Asylum seeking healthcare professionals in need of reformative schemes

The current workforce crisis within the NHS is well known, with a chronic shortage of doctors and vacancies in three in four medical specialties in England last year, so finding new sources for recruiting to the NHS has never been more important.

Workforce retention and recruitment is top of the agenda for initiatives such as Sustainability and Transformation Partnerships, however maximising every section of society’s contribution is less well understood and there are complex regulatory requirements that need to be addressed.

Back on feet 

NHS Improvement have recently publicised a retention master class so it would seem timely to consider other sources of staff for the NHS. Here in the North East, the shortage has coincided with a significant influx of refugees from some of the world’s most trouble-stricken areas, presenting us with a unique opportunity not only to address the recruitment issue, but also to help with the important task of integrating refugees into our local communities.

Healthcare workers who are asylum seekers or refugees face a number of unique issues as well as barriers common to all international graduates. These individuals are often out of practice for a long time, the process is daunting and long, and many are unsuccessful in achieving their career goals.

There are a number of schemes across the UK supporting refugee and asylum seeking doctors and other healthcare workers back into practice

Differences in culture, communication with patients and colleagues, clinical practice, healthcare structures, hierarchy etc. are also likely to arise (Kehoe, 2017). Findings have further suggested that overseas doctors are more likely to face fitness to practice difficulties (Tiffin et al., 2017). It is important that we provide adequate ongoing support for these individuals.

There are a number of schemes across the UK supporting refugee and asylum seeking doctors and other healthcare workers back into practice. Some are large and well established, such as Building Bridges in London and REACHE in the North West, a few with secured funding, others with annual confirmed funding only, but with highly successful outcomes. Others are newer and/or vary in size, such as this North East programme and those in Scotland and Wales.

Our scheme has three phases:

1. Identify local refugee and asylum seeking healthcare professionals wishing to return to practice and provide pastoral and language tutors to support either International English Language Test System (IELTS) or the Occupational English Test (OET). Other support includes clinical mentors; access to departmental clinical teaching; clinical educator and consultant tutor with personal development planning; regular meetings with career advice, BMA and GMC guidance; provision of simulation and library facilities; funding for language, childcare and travel expenses.

2. Tailored open ended clinical attachments with enhanced clinical supervision and pastoral support; a clinical education programme including simulation, bedside and classroom teaching, including communication skills, ethics, clinical examination technique, prescribing, structure of the NHS. Funding is provided for Professional and Linguistic Assessments Board courses and fees, accommodation, travel, General Medical Council registration.

3. Support in applying for jobs with career advice, pastoral and clinical supervision support and access to the Trust’s Programme for Overseas Doctors to support transition into work.

We are currently recruiting to our 3^rd cohort, both 2016 and 2017 cohorts had 12 participants, each 11 doctors and one pharmacist. So far, seven individuals have passed IELTs (5) or OET (2); five have passed PLAB 1 and 3 also PLAB2 and are registered with GMC, and two doctors are employed in the Trust filling vacancies. Many are awaiting exam results and beginning clinical placements.

Underpinning schemes

A rigorous evaluation is being undertaken by Dr Kehoe using realist evaluation methodology, contributing to the steep learning curve, and has found three key elements for success: learner characteristics (individual resilience and motivation), supportive organisational culture (including strong leadership) and ensuring the correct training programme is in place with ongoing support.

The scheme has been amended since the first cohort, with more pastoral and administrative support and planning

Acceptability and support for REPOD remains extremely high (including local trusts, regional and national bodies, and the public). Key barriers have included time, resources, passing the language exam, and other practical issues (eg obtaining documents from overseas, security checks, job centre issues, administrator support).

The scheme has been amended since the first cohort, with more pastoral and administrative support and planning, supporting the OET language exam, introduction of a learner agreement and increased support from educational staff at the trust, including a senior clinical lead to run REPOD. The iterative evaluation process has been crucial to success. Given that it can take up to 3.5 years for a recent overseas graduate and up to 7 years for mature overseas clinicians with a practicing gap to pass the required exams, the REPOD results to date are inspiring for future outcomes.

Consonance: an ingredient to success

Key to our success has been the partnership approach and support from Health Education North East, an empathic culture and ongoing support for participants, together with the evaluation which ensures a dynamic flexible programme.

The national group, the Refugee Doctors and Dentists Liaison Group (RDDLG), provides a useful forum for sharing ideas and information, supported by the British Medical Association and GMC. However, there is a lack of a nationally coordinated approach to support, fund and develop such programmes.

The national group RDDLG, provides a useful forum for sharing ideas and information, supported by the British Medical Association and GMC

Given that they have been shown to have both humanitarian and practical benefits, through restoring self esteem and hope, as well as addressing part of the clinician shortage in the UK, we believe that there is now a strong argument for national coordination.

In November we will be hosting a national conference in Durham, aimed at those wishing to support the establishment and extension of similar schemes as well as develop and influence national policy. We very much welcome input from those interested in working with us. For information please contact: Julie.Egan2@nhs.net.

Deputy medical director Prof Jane Metcalf of North Tees and Hartlepool NHS Foundation Trust (NTHFT) and Newcastle researcher Dr Amelia Kehoe have been working with Health Education England North East and local Middlesbrough charity investing in People and Culture to develop and evaluate a North East partnership, the resettlement programme for overseas doctors and healthcare professionals (REPOD) supporting refugee and asylum seeking health care workers back into practice. They are establishing key features for success, building on work previously reported to support overseas doctors’ transition into working in the NHS and advice from other project leads. Ultimately they hope to promote a national strategy to help fill clinician vacancies and support these clinicians into work. The REPOD partnership is hosting a national conference in November in Durham to share good practice and develop a national strategy.