The influx of EU doctors and nurses to plug NHS staffing gaps is doomed to failure unless the right support is available to bring them up to speed, writes Harry Harron

It is clear that the NHS cannot sustain its dependency on agency staff and this has been highlighted over the past 12 months in HSJ.

The yearly spend with agencies runs into billions of pounds and measures have now been put in place to address this.

The introduction of spending caps may or may not work, but some observers expect strategies such as this to have unintended consequences and actually create further staff shortages.

So what is the way forward? The root cause of the staffing crisis is the sheer lack of doctors and nurses, in terms of total numbers and in some cases specialties.

It is clear that increasing their numbers at a local level through UK universities would be a challenge. Offering trainees loans rather than paying for their training is supposed to address this in terms of nursing. Only time will tell if this strategy will be effective, but even if it is, its impact is still years away.  

In the past, the UK has relied on large numbers of graduates from non European Union countries and these numbers have reduced slightly. At the same time, the number of healthcare professionals coming to the UK from the non EU countries has also fallen and is not at a sufficient level to ‘solve’ any shortfall.

However, more than 7,000 EU (non UK) nurses registered with the Nursing and Midwifery Council in 2015. Could they offer a solution?

Protecting the public

Generally speaking, recruiting from the EU is a good idea. With freedom of movement and similar cultures, European healthcare workers tend to fit in well in the UK. But I expect the number of nurses that have registered from the EU has been fuelled by the NMC introducing a requirement on applicants from January 2016 to have reached an academic English language proficiency standard of IELTS 7.

Many of these potential employers will be sorely disappointed by the length of time it will take some of their applicants to reach the required level of English to take up any job offer

While this has been done to protect the public, I wonder how many of these 7,000 EU nurses can speak English at the required level. I would suggest not as many as we would like to think.

The unintended consequence of this language requirement, I believe, will have been to ‘flush out’ any EU nurse who had intended to come to the UK, but wants to get in before the requirement went live.

So with this language qualifier in place, will we see a significant rise in successful applications from EU nurses?

Sorely disappointed

Hospitals are probably interviewing hundreds and possibly thousands of nurses with a view to them starting work this year. But many of these potential employers will be sorely disappointed by the length of time it will take some of their applicants to reach the required level of English to take up any job offer.

The problem, as I see it, is that with additional language requirements, the number of doctors and nurses who can register successfully with the  General Medical Council and NMC will drop significantly.

And language is not the only issue. For those EU nurses that do have the correct level of English, their training may not equip them to the same standard as a UK graduate with the same number of years of work experience. So what can we do to help?

If we are to look at clinical competence, then the way forward would be to have observed structured clinical examination-style assessments where the candidates can demonstrate practical skills.  

Meeting applicants face to face will not always enable an employer to predict their practical abilities, but it will give them insights into their character and allow them to identify more easily how an applicant might fit into a team, or how adaptable they might be.

Capacity to cope

One way to nurture new EU recruits is to ensure they all get a protected window of time to adapt to their new surroundings and get up to speed. It is in producing such a recruitment plan that it will become clear to a hospital what it needs to do with a new-to-the-UK doctor or nurse, and if it has the capacity to cope.

We do not expect doctors and nurses to be re-trained, but there can be in some cases a significant amount of supervision required to support individuals in adapting to new ways of doing things.

And what of the language requirement? While the GMC and NMC are taking care of the quality, employers must address the language issue head on or face significant drops in the pool of available candidates.

The solution here is to work with candidates upstream – engaging with European nurses and doctors well before they are ready to register with the NMC or GMC.

Medical and nursing recruitment from Europe will continue to be a major part of the UK’s solution to its workforce issues. There will still be good candidates who will move over easily, but increasingly recruitment is going to get more sophisticated and rely heavily on local involvement with candidates at grass roots levels.

Harry Harron is managing director at A-Team Health Recruitment.