All Wales International Recruitment Programme
Anna Davies, All Wales Medical Efficiencies Manager, NHS Wales Shared Services Partnership
Introduction
The pandemic, increased demand for urgent care, the Nurse Staffing Levels (Wales) Act 2016, and a rise in healthcare professionals leaving the NHS have led to higher vacancy rates, often filled by costly agency staff. With domestic supply unable to meet demand for Registered Nurses and Doctors, NHS Wales' pay bill has surged by 53% since 2015-16, with 6% spent on agency workers.
In response, the National Workforce Implementation Plan was developed, emphasising the ethical recruitment of overseas healthcare professionals. To ensure fair recruitment across health boards, the "Welcome to Wales" programme was established to strengthen NHS Wales' international brand.
Methods
Commissioned by the Welsh Government in 2021, the International Recruitment (IR) programme aimed to appoint 422 Registered General Nurses (RGNs) across Wales. By March 2022, 413 offers were made, achieving 97% of the target. A formal MOU with the Government of Kerala led to a recruitment event in May 2023, appointing 58 RGNs.
The programme expanded into medical recruitment, with Wales becoming an all-specialty GMC sponsor in October 2023. Subsequent recruitment events resulted in the appointment of 96 RGNs and 37 doctors, including 22 psychiatry doctors, by January 2024. The "Once for Wales" approach standardised recruitment processes across the country, addressing significant variations in recruitment experience, eligibility criteria, and pre-employment checks.
Outcomes
- Recruited 997 nurses and 37 doctors through mass-recruitment, beyond the capacity of individual organisations.
- Cost savings of approx. £266,500 (nursing) and £229,698 (doctors), avoiding commercial agency fees.
- Reduced costs for NHS Wales through collaborative procurement and consistent supplier fees.
- Decreased reliance on agency staff, leading to cost savings and improved patient care.
- Increased morale and continuity for multidisciplinary teams, organisational procedures, and their patients.
- Improved health and wellbeing of substantive staff, improving attendance and retention rates, staff diversity.
- GMC sponsorship accreditation now allows recruitment of doctors previously ineligible.
Learnings
- Discussion to commission an external evaluation of the IR programme, but sustainability challenges remain.
- Challenges in sourcing suitable accommodation for international arrivals; a long-term strategy is needed.
- Access to OSCE training / exams for pre-registrant nurses is inconsistent, with discussions for a centralised All-Wales approach.
- Robust pastoral care is crucial for long-term retention of international recruits; a staff mobile app is being developed to support integration and retention.
What next?
- The Health Minister announced plans to recruit 250 international staff in 24/25, with £5million funding.
- Discussions to expand the programme to other clinical groups.
- Talks with NHS Scotland for a similar approach.
- Discussions with HEIW to develop an All Wales Portfolio pathway and explore GMC sponsorship at the Locum Consultant level.
