Frequently Asked Question

FAQs – International Permanent Recruitment is often a relatively new concept to our new NHS clients and the following are the usual questions that we get asked

Why run an international permanent recruitment campaign?

There are a number of reasons for choosing international permanent recruitment including, but not limited to:

  • High levels of unfilled vacancies that have perhaps been advertised several times are unlikely to suddenly be filled if doctors and nurses are simply not available in the region
  • Low levels of UK based applicants could mean a national or local shortage that needs to be addressed by international doctors and nurses
  • A disappointing uptake from deanery rotations can leave departments short staffed just ahead of winter pressures and could be avoided with a good international recruitment programme
  • Increased pressure on services, poor CQC inspections and regularly missing targets can be dealt with more easily by a sustainable permanent workforce than locum lead services.
  • Well trained doctors and nurses may be required to replace the increasing numbers that are leaving the NHS to work overseas themselves
  • There may be incumbent agency locums that have been in post for long periods of time with no successful applicants to the posts they are covering meaning potential for huge cost savings when replaced
  • Encouraging a diverse working environment can be highly beneficial, particularly in regions that reflect diversity within the community
  • Taking a collaborative approach to replenishing the overall pool of doctors and nurses in a local area can relieve pressures on multiple hospitals
  • Specialists from overseas often bring with them specialist experience and training in areas that aren’t currently practiced in the UK

How do I know that the doctors and nurses will be appropriately trained and clinically good enough?

  • We only work with doctors who have completed a GMC recognised qualification. In the case of junior doctors (FY1/FY2/CT1/CT2) this tends to be the PLAB exam and, in the instance of more senior doctors (ST3+/Speciality Doctor/Consultant) this will be a recognised postgraduate qualification such as the Royal College qualifications required to enter specialist training by UK doctors. Nurses will have the relevant numbers of years of practice experience necessary to join at the level required
  • In order to complete their UK based clinical examinations (like PLAB, OSCE, PACES etc) our doctors have usually been through a coaching or training scheme based in the UK. In the case of junior doctors, they tend to come to the UK for an intensive course for 2-4 weeks before sitting their part 2 exam and for more senior doctors, they usually partner up with an online Skype based tutor who helps them throughout their Royal College exams.
  • Most of our doctors have trained and worked in countries whose healthcare systems share many similarities with the NHS. This is particularly true of British Commonwealth countries that have long-standing ties with the NHS such as India, Australia, Singapore and Malaysia. That said, upcoming healthcare systems like those found in the United Arab Emirates, Saudi Arabia and North African Countries like Egypt, Sudan and Nigeria all share huge similarities with the NHS and recognise similar qualifications to here.
  • Our pre-screen interviews can include any questions which you would like to hear before we send you CVs and to ensure that you only see candidates that meet minimum thresholds. These might include basic things like listing qualifications or could also be specific to if they have experience in particular procedures. In some instances we can request audit data and log books of experience in particular areas though this tends to be aimed at more senior specialist roles.
  • Your Skype based interviews should be well thought out (we can help if you need previously successful examples) and usually include clinical scenarios that are relevant to real life situations that these doctors or nurses are likely to be faced with. We also recommend asking about the future career plans for your candidates as this will give a good indication of their willingness to train and progress with your department in to the future.

How can we be assured that the international doctors will have a good level of English?

All candidates that we send to our NHS clients will have been thoroughly assessed for their English language skills according to the criteria set out by the GMC or NMC. To be clear, we only present them to you once they meet these criteria so you are never left waiting for people to pass tests before they can start (an area we know that many agencies let themselves down is presenting candidates who just aren’t ready) The requirements include:

  • For Doctors

    • IELTS score of 7.5 with minimum score of 7 in each category, or;
    • OET grade of B with minimum grade of B in each category, or;
    • An acceptable primary medical qualification that was taught and examined in English
    • 2 years+ of experience working in a native English-speaking country, or;
    • A well assessed and completed structured English language reference (SELR)
  • For Nurses

    • IELTS score of 7 with minimum 6.5 in each category, or;
    • OET grade of B with minimum grade of B in each category, or;
    • A recent pre-registration nursing qualification which was taught and examined in English, or;
    • 1 year+ of experience working in a native English-speaking country

These tests are incredibly rigorous and tend to only be passed by those who have prepared thoroughly and already have a good base level of English. Most of the candidates that we work with come from countries that either use English as a first or second language and particularly where workplaces tend to be solely in English speaking. It is misconception that the level of English for international doctors and nurses is poor, particularly since the regulatory bodies have brought in such thorough testing. Once our NHS clients have been through their first Skype based interviews, they are generally overwhelmed by the level of English and it tends to become much less of a worry.

When will the doctors or nurses actually start?

International Permanent Recruitment campaigns are an ongoing and long-term commitment which do take slightly longer than a normal campaign. If you are used to recruiting locum staff, then you are likely to be used to quick turnarounds and it is important to reset this mindset and always think of the long-term perspective rather than simply plugging gaps in the short term. Think of how long it will take to employ a doctor or nurse in the UK… They usually take a couple of weeks to interview, negotiate with and then accept your offer, followed by 1-3 months for their notice period and to complete pre-employment checks. International recruitment is exactly the same however you also need to factor in an additional month for certificate of sponsorship applications, visa applications, and international checks that can add additional time.

In our experience a smooth-running international campaign will take 3-5 months from engaging our services until your doctors and nurses start with you. Throughout the process, we will keep you updated and you will have a clear idea of any possible hurdles that could require additional time right from the outset.

How much will it cost?

Our fees are negotiable and tend to be determined by the demand profile and the level of work required. For ad-hoc placements of specialist doctors or nurses we charge a one-off fee equivalent to a percentage of the first year salary or a fixed fee depending on the grade required (more senior requirements usually mean a little bit more to spend). For larger recruitment campaigns with multiple vacancies and that perhaps require full teams of staff, there are efficiencies to be had and we are happy to offer volume-based discounts accordingly. The best thing to do if you are wondering about costs is to get in touch with one of the team and we can provide you a quote based on your individual needs.

One of the most important considerations when weighing up the costs of an international recruitment campaign is to look at the long-term perspective and, in particular, consider how much it will cost to employ a locum alternative. On average, our clients tell us that the cost of recruiting permanently from overseas is just 15% of the equivalent costs that are associated with paying for locums on hourly rates. Remember that you are paying a one-off fee for a permanent member of staff that will join you on a normal salary rather than ongoing hourly costs for doctors that are never employed directly by you and could leave at any time.

When will we pay for your services?

We invoice for our services when your doctors or nurses actually arrive in the UK and start with you. This means there are no upfront costs associated with interviewing or reviewing CVs. Basically, our service is free to the point that your doctor or nurse commences employment with you.

What happens if the doctor or nurse leaves us?

We are incredibly confident that you will be happy with the candidates that join you and, in our history, we have not had a single doctor or nurse have to leave because they were not suitable for the job or had any work-related issues. That said, an international move can be stressful and there is always a very small risk that a doctor or nurse may struggle to settle in and choose to leave (the thorough nature of our screening and recruitment process means that this has only happens with around 1 in 150 placements that we make). In these rare instances we offer a rebate period on our fees to ensure that you are not left out of pocket. This is usually a three-month period which slides down as the months pass by.

Once our doctors and nurses start with you, our communication with them doesn’t end and we offer full, on-going pastoral care to ensure that our candidates always settle in well. We are also happy to work with you to ensure that you are well prepared with an induction and orientation programme that is tried and tested for international professionals and gives the best chance of staff retention.

How will we interview doctors who are currently living abroad?

Whilst face-to-face interviews are often preferred, it is a good idea to embrace technology and focus on Skype or other web-based interview facilities. We have heard of so many horror stories of teams travelling around the world to attend face-to-face interviews only for very few of the candidates to ever actually start working for the employers. All of this extra cost, time and effort can easily be avoided by selecting fully registered and motivated candidates and using Skype facilities to interview them from the UK.

We know that technology and internet access for wireless devices can have its limitations in the NHS so if you need us to attend your interview and bring along laptops with 4G connectivity then this is absolutely fine. We can also have all the candidates added and ready for their allocated interview slots and access to all of their other contact details to ensure everything runs smoothly.

Where are the doctors from? Which countries?

The first thing to note here is that we are committed to sustainable international recruitment and signed up to the NHS Employers code of conduct for international recruitment. This ensures that international recruitment of healthcare professionals should not prejudice the healthcare systems of developing countries and means that we do not actively recruit from those developing countries.

Outside of this commitment, we do not limit our searches to particular countries as we feel that our approach should be truly global. Of course, there are countries that tend to be more accessible to us and they tend to be those who have access to the Royal College and PLAB exam test centres so that we can ensure excellent levels of clinical suitability. Equally, the healthcare systems of some countries run very much inline with the NHS and, of course, some operate in English speaking environments, so these are obvious choices for doctors that will be suitable. If you wish to run a campaign targeted at a particular region or country then we can certainly do this for you and will focus our attentions on existing networks, event attendance and marketing in those countries.

How long will it take for the candidates to become GMC or NMC registered?

At the point we present our candidates to you, they will have already gone through the longest parts of the process which are completing the recognised qualifications and demonstrating their level of English. This means that they already hold all of the documentation required to gain their registration, so it is just a matter of making the submission to relevant regulatory body and then attending an ID check (where applicable). This process takes around 3-4 weeks in normal circumstances and is completed well in advance of any proposed start dates. Again, we are very aware that some agencies send candidates who are yet to complete their registrations and purport to be able to help them later on however this is a very risky style of recruitment and we advise avoiding it.

Will these doctors and nurses need certificates of sponsorship and visas?

If your chosen doctor or nurse is from the EU then they will not require a visa or certificate of sponsorship and can start working on their current EU passport.  If they hold a non-EU passport then they will require a certificate of sponsorship. Fortunately all NHS Trusts are recognised by the home office as ‘A-graded’ sponsors, giving them quick and easy access to certificates for all doctors and nurses.

Recent home office changes have also meant that doctors, as well as nurses, now fall outside of the annual allocation limit for Tier 2 visas which effectively means the NHS can appoint as many non-EU doctors and nurses as it requires without having to compete with other industries and sectors for a restricted annual number of visas. We were actively involved in the #ScrapTheCap campaign which brought about this change and more information can be found here.

Your HR department will already know the process for applying for certificates of sponsorship however we can offer full guidance on the sponsorship management system if required. There is a cost of £199 for each Tier 2 certificate of sponsorship as well as an immigration skills charge of £1,000 payable to the home office for each candidate. These costs are refunded in full if the candidate doesn’t go on to use their certificate within three months and pro-rata refunds are applied if they leave before the end of your contract with them.

You may find this article helpful.

Do I need to pay for relocation expenses?

Each Trust has its own policy on offering relocation expenses. Whilst it isn’t essential, this can be a huge selling point for many international doctors and a great way to encourage them to stay with you for a long time. Put yourself in the shoes of an international doctor or nurse and imagine that you were emigrating to another country. If you were faced with two possible options of employment which were identical in salary, job type and hospital size however one were offering to help you and your family with flights and somewhere to stay for a month when you arrive then you would probably choose that one.

When considering your relocation policy you should think about how relevant and attractive it will be to an international candidate along with ensuring that you have a clause to ensure that you can recoup funds in the rare instance that your candidates leave. A lot of current relocation policies are outdated and really only apply for doctors already in the UK (so don’t include relevant things like flights and shipping). Things to consider are:

  • Hospital accommodation that can be accessed relatively cheaply or free of charge
  • Requirements for short term stays in hotel on arrival
  • Support for GMC and visa applications (for applicant and possible dependents)
  • Cost of flights to the UK and transfers to the hospital
  • Relocation expenses for shipping personal belongings

You should also consider applying a maximum amount to your relocation packages to keep costs under control. Usual amounts are between £2000 and £8000. You may wish to visit our blog article on relocation packages which can be found here.

Who does all of the pre-employment checks?

Since the doctors or nurses will be joining you directly, the same pre-employment checks should be done as with any normal direct applicant. Since the applicants will be outside of the UK and sometimes more difficult to contact, we will be on hand to assist with obtaining these as much as you need us to be. Some NHS clients prefer to handle their own pre-employment checks so that they have full oversight and can manage the whole process. That said, others prefer to send over a checklist for us to work towards and then let us manage the entire pre-employment process from start to finish before they check off at the end.

There are certain elements which need to be handled directly with you as the employer. For example, you will need to make the application for the certificate of sponsorship, the DBS check will need to be held in your name and occupational health will need to be screened by your internal department. That said, we can gather all of the documents and certificates necessary to apply for these and guide the candidates through the application processes in order to take as much of the effort away from you as required.

Some elements will also need to be handled by the candidate and this is particularly true when it comes to making GMC and Visa applications. To ensure that these are done correctly we run a document checking service before applications are made. We have access to an immigration lawyer for any difficult Tier 2 applications and we have a 100% success rate in visa applications.


* By submitting these details, you agree to us holding personal details on you.

error: Content is protected !!