Health and social care personnel - international recruitment: updated code of practice

Best Practice Benchmarks

All health and social care sector employing organisations, recruitment organisations, agencies, collaborations and contracting bodies will comply with the Code of Practice and will apply the best practice benchmarks.

These best practice benchmarks should be read in conjunction with NHS Employers’ International Recruitment Toolkit. The toolkit is designed to embed supportive practices and processes for the recruitment of international staff across a wide range of professions.

Although the toolkit was developed for employers in England, the general principles within the toolkit are applicable in Scotland.

There is no active recruitment of health and social care personnel from countries on the red list.

The red and amber country list is available at Annex A and is available on the NHS Employers website. The red list is drawn from the WHO Health Workforce Support and Safeguard List 2023. No active recruitment of health and care staff should occur from the red list.

Government-to-government agreements may be signed by the UK Government with partner countries to support managed recruitment activities and ensure they are undertaken in compliance with the terms of that agreement. When a government-to-government agreement is signed with a red list country it is moved to the amber country list.

Employers and recruiting organisations should check the country list for updates before undertaking any international recruitment.

Health and social care organisations may consider direct applications from individuals’ resident in a country on the red or amber list if that individual is making a direct application on their own behalf and not using a third party, such as a recruitment organisation, agency or collaboration.

In determining the country that an international candidate is applying from, health and social care employers should consider the applicant’s country of residence not their nationality. When considering how to handle direct applications from red or amber list countries, employers should be mindful of their responsibilities under the Equality Act 2010 to treat applicants equitably.

Guidance on how employers can publicise international recruitment activities while keeping in line with the Code of Practice is provided by NHS Employers.

International recruitment will follow good recruitment practice and demonstrate a sound ethical approach

Health and social care employers and contracting bodies, when using a recruitment organisation, agency or collaboration should only contract organisations that comply with the Code of Practice. A list of those agencies, recruitment organisations and recruitment collaborations - known as the ethical recruiters list - can be found on the NHS Employers website.

A recruitment organisation, agency or collaboration may be removed from the ethical recruiters list if, following an investigation, it is found to be breaching the principles of the Code of Practice.

A prerequisite of being on any international recruitment framework is to be on the ethical recruiters list. Any agency that is removed from the ethical recruiters list will be removed from the international recruitment framework. NHS National Services Scotland can provide further information about frameworks in Scotland.

NHS Employers will share organisation information (including name and postcode) with frameworks, DHSC, and the Employment Agency Standards Inspectorate for the purposes of adding and removing organisations on the ethical recruiters list.

The employer will be fully involved in the recruitment process.

International health and social care personnel will not be charged fees for recruitment services in relation to gaining employment in Scotland

It is illegal under section 6(1) of the Employment Agencies Act 1973 , for any recruitment organisation, agency or collaboration based in Great Britain to charge a fee for providing a work-finding service to any person seeking a job in the UK. Any organisation charging fees to an individual for a work-finding service will be reported to the Employment Agency Standards Inspectorate (EAS).

The EAS has a Great Britain wide remit, however any concerns relating to fees or conduct of non-Great Britain based agencies can also be reported to the EAS.

Any costs incurred by a recruitment organisation, agency or collaboration will be incorporated into the negotiated fee charged to employers. At their discretion, employers may meet the Visa fees incurred by a candidate to exit their home country/enter UK and/or any professional registration fees.

Employers will not contract recruitment organisations, agencies or collaboration that charge fees to candidates wishing to be considered for recruitment in Scotland. Any recruitment organisation that sub-contract to agencies outside the UK, must not use non-UK agencies if that agency charges applicant fees.

International health and social care personnel will have the appropriate level of English language to enable them to undertake their role effectively and to meet registration requirements of the appropriate regulatory body.

If a regulatory body requires an assessed competency in English language for the applicant to be eligible for registration, this should be achieved, where possible, before the selection interview.

Employers and contracting bodies must undertake the necessary checks to ensure any English language test results are verified and genuine using the available online verification services.

All potential employees will be able to communicate effectively in English to practice safely and to communicate with patients, clients, carers, family and colleagues.

It is lawful for employers, contracting bodies and professional regulators to apply conditions relating to a candidate’s linguistic ability because this is required to meet the demands of the post.

The Code of Practice on the English language requirements for public sector workers, aims to help public authorities to meet their obligations under Part 7 of the Immigration Act 2016.

Appointed international health and social care personnel must be registered with the appropriate UK regulatory body

Candidates should be advised of the requirements to practise in the UK and how to obtain relevant professional registration and be signposted to the relevant regulatory body. It is the responsibility of the individual recruit to progress the registration process, with support from the relevant regulatory body. Employers and contracting bodies should continue to communicate with their recruit to make sure they are clear about the process and support them to avoid unnecessary delays.

Candidates should start the registration process in good time, ideally before applying for a post (with the exception of registration with Scottish Social Services Council (SSSC) as this cannot be undertaken until employment is secured. See Annex D for contact details). If a candidate does not have registration at the time of appointment, employers and contracting bodies should factor this in when agreeing contracts and start dates.

Employers and contracting bodies should consider approaching the appropriate regulatory body early in the recruitment process. Early insight into upcoming demand for registration supports the regulatory body to manage capacity.

Employers and contracting bodies must ensure that they have received confirmation of professional registration, including notification of any stipulated period of supervised practice from the candidate prior to them taking up the post.

Candidates should be advised of the role of membership representative bodies and the professional support, medical defence and representation they provide.

International health and social care personnel required to undertake supervised practice by a regulatory body should be fully supported in this process.

Newly appointed staff must be appropriately supervised, and the employer must ensure the workplace support all staff to demonstrate their competence.

Employees will not be charged for any part of supervised practice and will be employed on the same terms and conditions of employment as other trained employees. Employers are encouraged to recognise previous relevant experience.

Staff will have appropriate opportunities to reach the required standard for UK registration and will be objectively and fairly assessed.

International health and social care personnel will undergo the normal occupational health assessment prior to commencing employment.

All employment offers will be made subject to occupational health clearance. Occupational health assessment information is confidential and will only be divulged to the relevant occupational health bodies, or as permitted or required by law.

Successful applicants will be informed of guidelines issued by the relevant regulatory body related to serious communicable diseases.

Employers and contracting bodies will ensure that thorough and sensitive individual risk assessments are conducted for all new international migrants before they work in a clinical environment.

International health and social care personnel will have appropriate pre-employment checks including those for any criminal convictions or cautions as required by UK legislation

Employers and contracting bodies must carry out pre-employment checks seeking to verify that an individual meets the preconditions of the role they are applying for. These checks may be performed on behalf of employers and contracting bodies by an appointed agent.

Applicants will be informed that any individual who has made a false declaration may be dismissed from their post.

All appointments should provide references from current and previous employers and/or education provider.

All personnel will be required to complete a statement informing the employer of any criminal conviction. Employers should undertake the necessary checks for criminal convictions as required under Scottish law.

In Scotland, personnel working with children and protected adults will be required to join the “Protecting Vulnerable Groups” (PVG) scheme which is managed by Disclosure Scotland. The application process involves gathering criminal record and other relevant information, from within the UK only.

International health and social care personnel offered a post will have a valid visa or appropriate permit before entry to the UK.

Overseas recruits offered a post in the UK must have an appropriate visa that allows them to undertake employment or training. The cost of any visa may be met by the employer at their discretion.

Health and social care employers and recruiting organisations should share information about the immigration system and visa application process with candidates as early as possible in the process.

This should include the rules on bringing dependents to the UK, and in particular the rules around sole responsibility and adult dependency, to ensure the candidate is clear about:

• The process
• What evidence they will be expected to provide
• The ramifications if their application is unsuccessful

Care workers and senior care workers on a Health and Care Worker visa are not eligible to bring dependents to join them unless they are on a Health and Care Worker visa that they applied for before 11 March 2024.

Appropriate information about the post being applied for will be made available so candidates can make an informed decision.

Candidates will be provided with all the relevant information about the post they have applied for prior to acceptance to enable them to make informed decisions. The information should be written to take account of individuals whose first language is not English.

Guidance on applying for health and social care jobs in the UK from abroad must be made available to a candidate at the earliest opportunity.

Information provided should include:

• The job description and person specification
• The terms and conditions of engagement, including but not limited to:
  • Place of work
  • Grading structure
  • Remuneration and intervals when remuneration is paid
  • Days and hours of work
  • Annual leave
  • Sick pay entitlement
  • Notice periods
  • Maternity or paternity pay and entitlement
  • Details of eligibility and support for training (including mandatory training and development)
  • Pension
  • Any repayment clause
• The visa application process for candidates and dependents, and an understanding of current restrictive immigration rules, including the rules on sole responsibility and adult dependency
• Professional registration processes (details for each of the professional regulators and links to further information are provided at Annex D)
• Location of job and indication of likely living costs in that area
• Access to health services for the candidate and, if relevant, their family
• Proximity of relevant religious institutions, if applicable
• Access to education for family members
• Information on national associations, diaspora groups and communities, and relevant trade unions for further support
• Information on this code of practice and how to raise a complaint if they feel any part of this code is breached during the recruitment process, as set out later in the code.

Health and social care employing organisations will liaise with recruitment organisations, agencies, collaborations and contracting bodies to ensure the information is provided to the candidate in a timely manner.

Recruiters, contracting bodies and employers must observe fair and just contractual practices

On making the job offer, employers and recruiting organisations should provide candidates with the exact terms of the contract under which they will be working to enable the candidate to make an informed decision before accepting the job offer.

Changes to an employment contract’s terms and conditions must not be made without prior signed consent of the staff member. Contract substitution - where a contract is changed without the consent of the health and social care personnel - is in breach of the Code.

Any element of the contract that may differ before and after professional registration - such as salary, repayment clauses, incentives and reclaim of advances - must be clearly explained in writing before an offer of work is made. This applies regardless of when the formal contract is issued.

Recruiting organisations must ensure the health and wellbeing of staff. An employment contract must not be signed under duress, or because of undue influence or coercion.

Any concerns about the welfare and employment rights of health or social care personnel must be reported to the appropriate agency to investigate, as set out later in the code.

Repayment clauses must be transparent, proportionate, time-limited and flexible

Repayment clauses may be included in contracts to recover some of the upfront costs that the employer has invested in recruiting health or social care personnel if they leave employment within a given period. UKVI may class some business or immigration costs, included in a repayment clause, as deductible when assessing if the minimum visa salary threshold has been met. Employers should ensure that any such costs, included in a repayment clause, do not take the employees salary below the required threshold or the employer may be in breach of their sponsor licence. Check GOV.UK for more detail.

Repayment clauses must be clearly set out in writing in the employment contract and abide by the principles of:

• Transparency
• Proportionate costs
• Timing
• Flexibility

To be transparent:

• The repayment clause must be set out in the contract or job offer letter and explained in full to the candidate before the job is accepted
• An itemised list of costs to be reclaimed should be provided to show how the amount has been determined
• Only genuine, evidenced, auditable expenses incurred can be reclaimed
• It must be made clear how the costs will be recouped using an auditable method such as bank transfer or salary sacrifice. Payment in cash is not acceptable
• Confirmation must be sought that health and social care personnel did not contribute towards the costs or expenses being reclaimed before they arrived in the UK.

To ensure costs are proportionate:

• The cost must include only those expenses met by the employer on behalf of health and social care personnel. These include but are not limited to:
  • Relocation expenses
  • Visa fees
  • Regulatory exam fees
• Costs that the employer is liable to pay as part of the recruitment process must not be reclaimed from health and social care personnel. These include but are not limited to the:
  • Agency fee
  • Immigration skills charge
  • Sponsor licence fee
  • Certificate of sponsorship
  • Cost of the interview process
• Expense costs must not incur any interest on the amount reclaimed
• Employers should give health and social care personnel the option to repay the costs or expenses through a monthly repayment plan

To ensure the timing of repayment clauses is appropriate:

• A repayment schedule must be provided, and rechargeable costs must taper downwards with time - for example, over a 3-year period. An example is set out below:
  • Leaving within 0 to 12 months: can be charged 100% of total itemised expenses
  • Leaving within 13 to 24 months: can be charged 50% of total itemised expenses
  • Leaving within 25 to 36 months: can be charged 25% of total itemised expenses
  • Leaving after 36 or more months: no repayable expenses after 36 months of service

To be flexible:

• Employers should consider when they levy the repayment clause and take individual circumstances into account. Each decision should be made on a case-by-case basis. Examples of when a repayment clause should be waived could include:
  • Where the health and wellbeing of a health and social care recruit is being adversely impacted
  • Where the health or social care recruit leaves due to bullying, discrimination or poor working conditions
  • If a health or social care recruit’s circumstances have changed beyond their control, either in the UK or in their home country
  • If the health and social care recruit wishes to move roles for career progression

Further guidance on the use of repayment clauses in employment contracts is available on the NHS Employers website.

Newly appointed employees will be offered appropriate support and induction. Employers and contracting bodies should undertake pre-employment and placement preparation to ensure a respectful working environment

Employers, contracting bodies and potential education providers should ensure they understand the culture, context and system within which the individuals work in their home country before the staff member arrives.

The potential financial position of health and social care employees should be considered.

Employers should ensure diversity and inclusion policies are appropriate and that employees understand their duties to abide by them, encouraging a compassionate and inclusive culture. Induction should include aspects of cultural awareness, equal opportunities and diversity. Ongoing support should be culturally sensitive and offer career development and opportunities for progression.

Feedback should be sought from currently employed staff and internationally recruited individuals as the employment or placement progresses, and any issues identified and resolved in a timely manner.

Each international recruit must be made aware of how to find help and assistance in all aspects of their appointment. They should undergo a comprehensive programme of induction to ensure that they are clinically and personally prepared to work safely and effectively within the UK health and/or social care system. The provision of a mentor can be helpful. The NHS Employers international recruitment toolkit provides advice and good practice guidance on the support required.

Induction programmes should encompass cultural and pastoral support to settle into working and living in Scotland. They should cover:

• An initial welcoming of staff (and family)
• Accommodation
• Pay
• Registering with a GP, dentist and school (if applicable)
• Setting up a bank account
• Information relating to professional organisations, union representation, national embassies or high commissions
• Introduction to social networks

Employers and recruitment organisations should respond appropriately to applications from international health and social care personnel who are making a direct application

Individuals making enquiries from outside of the UK for a regulated role should be directed to the appropriate regulatory body in the first instance.

Individuals making a direct application to vacant posts, including those residing in red or amber list countries, should be dealt with equitably and fairly. Employers should be mindful of their responsibilities under the Equality Act 2010.

If a recruitment organisation, agency or collaboration is approached by an individual who is resident in a country on the red or amber list, they should signpost them to a relevant jobs board where they can seek out direct application opportunities independently.

Employers and contracting bodies should consider travel arrangements of short-listed candidates when setting the interviews. Interviews can be undertaken in person or via video conferencing if conducted with appropriate safeguards. Telephone interviews are not normally an appropriate method to select health or social care personnel for appointment.

International recruitment activities should be recorded to support the monitoring and measurement of international workforce flows and their impact

It is important to have a national perspective on international recruitment supply and demand to:

• Inform policy development, workforce planning, and to understand recruitment processes and attrition rates
• Identify best practice in maximising benefits to the UK, the country of origin’s health and social care systems, and health and social care personnel

Health and social care organisations should ensure they record information about their recruitment activity. This includes:

• Countries targeted
• Planned and actual recruitment numbers
• Headcount
• Nationality
• Country of application
• Professions of international recruits in employment

Health and social care organisations are encouraged to respond to all surveys capturing international recruitment activity.

Organisations on the ethical recruiters list are required to submit timely and accurate data on recruitment activity when requested by NHS Employers or UK statutory regulators. All organisations on the ethical recruiters list must respond to the NHS.

Employers data collection of recruitment activities when requested, to aid in monitoring of the Code of Practice.

Failure to respond will result in removal from the ethical recruiters list, without the need for an independent panel.

Submission of 3 consecutive nil returns to the NHS Employers data collection will result in removal of the organisation from the ethical recruiters list, without the need for an independent panel. Organisations are permitted to reapply as soon as they are able to recruit internationally.

Health and social care employers and contracting bodies are encouraged to share information on any known breaches of the Code of Practice to internationalrecruitment@nhsconfed.org.