Overseas recruitment to fill 'NHS rota gaps' is unsustainable

The NHS has always welcomed and valued the contribution that staff from overseas bring. The modern clinician is in demand and highly globally mobile; as are we all.  

Whilst the NHS continues to recognise the value that overseas clinicians bring to the delivery of care in the UK, we are increasingly aware of the need to manage the flow of international human resources into the NHS in a more consistent and equitable way.

Treat each country as a partner

We must seek to support individual clinicians in their legitimate professional ambitions whilst working to ensure that the needs of health systems and patients are met.

It is true that economics drives much migration and Health Education England is emphatically not suggesting that an individual’s rights to move and live as they choose should be curtailed.

However, how we as a country, a health system, and an organisation interact with partners in low and middle income countries matters.

Too often, in discussions on international recruitment, we have applied a generic one-size-fits all approach rather than treating each individual country as a partner, and recognising that each partner has the urgent desire to improve healthcare delivery to its own population and each with different local challenges and needs.

 How we as a country, a health system, and an organisation interact with partners in low and middle income countries matters

While the individual desires of a clinician to migrate for economic reasons must be respected, collectively we need to consider whether we should actively encourage this choice given the scale of global workforce shortages (which are most acute in LMICs), or seek to create new pathways which aim to be “win-win” for each partner and ultimately benefit all health systems by driving down world workforce deficiencies.

Money matters, but increasingly so does the opportunity for self-betterment.

There are many clinicians, and their numbers will increase as the standards of living for the middle classes improve, in the “transition” countries who are looking for educational opportunities, who are driven to improve their CVs and potentially career prospects by undertaking an educational programme overseas, before returning home to work in their home country.

This includes many UK clinicians working in the NHS today who want to spend a year in New Zealand, South Africa, or India – before returning home.

As the eighth richest nation in the world, the UK should be self-sufficient in terms of domestic supply.

HEE, in concert with Department of Health and Social Care, NHS England, NHS Improvement and others is working to ensure that the LTP workforce implementation plan moves towards that position.

However, even with much needed investment in training places, training more staff will only be part of the solution. New service models and technology will go some of the way.

Increase the inflow of overseas staff 

However, there is in the short and medium term a need to increase the inflows of staff from overseas. But we will do this ethically.

Our work specifically aims to recognise the importance of strengthening bilateral and multilateral co-development in mutual health systems. It recognises that whilst the NHS, as the largest universal health coverage system in history, is a rich (and ever popular) learning environment for clinicians of all nations, simple recruitment to fill ‘rota gaps’ is both unethical and unsustainable.

Our engagement strategy must be two-way, transparent, encourage learning both in the NHS and partner healthcare systems and attempt to use migration to enhance bilateral relationships, not disrupt them.

Finally, the earn learn and return programmes create a fixed term educational programme for participants. They do not insist on a return but rather attempt to work with partners overseas to create pathways which are attractive to individuals and allow the clinician to utilise their experience for the betterment of global health systems.

The earn learn and return programmes do not insist on a return but rather attempt to work with partners overseas to create pathways which are attractive to individuals and allow the clinician to utilise their experience for the betterment of global health systems

These clinicians, on finishing the programme, are free to apply for extensions or other jobs within the NHS or return to their country of origin, as they see fit. HEE sees this as empowering the clinician to improve the quality of healthcare that they deliver irrespective where they choose to reside.

HEE’s work recognises throughout the need for co-development. It was constructed following a wide stakeholder consultation which included international stakeholders and NHS partners.

The earn, learn and return model and pilots (many of which sit underneath government-to-government agreements) are designed to recognise the mutuality required for bilateral sustainable health systems strengthening – they provide a complementary alternative to a purely economic approach to migration, they don’t replace it.

HEE’s approach to global engagement and our pilot International Recruitment Programmes are not, by themselves, the solution to the workforce issues the NHS faces today.

They attempt to create a new narrative and rationale for the NHS to engage in Human Resources for Health issues globally – one where the NHS can play a constructive role in partnerships between equals as we work to meet common challenges.