International flows

The NHS in England has always relied heavily on international recruitment of nursing and medical staff.

In the 1970s, 26 per cent of doctors in the United Kingdom were trained in another country; by 2005 this had increased to 33 per cent (1). In recent years this has levelled off with the growth in the numbers trained in the United Kingdom (see medical workforce trends). In 2012, 37 per cent of doctors on the General Medical Council’s (GMC) list of registered (though not necessarily practising) practitioners trained outside the UK; most originate from outside the European Union (EU), though the proportion coming from the EU has increased slightly in the past 10 years.

Number of doctors registered on the GMC list of registered medical practitioners as of 31 December each year, 2002-12

Source: General Medical Council data requested through FOI

The EU directive on the mutual recognition of professional qualifications is being revised to make it easier for health care professionals to work across Europe, which could also have consequences for both inward and outward migration (2,3). In the future, UK-trained graduates may also have to compete with EU-trained doctors for foundation places (4).

In the 1990s, a shortage of nurses prompted a formal policy to recruit large numbers of nurses from outside the United Kingdom. Between 1997/8 and 2005/6, the inflow of nurses rose considerably; at its height more than 16,000 international nurses were added to the United Kingdom nursing register, over half of all new registrants. Since 2004/5 these numbers have declined as more United Kingdom trained professionals have entered the workforce and the need for international staff has eased (5).

An increasing number of UK-trained doctors, nurses and allied health professionals choose to move abroad, particularly to Australia, New Zealand and other developed English-speaking countries. The numbers of doctors seeking to register in the United States is rising, and temporary migration to Australia is also rising (1). The number of UK-trained nurses leaving the country has risen steadily since 1994, and, despite a sharp fall in 2009/10, overall more nurses are now leaving than entering the country (5).

Inflow and outflow of nurses from the United Kingdom, 1993-2011

Source: Royal College of Nursing (2011). A Decisive Decade: The UK nursing labour market review 2011

These professionals are moving to fill gaps in the workforce in English-speaking countries across the world.  In the United States, the Association of American Medical Colleges predicts that, at current levels of demand and supply, there could be a shortage of  up to 130,600 doctors by 2025 and 808,000 nurses by the end of the decade (6,7). In Canada, the demand for nurses is expected to outstrip supply by 100,000 nurses (8); and projections indicate a shortfall of more than 28,000 health care workers by 2021 in New Zealand (9).

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  1. Organisation for Economic Co-operation and Development (OECD) (2010). Policy Brief. International Migration of Health Workforce
  2. Cable V (2012). Article. 'The tide is turning against EU bureaucracy' The Telegraph, 7 May 2012
  3. NHS European Office (2012). Briefing. Mobility of health professionals across Europe
  4. Smith R (2012). Article. 'Up to 1,000 new doctors could face unemployment' The Telegraph, 19 May 2012
  5. Royal College of Nursing (2011). Report. A Decisive Decade: The UK nursing labour market review 2011
  6. Association of American Medical Colleges Center for Workforce Studies (2008). Report. The Complexities of Physician Supply and Demand: Projections Through 2025
  7. Center on Education and the Workforce (2012). Report. Healthcare. Georgetown Public Policy Institute, June 2012
  8. Aiken LH, Cheung R (2008). Briefing paper. Nurse Workforce Challenges in the United States: Implications for Policy. OECD Health Working Papers, No.35
  9. NZIER (2004). Discussion document. Ageing New Zealand and Health and Disability Services: Demand Projections and Workforce Implication, 2001-2021. Wellington: Ministry of Health