15 key points to know if you recruit health & social care workers from overseas

The Government has recently published a revised Code of Practice (the ‘Code’) for organisations in England that recruit health and social care workers internationally. The Code applies to local authorities, contracting bodies, recruitment organisations, agencies, collaborations, and sub-contractors who recruit from overseas for roles in the UK health or social care sector. Mandie Sewa, Solicitor and Head of Immigration at Brevis Law summarises the main points to consider to ensure you comply with the latest regulations and guidance.

1. Don’t recruit from red list countries

The red list is drawn up by the World Health Organisation. It includes:

Afghanistan, Angola, Bangladesh, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Comoros, Congo, Côte d’Ivoire, Democratic Republic of Congo, Djibouti, Equatorial Guinea, Eritrea, Ethiopia, Federated States of Micronesia, Gabon, Ghana, Guinea, Guinea-Bissau, Haiti , Kiribati, Laos, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Niger, Nigeria, Pakistan, Papua New Guinea, Republic of Yemen, Rwanda, Samoa, Senegal, Sierra Leone, Solomon Islands, Somalia , South Sudan, Sudan, The Gambia , Timor-Leste Togo, Togo, Tuvalu, Uganda, United Republic of Tanzania, Vanuatu, Zambia, Zimbabwe.

You can’t physically or virtually recruit someone from these countries (this includes advertising and referral schemes) unless the candidate has approached you directly without using a third party e.g. a recruitment agency.

2. Don’t charge candidates to get a job in the UK

Under the Employment Agencies Act 1973 it is illegal to charge a fee to the candidate for a work finding service in the UK or abroad.

3. Follow good recruitment practices and show a strong ethical approach

Even if you use a recruitment agency you will need to be fully involved in the recruitment process. Firstly check the agency is on the NHS’s ethical recruiters list. This is a list of recruitment organisations, agencies, and collaborations that operate in accordance with the revised Code of Practice. It is crucial that you check the list every time you work with a recruitment organisation to make sure they remain on the list.

You can use international recruitment frameworks. Workforce Alliance and Health Trust Europe are endorsed in the Code. Both organisations comply with NHS pre-employment standards and can give you access to vetted international recruiters.

4. Respond to direct candidates appropriately

If you are approached by an individual who is resident in red or amber list country sign post them to a relevant jobs board so they can seek out direct application opportunities independently. Direct any individuals making enquiries from outside the UK for a regulated role to the appropriate regulatory body.

You can conduct interviews in person or via video conferencing, but telephone interviews are not normally an optimal method to select health or social care personnel for appointment.

5. Give the candidate all the information needed to make an informed choice

As early as possible in the recruitment process provide the prospective employee detailed information about the role including, for example:

  • Job description and person specification
  • Terms and conditions of engagement
  • Remuneration and when paid
  • Days and hours of work
  • Annual leave and sick pay entitlement
  • Notice periods
  • Eligibility and support for training
  • Pension
  • Visa application process for applicant and any dependents
  • Location of job and indication of living costs

You should also provide a copy of the Department of Health & Social Care guidance about applying for health and social care jobs in the UK from abroad.

This list of suggested items is not exhaustive. Further suggestions for inclusion can be found in the Code itself.

6. Provide all contract details

When making the job offer, give the prospective employee the exact terms of the contract so that they can make an informed decision before accepting the offer.

Changes to the employment contract terms and conditions from those originally agreed upon when the contract was signed can’t be made without the consent of the prospective employee/employee. Any changes made without consent will be in breach of the Code.

Clearly explain in writing any parts of the contract that may be different before and after professional registration e.g. salary; repayment clauses; incentives; and reclaim of advances, before an offer is made. This applies regardless of when the formal contract is issued.

Ensure the contract is not signed under duress, undue influence, or coercion.

7. Observe 4 key principles in repayment clauses

You can insert a repayment clause in the employment contract to recover some of the upfront costs you invested in recruitment if the employee leaves within a specific time frame. The repayment clause must be clearly set out in writing in the employment contract and observe 4 key principles of Transparency, Proportionality, Timing and Flexibility. The guidance within these 4 areas includes, for example, ensuring that:

  • Only genuine evidenced, auditable expenses can be reclaimed
  • Employers must be clear how costs will be recouped using auditable method e.g. bank transfer. Cash payments are not acceptable
  • Employees should be given the option to repay costs/expenses through a monthly repayment plan.

This list of guidance on repayment clauses is not exhaustive. Further items can be found in the Code itself.

7. Arrange occupational health clearance

Before your employee starts work, you should arrange an occupational health assessment. The report should remain confidential unless you need to disclose it to occupational health bodies or are required to do so by law.

8. Undertake the necessary pre-employment checks

There are 6 key NHS employment checks you will need to follow to verify that the individual meets the preconditions of the role. These are:

  • Identity check
  • Professional registration and qualification check
  • Employment history and reference check
  • Work health assessment
  • Criminal record check
  • Right to work check

If you are registered with the CQC there 8 items of documentary evidence that you will need to obtain from each employee:

  • Proof of identity including a recent photograph
  • Criminal record certificate
  • Enhanced criminal record certificate (if required)
  • References to show evidence of conduct in past employment
  • Qualifications relevant to the role
  • CV with full employment history and an explanation of any gaps in employment
  • Information about physical or mental health conditions relating to capability.

9. Ensure registration requirements & English language ability will be met

It is very important that your prospective employees can communicate with service users and colleagues effectively. Where possible confirm an applicant’s English language ability before the selection interview if it is required by a regulatory body. It is not discriminatory to set conditions relating to English language ability. You can find out more about English language requirements for the public sector here.

10. Check registration requirements with UK regulatory bodies

Ensure that your prospective employee understands the requirements to practice in the UK. Whist it is the individual’s responsibility to progress their registration, it is advisable that you explain the process to avoid any delay in start date.

11. Check the visa is valid

Before your employee comes to the UK, establish if they have the correct work visa. If you are a licensed sponsor this will usually be a ‘Skilled Worker’ visa. The employee will have a vignette in their passport and be required to collect a Biometric Residence Permit within 10 days of their arrival.

It’s important to explain the process and documents required for the employee and any dependants. Visa processing times can be lengthy so make sure you factor this in, so the start date will not be delayed.

12. Provide support for any required supervised practice

Set out a plan so that your employee is properly supervised and supported in the workplace. You can’t charge the employee for any supervision activity, and you must ensure that they are employed on the same terms as trained employees. The Code encourages you to recognise previous experience.

13. Have an effective onboarding process

Understand the culture, context, and system that the employee worked in their home country before they arrive.

Consider the employee’s financial position and be aware that additional support may be required at varying levels, depending on each situation.

Inform other staff why you need to recruit internationally, and the types of support expected of them, to encourage a culture in which diversity is valued and respected.

Implement a comprehensive induction programme so that the employee will be able to work safely and effectively. This should ideally include support not only for the employee’s working environment, but also for them privately as they begin to live in the UK. Full details of suggested elements to include in this induction can be found in the Code.

Consider providing a mentor or buddy. Advice and good practice guidance is also available in the Code.

Seek regular feedback from current staff members and internationally recruited workers as the employment progresses and put in place a procedure for identifying and resolving any issues promptly.

15. Monitor your international recruitment activities

Regularly record information about your their recruitment activity. This should include for example:

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

Share information if you become aware of any breaches relating to the Code at internationalrecruitment@nhsemployers.org.

Mandie Sewa / Head of Immigration / Brevis Law

To discuss how Brevis’ Immigration team can support your organisation, contact Mandie via an initial consultation.

Further reading:
The Code: NHS Employers International Recruitment toolkit

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