Published: 05/12/2002, Volume112 No. 5834 Page 26 27

Faced with an acute lack of consultants in anaesthesia, a trust in the North East looked to Germany to recruit. Lorraine Lambert offers lessons from a successful programme

In early 2001, South Tyneside Healthcare trust found itself almost completely depleted of anaesthetists.

We had lost five consultant anaesthetists over a year and faced ending up in a situation in which we had only one consultant, supported by locums. It felt as though the walls were closing in on us from all sides.

Training recognition was threatened, further reducing the likelihood of us recruiting to these key posts. It was a challenge to maintain service commitments and staff were becoming anxious and restless.All this while the NHS plan was looking for huge increases in capacity nationally.

Having tried and failed to recruit in this country, we were faced with desperate measures to protect the stability of our small district general hospital.

The trust has 597 beds, of which 484 are acute.

We had an excellent German colleague, Dr Ingrid Kruepe, heading our anaesthetic department. One particularly bleak day, she and I reflected on the possibility of recruiting doctors from Germany.

This was before the launch of the Department of Health's international recruitment programme, and many of the essential building blocks were not yet in place.

We sent Dr Kruepe to Bonn in August 2001 to meet with a local recruitment agency and research the potential for filling our staffing gaps. Based on her findings, we decided to place an advertisement for 'expressions of interest' in German medical magazines, as well as a standard recruitment advertisement in the UK.

Within days of running the advertisement, we had attracted a lot of responses from Germany - and none from this country. But we faced a hurdle: some colleagues were not ready to accept that international recruitment was essential. The idea that it was necessary for a senior team to go abroad to find doctors was treated with scepticism and alarm.We were moving at speed and perhaps should have taken more time to explain to colleagues what we were doing and why.Making sure that everyone in the trust understood the problem and the possible solutions would have saved time and increased confidence in the long run.

We knew that if we really wanted doctors to consider seriously leaving an established life to work in England, we needed to make a big effort to sell the job, the place and the people. So a team of senior managers set off for Bonn and D³sseldorf.

We booked two meeting rooms, one for personal interviews with doctors who had expressed an interest in the appointments we had advertised and one for an exhibition on South Tyneside giving information about the job, hospital, schools and social activities.

We had people on hand to do photocopying and field telephone calls. But we did not get everything right.We learned, for instance, that the concept of a drop-in session does not exist in Germany.Without exception, everyone who contacted us wanted a scheduled appointment.

We made three separate three-day visits to Germany in 2001 and 64 doctors applied. Initially we advertised exclusively for anaesthetists, but later extended this to radiology, psychiatry, orthopaedics and medicine for the elderly. Shortlisted applicants were invited to England to meet the advisory appointments committee responsible for making consultant appointments. The candidates and their partners were put up in a hotel in Newcastle and given a weekend tour of the area before the job interview.We eventually appointed three consultant anaesthetists and one consultant orthopaedic surgeon in autumn 2001.

All are on permanent contacts and are still with the trust.We offered removal expenses, access to a lease car, six to 12 months' accommodation on site and up to two return flights for themselves and their immediate families in the first two years.

Reaching the shortlist stage was not straightforward.We learned early on that helping candidates to understand the curriculum vitae requirements for an advisory appointments committee shortlist was essential if they were to have any chance of a fair hearing.

But the presentation and the quantity of information required on a medical CV in the UK is not standard practice across Europe. Nor were the German candidates accustomed to interview panels. In Germany, a candidate would be interviewed by the departmental head, have their certificates scrutinised and then be told whether they had got the job.

The words 'royal college'were met with blank expressions by our candidates, and interviews involving up to eight people were unheard of.

These cultural differences reminded us of the need always to look at the recruitment procedure from the point of view of the person you are seeking to recruit.

What works traditionally in the UK is not necessarily the way in which recruitment is carried out elsewhere. In many instances, our practices diverge sharply from those in the rest of Europe. This does not necessarily mean that they are better or worse - simply different.And failure to recognise that can have a marked impact on success rates.

Trusts hoping to recruit from abroad should also be prepared for hurdles in the UK.

I still do not understand why anyone would assume that a responsible NHS employer would suddenly decide that it was acceptable to flout all the usual appointments procedures, go abroad and come back with a trolley full of doctors, improperly appointed. But we found that we constantly had to reassure colleagues within the trust and the royal colleges about our intentions. Such was the level of early resistance to our initiative that one might have thought there were queues of British graduates for these jobs.

I suspect it did not help that the royal colleges were not yet fully geared up to deal with the complexities of the process. This, combined with a widespread assumption among the clinical community that 'our' doctors were better by right and that doctors from Germany may have equivalent training in a technical sense but certainly not in any real sense, made life very difficult indeed. Breaking down these barriers was time consuming and frustrating, but ultimately very worthwhile.

We used the weekend before the interview to give candidates and their partners a chance to meet colleagues, visit the hospital and be guided around the local area.Many of our senior clinical and managerial staff gave up their own time to give candidates a 'Geordie willkommen' and to get to know them. This was a major building block in developing mutual confidence.We also used the time to do pre-interview preparation with the candidates and deal with any last-minute queries.

We were less successful on the first round of interviews than the second. This was mainly because we had not learned just how much preinterview preparation and familiarisation the candidates needed. Our peers and colleagues internally and externally were not as familiar with equivalence requirements.We were learning at high speed, improving all the time but inevitably making mistakes along the way.

By the second round, we had the process down to a fine art.With our support, CVs were professionally presented to the required standard, certificates were all translated and authenticated in advance, applications to the specialist register were already in process and candidates had been prepared for what they might face at interview. But perhaps most importantly of all, we had excellent support from Royal College of Anaesthetists assessor Dr Emer McAteer. She had worked in continental Europe, understood equivalence issues and had done extensive preparation with the college to ensure that problems on the day were minimised.

Dr McAteer came to interviews armed with the whereabouts and contact numbers of the president of the college in order that any problems which emerged could be solved there and then.The day went smoothly and had an excellent outcome, thanks in no small way to her.

But job offers were by no means the end of the process.Getting the doctors onto the specialist register required persistence.The office manager chased the General Medical Council until all the requirements were fulfilled without delay. If we are to be successful across the NHS in attracting doctors internationally, ensuring all the organisations that influence the process are geared up to respond at speed is going to be a key component of success.

It is essential to offer newly appointed doctors from abroad practical support to smooth their transition to this country and ease their integration into the trust and the local area.We quickly became experts in bank accounts, insurance, pensions and passports.

More than anything, the need is for a team that finds solutions not problems.We were right to put in a team of senior managers to lead this and very lucky to have excellent support from our local royal college advisors, who put considerable personal time and effort in to helping our newly recruited colleagues to settle, to tailoring a programme to meet their needs and generally making them feel welcome and supported.

For the sceptics out there, I can only say that we received a significant number of expressions of interest from high-quality doctors, giving us a choice of candidates - which is a rarity in this country.We successfully recruited to four essential posts at a cost of under£10,000, which was funded from the recruitment budget, retained training recognition and assisted other local organisations in finding doctors.

All those appointed speak excellent English and have become well integrated in the trust.

The consultant orthopaedic surgeon is now the liaison person for our overseas clinical teams initiative, which involves a team of German orthopaedic surgeons and anaesthetists visiting on a regular basis to reduce waiting lists across our strategic health authority patch.A further three potential consultant appointments are going through the system.

We are planning to go to Spain this month to look at potential recruitment of pharmacists.

It took immense effort to get from the starting point to a successful outcome, but our new team have brought with them added value, commitment and enthusiasm and a healthy new perspective.

Change, managed well, can be mutually productive, and we believe not only that our service is richer as a result but that our patients have gained real benefit from this initiative. l Lorraine Lambert is chief executive, South Tyneside Healthcare trust.

Key points lA recruitment drive in Germany resulted in the appointment of three consultant anaesthetists and one consultant orthopaedic surgeon for a small acute trust in the north east of England, at a cost of about£10,000.

l The initiative involved a senior management team making several visits to Germany to talk to prospective applicants.

l Shortlisted applicants and their partners were invited for a familiarisation tour of the local area.

l The initiative met with initial opposition from within the trust but the appointed doctors are now well integrated.

l Trusts hoping to recruit from abroad should not underestimate the amount of practical support that will be needed by those moving from other countries.