Restarting international recruitment

Pulse is part of the Acacium Group which recruits healthcare workers from across the globe for UK, Australasia and Middle Eastern markets. Using an international presence and breadth of recruitment knowledge, Pulse is helping to tackle the growing workforce challenges its clients are facing.

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Unsurprisingly, logistical challenges around inbound and outbound recruitment have arisen during the pandemic. Throughout March 2020 there were restrictions on travel prior to the closures of the visa processing services across the world and full lockdowns being implemented in the UK and our other markets. Priority visas were unavailable during full lockdown and although now available, availability across the globe is limited with candidates having to check hourly to confirm allocation. Recruiters could mobilise candidates until 13 March but those due to travel after this date faced flight cancellations, impacting the arrival process of pre-booked accommodation and UK orientation.

Despite some nations allowing flights, many visa offices and the medical centres that carry out final travel checks remain closed, making it impossible to leave the country.

Lack of clarity from the overseas employment administrations has led to referral agents pausing new applications to avoid any reputational damage. There have been a host of further challenges for those wishing to move including flight cancellations with only 12 hours’ notice.

Recruiters are planning to restart campaigns in 2021, with trusts supported by the injection of £25 million announced by the Chief Nursing Officer to support international recruitment to increase the delivery of nurses to meet the growing workforce needs. This timeline will allow the pipeline to be replenished following a 60% decrease in worldwide applications since March 2020,

Challenges also persist for staff obtaining a Nursing and Midwifery Council (NMC) PIN due to the impact of COVID-19 on the objective structured clinical examination (OSCE). Their programme was suspended as OSCE test centres closed on 24 March until July 2020. This closure prevented those in the UK with booked exams from obtaining an NMC PIN whilst others who were in the UK on visit visas were left stranded unable to take the exam or get flights home.

The NMC allowed overseas candidates who were in the UK to join the temporary COVID register allowing them to practice as nurses in the UK during the time of emergency. The temporary COVID register closed overseas candidates when the OSCE centres re-opened in July 2020. The United Kingdom Visa and Immigration Office has granted extensions to temporary visas to support in candidates who were stranded in the UK due to borders closing.

For those still in their home country, the NMC has continued to process non-EEA applications with candidates getting to the OSCE stage. However, with some candidates unable to arrive and sit their OSCE in the UK, the NMC has also extended the expiry of the first part of the Test of Competence (CBT) by six months which, it is hoped, will allow the process to align with the easing of global travel restrictions. In September 2020, the NMC announced that they would be accepting results from the OET@Home as proof of English language eligibility for an application for registration, allowing nurses across the world to continue with the applications as some test centres remain closed.

The OSCE has a legal requirement aligned to a candidate’s visa, stating that the first exam must be taken within three months of the start date and attained within eight months otherwise the right to work in the UK is revoked and the candidate must return to their home country and wait for a period of 12 months before making another UKVI application to come to the UK. UKVI has agreed that, as a result of the pandemic, non-EEA nurses who are in the UK have until 31 December 2020 to take their first exam and until 31 May 2021 to achieve a pass in the three attempts available.

The NMC has responded with these significant changes and is looking to make further improvements, with some measures suggested following successful supplier campaigns.


In summary, international recruitment is a key and fundamental part of the Interim NHS People Plan that has effectively ceased this year. We anticipate ongoing restrictions will result in recruited nurse numbers being far below what is required while the world continues fighting the pandemic.

In addition to international recruitment, the NHS and its supply partners rely heavily on the diversity of professionals among its existing workforce, many of whom have migrated to the UK for work and now call it their home. Many more citizens from across the globe migrate to the UK for work periodically or travel between their country of residence and the UK for work assignments within the NHS. Significant numbers of each of these have repatriated back to other countries to be with family during COVID-19.

Now, more than ever, there is value in collaborating to better navigate the complexities of international recruitment, rather than trusts attempting to do so in isolation.

Further insight

This is the second in a series of seven articles from our ‘NHS workforce provision in a new world’ report. To access part three, where we look at healthcare labour market dynamics, keep an eye on our LinkedIn.