Restrictions on staff leaving the NHS to work in second-wave independent sector treatment centres are to be scaled back.

The Department of Health is to take 16 specialities off its shortage list on 1 September, allowing these employees to transfer directly from the NHS to wave-two ISTCs.

The move is being heralded as the beginning of the end of the government's controversial 'additionality' policy, which was put in place following fears that the independent sector would tempt away NHS staff.

At present, staff cannot work for an ISTC within six months of working for the NHS. Instead, staff are usually brought in from abroad, a policy known as 'additionality'.

But the time is now right for more flexibility, a DoH spokesman said. 'The NHS has moved from workforce shortages to a closer match between affordable demand and supply.'

Graham Kendall, acting general manager of NHS Partners, which represents the independent sector, said he saw it as a move towards ending additionality.

NHS Employers deputy director Sian Thomas said the change would help staff in some parts of England who found it 'impossible' to find NHS jobs. Professions taken off the list include occupational therapists and general surgery consultants.

But there was a strong duty on workforce planners at strategic authority level to ensure changes in staffing numbers would not hit NHS services, Ms Thomas said.

Additionality has always been flawed, said Dr Jonathan Fielden, chair of the British Medical Association's central consultants and specialists committee, as it restricts training.

Steven Spoerry, chief operating officer at Trafford Healthcare trust, which leases a site to an ISTC, said additionality had caused problems nationally because foreign medics were unfamiliar with British clinical practices.

Specialities and professions to be removed from the shortage professions list from 1 September


  • clinical radiology;

  • trauma and orthopaedic surgery;

  • plastic surgery;

  • respiratory medicine;

  • rheumatology;

  • neurosurgery;

  • general surgery;

  • gynaecology;

  • ophthalmology;

  • physiotherapy;

  • urology;

  • gastroenterology;

  • anaesthetics;

  • otolaryngology.


  • biomedical scientists;

  • therapeutic and diagnostic radiography - bands 6 and below;

  • occupational therapists;

  • medical physics and engineering (HCS).