There is widespread evidence of the benefits of having diverse teams, with inclusive and diverse organisations being eight times more likely to achieve better business outcomes (McKinsey). International recruitment not only addresses workforce shortages, but adds value by increasing the diversity of skills, practice and thinking, and the overall cultural competence of the workforce. This is essential for delivering high-quality care to all patients, many of whom are also from diverse and international backgrounds (NHS England).

The experience of the internationally educated workforce (IEW) through recruitment, onboarding and induction processes is critical to successfully integrating new employees into their organisations, team and wider community (Chartered Institute of Personnel and Development). However, employers need to consider what a positive experience looks like for their IEW and review the support and resources available to acclimate them into the NHS and enable them to succeed in their new roles and lives.

Support needs to include existing staff engaging with new recruits and welcoming them into a positive environment; providing applicants with information on the NHS's values, policies, and procedures; arranging a welcoming arrival into the UK; and offering practice language assessments and training to help them prepare for the recruitment process (NHS Employers).

Ensuring effective recruitment, onboarding, and induction programmes can help the NHS retain their IEW. In turn, this can reduce turnover rates and ensure that the organisation can benefit from their skills and expertise in the long term (Health Education England). Recognition of the importance that a positive onboarding and induction process plays in supporting the IEW to integrate and prepare for the differences in UK practice, has led to the development of tailored support from professional bodies. The General Medical Council (GMC) has developed a Welcome to the UK practice programme and a similar programme is in development from the Nursing and Midwifery Council (NMC).

Board members have a duty to embed equality, diversity and inclusion (EDI) in the workplace and ensure that the NHS is providing equitable access to care for all patients, regardless of their background. To help promote the recruitment, onboarding, and induction of their IEW, board members can take the following actions:

  • Invest in a designated lead for international recruitment.
  • Support and promote a clear narrative on the rationale for international recruitment, outlining the benefits to the organisation and patients, and promoting organisational values to begin engendering a culture of belonging ahead of planned recruitment activity.
  • Review recruitment policies and practices, considering access and support that may be required to ensure that they are inclusive and promote diversity and equality.
  • Provide support and resources, which may range from guidance on what to expect from the interview process to supporting new recruits through the onboarding and induction process. This support can cover language training to mentorship and guidance, supporting the IEW to pass their objective structured clinical examinations (OSCE) and achieve their UK clinical registrations.
  • Foster a culture of respect and inclusion in the workplace that values and supports the IEW, working with senior management and other stakeholders to promote the value of diversity and inclusion in the workplace and encourage others to support these efforts.
  • Ensure a range of pastoral care measures are in place ahead of induction, to help develop confidence in day-to-day life in the UK. Board members should be aware that pastoral care may encompass a range of issues from unexpected flight changes to assistance setting up bank accounts and ongoing peer support.
  • Monitor and evaluate the effectiveness of recruitment, onboarding, and induction programmes to ensure that they are meeting the needs of the IEW.

Below are two areas that trusts are working on to support international workers when recruiting, onboarding, and inducting:


A significant challenge for international workers is gaining registration with the relevant professional body, for example, the GMC or the NMC. The OSCE is a practical assessment that aims to test the clinical skills and knowledge of overseas-trained nurses. IMGs looking to register with the GMC undertake the Professional and Linguistic Assessments Board (divided into PLAB1 and 2), where PLAB2 is an OSCE. The assessments are designed to ensure that doctors and nurses have the necessary skills to practice safely in the UK (NHS Employers).

NHS trusts can support their IEW by providing OSCE preparation courses and funding for the assessment fees. Preparation courses can help overseas-trained doctors and nurses familiarise themselves with the UK healthcare system and the language used in the NHS. NHS trusts can also offer support by aiding with visa applications, finding accommodation, and settling into a new country, minimising the potential for stress and enabling the IEW to focus on achieving their required registration.

Board members can aid overseas-trained doctors and nurses by promoting OSCE support available to stakeholders, and review funding and support for OSCEs to ensure it is fully inclusive and effective.

Click here to explore this topic further with a case study from Guy's and St Thomas' NHS Foundation Trust.

Pastoral Care

Pastoral care is essential for supporting the IEW integrate into their teams and roles within the NHS, as well as life in the UK. The IEW are likely to face numerous challenges which may include language barriers, cultural differences, isolation and homesickness. They may also have to navigate very practical issues including transport to work, access to banking without a permanent UK address, securing accommodation and navigating their new hometowns. It is crucial that NHS trusts provide pastoral care to ensure that their IEW feel supported and valued.

NHS trusts can provide pastoral care in several ways, including:

  • Assigning a dedicated point of contact for members of the IEW who can help with any issues they may face, such as visa applications and extensions, finding accommodation, and settling into a new country.
  • Providing language courses and familiarisation tours for the IEWs.
  • Delivering cultural awareness to existing staff to help raise their awareness and understanding of how they can support their IEW colleagues.
  • Providing peer support spaces such as a staff network for the IEW and/or workplace 'buddies'.

Click here to explore this topic further with a case study from East Suffolk and North Essex NHS Foundation Trust.