NHS trust spending on international recruitment


Currently, 40 per cent of doctors on the GMC register hold primary medical degrees from foreign universities.[1] Overseas recruitment campaigns are a short term tool for filling rota gaps. In 2019, NHS Improvement set a target of recruiting 5,000 foreign nurses every year until 2024.[2] The 2019 Conservative party manifesto also committed to recruiting 50,000 nurses.[3]

NHS trusts have autonomy when it comes to international recruitment, and can choose whether they prefer to outsource campaigns to agencies or not. However, trusts in England can only use agencies approved by NHS Employers,[4] and should abide by nationally-set recruitment rules. These include avoiding developing countries[5] unless the UK government has an agreement with one of them, as in the case of the Philippines.[6]

Given an increased emphasis on targeted overseas recruitment by workforce planners – and the degree of discretion trusts exercise over the process – this paper compares the varied approaches taken by acute NHS trusts in England over a three-year period.




Key findings

Between 2016-17 and 2018-19:

  • Acute NHS trusts in England spent at least £3,347,084 on overseas recruitment of nurses, doctors and allied health professionals.

  • Taxpayers funded 762 trips abroad for NHS employees. Including agency staff, there were 843 trips for recruitment purposes.

  • There were 239 recruitment drives, targeting 15 countries. The countries most targeted by the trusts were the Philippines (the focus of 88 recruitment campaigns), India (64), the United Arab Emirates (20), Ireland (14), Italy (14) and Australia (13). Other destinations included Spain and Romania.
  • Ten trusts spent less than £400 per new-starter. George Eliot Hospital paid the most, at £9,328 for each clinician recruited.

  • Rotherham sent nine staff on a single expedition, while the majority managed trips with four or fewer.
  • Royal United Hospitals Bath alone spent £415,184, or 12 per cent of the total.

  • The ten biggest spenders accounted for 69 per cent of the total.





[1] General Medical Council, Data Explorer: the Register, 2021, https://data.gmc-uk.org/gmcdata/home/#/reports/The%20Register/World%20maps/report, (accessed 29 October 2021). 

[2] Baska, M., NHS plans global recruitment drive for thousands of nurses, People Management, 7 May 2019, (accessed 18 November 2021).

[3] Conservative Party, The Conservative and Unionist Party Manifesto 2019, 2019.

[4] This is the employers’ organisation for the NHS in England. Its responsibilities include managing the relationships with NHS trade unions on behalf of the secretary of state for health and social care. More information can be found at: www.nhsemployers.org/about-us.  

[5] NHS Employers, Code of Practice for international recruitment, 11 November 2021, www.nhsemployers.org/articles/code-practice-international-recruitment, (accessed 17 November 2021).

[6] Department of Health and Social Care, Code of practice for international recruitment of health and social care personnel in England, 11 November 2021, www.gov.uk/government/publications/code-of-practice-for-the-international-recruitment-of-health-and-social-care-personnel/code-of-practice-for-the-international-recruitment-of-health-and-social-care-personnel-in-england, (accessed 17 November 2021).

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