after the UK left the EU in 2020, allowing EEA-qualified healthcare professionals to work in the NHS without needing to sit additional exams or assessments. These provisions have now been extended until 2028, when a further review is expected to take place.

The Department of Health and Social Care (DHSC) has also announced that a decision will be taken on whether to establish emergency cross-border working arrangements with the Republic of Ireland at a later, as yet to be determined date.

International Recruitment in the NHS Policy

The Trust’s policy on international recruitment includes details of:

  • statement of intent and rationale for international recruitment

  • geographical recruitment areas and restrictions imposed by NHS policy or immigration rules

  • the types of health professionals to be sought through international recruitment

  • use of any national or local recruitment or exchange programmes

  • method of recruitment to be used and intentions on use of agencies

  • attraction and recruitment process