The UK urgently needs a joined up and strategic approach to the recruitment of international health professionals, argue experts in The BMJ today.
James Buchan and Anita Charlesworth at The Health Foundation say the UK government's decision to review the visa regime for international doctors is "a rare glimmer of common sense in an issue that has been more usually characterized by national policy incoherence."
What remains of concern, however, "is that the underlying problems of the UK approach to international recruitment of health professionals remain to be acknowledged and addressed."
These problems "owe much to a debilitating mix of conflicting policy goals and inadequate national health workforce planning and funding," they explain. "This has led to a long-term 'stop-go' approach to international recruitment of doctors and other health professionals, which has often been misaligned with domestic health workforce and immigration policies."
They point out that ten years ago, the UK Parliament Health Committee report on NHS workforce planning concluded that there had been a "disastrous failure" of planning, in part because of a "clear lack of alignment" between domestic training and active international recruitment.
It recommended that the Department of Health "needs to work more effectively with other departments, notably the Home Office, to ensure that international recruitment is fair and consistent."
Yet little appears to have changed, say Buchan and Charlesworth - except NHS funding is tighter, and staff shortages are now more pronounced.
"While there have been glib statements about the UK achieving "self sufficiency" in doctors and nurses, if this means ending reliance on international recruits "then it is unlikely to happen in the foreseeable future, given current high vacancy rates, the ageing of the NHS domestic workforce, and retention indicators showing no substantial improvement," they argue.
In the meantime, they point out that the UK continues to be heavily reliant on international doctors, while a combination of Brexit and a hardening stance on immigration may leave the UK vulnerable.
The simple truth is there is no overall government policy, published plan, or immediate likelihood of UK self-sufficiency in doctors or nurses, they write.
"What we need is a joined up and strategic approach to international recruitment of health professionals, involving government health departments, the Home Office, regulators and employers, which is embedded in overall national health workforce planning," they conclude.