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The share of homegrown doctors and nurses joining England’s NHS is at its lowest for seven years, BBC Shared Data Unit analysis of workforce data has found.
Some 58% of doctors joining the health service last year came from the UK, with health bosses increasingly turning to international recruitment.
The British Medical Association said the NHS faced a “workforce crisis”.
The government, however, insisted there were record numbers of doctors, a rise of 34% since 2010. While overall numbers have been increasing, critics said declining domestic recruitment was unsustainable to keep pace with demand.
The BBC’s Shared Data Unit analysed workforce data provided by NHS Digital from 2015 to 2021, to investigate if trends we reported following the Brexit referendum in June 2016 continued.
It found the share of UK doctors joining the health service had fallen from 69% in 2015 to 58% last year. Over the same period, the share of new UK nurses fell from 74% to 61%.
Recruitment of doctors from the Rest of the World rose from 18% to 34% over the same period, and that share of international nurses rose from 7% to 34%.
Note: Data released to us under FOI laws covering health services in Scotland, Wales and Northern Ireland was incomplete, but the data supplied can be viewed separately in the dataset and story pack shared with you under embargo.
Use the two tabs below to flick between data for doctors and nurses and health visitors. This breakdown is only available on a national level.
This table (scroll down) shows the changing nature of the NHS workforce from 2015 to 2021 in England.
Here’s a breakdown of the column names for this table:
Type: Whether the column describes a member of staff joining or leaving the NHS
Staff group: The type of job
Nationality group: Whether the employees joining or leaving the NHS came from the UK, from the EU, or from the Rest of the World
Dec14_Dec15: The number of people joining or leaving the NHS in the time period
PercentageShare_Dec14_Dec15: The proportion of the total number of people joining or leaving the NHS who came from the UK, the EU, or the Rest of the World
You can scroll across to the right of the chart using the scroll bar at the botton.
Please note the unknown values have been removed from the total when making the above calculation.
The last two columns are repeated for the years 2014 to 2021.
Use the tabs below to flick between staff who have joined the NHS (‘Joiners’) and staff who have left the NHS (‘Leavers’).
The tables contained within the tabs (scroll down) show the changing nature of the workforce within NHS Trusts and CCGs from 2015 to 2021 in England.
Here’s a breakdown of the column names for this table:
UK change 2015-2021: This shows the increase or decrease between the total number of staff who joined the trust from the UK in 2015 compared to the total number of staff who joined from the UK in 2021.
UK percent point change 2015-2021: This shows the percentage point increase or decrease between the share of staff joining from the UK in 2015 to the share of staff joining from the UK in 2021
EU change 2015-2021: This shows the increase or decrease between the total number of staff who joined the trust from the EU in 2015 compared to the total number of staff who joined from the EU in 2021.
EU percent point change 2015-2021: This shows the percentage point increase or decrease between the share of staff joining from the EU in 2015 to the share of staff joining from the EU in 2021
World change 2015-2021: this shows the increase or decrease between the total number of staff who joined the trust from the Rest of the World in 2015 compared to the total number of staff who joined from the Rest of the World in 2021
World percent point change 2015-2021: This shows the percentage point increase or decrease between the share of staff joining from the Rest of the World in 2015 to the share of staff joining from the Rest of the World in 2021
An example line from this data could read:
At Medway NHS Foundation Trust, the share of UK staff joining the trust dropped by 29.6 percentage points between 2015 and 2021. Over the same period, the share of staff recruited from the Rest of the World rose by 30 percentage points.
Note: organisations with no new joiners or leavers recorded in the initial years of the England data have been excluded.
Flick between the below tabs to view each quote. All quotes were sourced by the BBC Shared Data Unit and are availabel for partners use.
"The staff working in the NHS are its greatest asset and whether they trained in the UK or further afield, they all make invaluable contributions to patient care.
“The NHS is facing a workforce crisis and since well before the pandemic has struggled to recruit and retain staff. As of December 2021, more than 110,000 posts in secondary care are vacant, almost 8,200 of which are medical posts.
"High vacancies create a vicious cycle: shortages produce environments of chronic stress, which increases pressure on existing staff, and in turn encourages higher turnover and absence.
“The NHS has always been reliant on the commitment and expertise of international medical graduates and the last few years have seen the UK become more reliant on them.
"During the pandemic, international doctors have been on the NHS frontline, contributing their valuable skills and expertise to save the lives of others – with a disproportionate number sadly losing their lives to the virus.
“It is vital that the Government leaves no stone unturned in finding solutions to the NHS workforce crisis – and ensuring that international staff feel welcomed and valued is hugely important in recruiting and retaining them in the long term.
“For example, we know that following the referendum Brexit had a huge impact on the morale of EU NHS staff working in the UK. Our own research from that time showed that four out of ten EU NHS staff were considering leaving the UK following the referendum result in 2016. The top reason doctors cited for this at the time was the UK’s decision to leave the EU.
“The BMA has called on the Government to reduce the financial and bureaucratic barriers faced by international doctors in the UK who contribute their skills and expertise to the UK’s health service.
"Currently, international medical graduates are charged £2,389 – as well as £2,389 for each of their dependents – to apply for indefinite leave to remain, as well as expensive visa fees leading up to that point. We know from our members that the financial and mental burden of the immigration process is immensely debilitating.
“Doctors are cutting their hours or making plans to leave the health service altogether for a range of reasons – including punishing workloads, stress, exhaustion, punitive pensions’ taxation rules, restrictive immigration rules such as the adult dependent relative rules and, sadly, verbal and physical abuse. All of these issues need to be addressed for the NHS make headways in tackling the enormous backlog of patient care.
“The BMA has been a leading voice in a coalition of over 100 organisations, urging the Government to amend the Health and Care Bill to increase accountability for ensuring there are adequate numbers of healthcare staff to meet growing patient demand. Now that this opportunity has been squandered by the Government – despite such compelling consensus behind the need for the amendment from cross-party parliamentarians and former NHS leaders – DHSC’s recent commission for NHS England to publish a long-term workforce strategy must commit to delivering these assessments of current and future workforce numbers.”
“The number of unfilled nursing posts in the NHS is unsustainable. Every vacant role makes safe patient care harder to maintain.
“We are seeing a sharp increase in people leaving nursing, with 25,000 leaving the UK register in the last year.
"After a decade of real terms pay cuts, a growing over reliance on international recruitment and limits on education funding, our members are saying enough is enough. Those working in the NHS in England and Wales will have their say in a ballot on industrial action over pay. Ministers must begin to listen.
“Our internationally-recruited nurses are, and have always been, invaluable to our health and care services, but ministers must do more to boost the domestic recruitment of nursing staff. One of the simplest ways to recruit and retain staff is to pay them fairly.”
“Staff shortages in the NHS and the wider healthcare sector are the worst they have ever been. However, the shortages were severe even before the pandemic and the fact is that recruitment and retention in healthcare have not been good enough for a long time.
"Between 2015 and 2021, recruitment businesses in the sector consistently highlighted shortages of care workers, nurses and healthcare assistants, as well as support workers and other roles.
“There are lots of reasons for the shortages but healthcare recruitment agencies frequently cite burnout and poor working conditions as the main reason staff leave the NHS, and a desire to work flexibly as a reason why some people take agency shifts instead.
"The shortages cause worse conditions for remaining staff which contributes to a vicious cycle. Brexit has also had an impact, but less so than in other sectors such as hospitality. In healthcare, it has been easier for some time for foreign nationals deemed highly skilled by the immigration system to come from outside the EU to fill some of the gaps.
"It has only been very recently that social carers have qualified under the immigration rules, so we are yet to see an impact there.
“Ultimately, we need a long-term solution which involves a flexible immigration system, so that the NHS has the right skills at the right time to meet patient needs.
“To help shape their workforce planning strategy, the government and the NHS would also do well to collaborate with staffing agencies who understand the concerns of frontline workers and can see the trends in demand for certain skills.”
“The NHS recognises the long-standing value of international recruitment and the incredibly important contribution colleagues from around the world make to the delivery of health and care for our communities.
“It is also important that we ensure our international colleagues are retained to develop and achieve their potential in the health service.
“However, NHS employers were very concerned about the relentless demand being placed on their teams due to the staffing vacancies which now stand at 110,000 – gaps which cannot and should not be filled through international recruitment alone.
“The NHS is facing chronic workforce shortages, and these are getting worse. These posts urgently need to be filled to make sure our communities receive the best care possible and to alleviate the strain our teams continue to face, against a backdrop of spiraling workloads and ever-growing backlogs of treatments. It is now high time for the Government to commit to a fully funded long term workforce plan for the NHS.”