This resource is designed to quickly outline the Code of Practice for International Recruitment, highlight important definitions, list the countries the UK cannot currently actively target, and explain the guiding principles which health and social care employers, contracting bodies, recruitment organisations, agencies, and collaborations should follow when sourcing candidates from overseas.
All UK health and social care employing organisations, including the NHS, commit to recruiting ethically through adhering to the Code of Practice (CoP) for International Recruitment which implements the World Health Organisation's (WHO) Global Code of Practice.
The CoP promotes high standards of ethical practice in the international recruitment and employment of health and social care personnel in the private, public, and independent health or social care sectors. It also aims to protect and promote health and social care system sustainability through international cooperation, ensuring safeguards and support for countries with the most pressing health workforce challenges.
The CoP is aligned to the World Health Organisation's list of 55 developing countries, which the UK cannot target for active international recruitment.
The Code of Practice belongs to the Department of Health and Social Care (DHSC) and has existed since 2001. It was last updated and re-published on 23 March 2023. Each of the UK’s four nations’ devolved administrations adhere to the Code of Practice but each has their own Code to reflect individual structures.
- Hosts information on our website and promotes the CoP.
- Provides a dedicated advice and support service to health and social care providers to help them adhere to the CoP.
- Provides a mechanism for stakeholders across the system to promote the CoP, assess activity and, if necessary, challenge poor practice with employers.
- Manages the Ethical Recruiters List of organisations recruiting internationally that adhere to the CoP, including the processing of applications and regularly monitors the countries organisations recruit from.
- Works closely with IR Framework providers to ensure organisations that are on frameworks are on the Ethical Recruiters List.
- Works closely with the unions to help detect any issues following the recruitment of overseas recruits.
- Carries out spot checks and annual reviews on those that appear on the Ethical Recruiters List.
- If necessary, investigates recruitment organisations, agencies, or collaborations, suspected of contravening the Code guiding principles and best practice benchmarks. If an organisation is found to have contravened the CoP, NHS Employers can recommend its removal from the Ethical Recruiters List.
There are 347 agencies, organisations and collaborations on the list as of 22/05/2023
Although NHS Employers maintains the Ethical Recruiters List, the list should be used by all health and social care organisations engaged in international recruitment, both in the public and independent sectors.
The CoP itself.
The list of countries the UK cannot target for active recruitment.
The list of recruitment organisations, agencies, and collaborations who adhere to the CoP (the Ethical Recruiters List).
A set of guiding principles and best practice benchmarks for recruitment organisations, agencies, collaborations and health and social care employers.
The Code of Practice applies to all recruitment organisations, agencies, collaborations, employers and contracting bodies recruiting international candidates for health and social care roles. That is to say, the Code applies to both the public and private health and social care sector.
Active international recruitment – the definition
Active international recruitment is defined as the process by which UK health and social care employers (including local authorities), contracting bodies, recruitment organisations agencies, collaborations and sub-contractors target individuals, either physically or virtually, to market UK employment opportunities, with the intention of recruiting to a role in the UK health or social care sector, whether or not it leads to substantive employment.
This can include but is not limited to, advertising to candidates through all types of communication mediums, incentivisation activities such as referral bonus schemes, and referring candidates to specific vacancies in the UK in return for a fee from the employing organisation. It is illegal under section 6(1) of the Employment Agencies Act 1973 for recruitment organisations of any type to charge fees to the individual applicant for job finding services.
The only exception to this definition is where a candidate has already been appointed by a UK employer following an independent direct application and selection without the support of a recruitment organisation, agency, or collaboration. In this case, if required, these organisations can support and facilitate the employee’s passage to the UK. In such cases it is the responsibility of the recruitment organisation, agency, or collaboration, if challenged, to provide evidence that the services they are providing are permitted under this exception.
Direct application – the definition
A direction application is defined as when an individual makes an application directly and on their own behalf to an employing organising and not using a third party, such as a recruitment organisation, agency, or collaboration. Individual health and social care employers may consider direct applications from individuals’ resident in countries on the WHO Health Workforce Support and Safeguard List, 2020 (red country list) if they have made a direct application to a vacancy at their organisation. A direct application can only be made in response to a vacancy which is hosted by, and recruited to, the same sponsoring organisation.
The CoP is based on residency, not nationality, of candidates
Resident refers to the country an individual is living in when they apply for a health or social care job. The rules on active recruitment and direct applications are based on the country within which an individual is resident when they apply for health or social care job, rather than the nationality of the individual or their original country of training.
Employment agencies, organisations, and collaborations are required to appear on the Ethical Recruiters List
- An employment agency is a business that recruits candidates for vacant positions (permanent or temporary), for health and social care employers in need of personnel.
- A recruitment organisation is an organisation that recruits candidates for vacant positions (permanent or temporary) on behalf of a health or social care employer whether or not it is on a commercial basis.
- A recruitment collaboration is a group of organisations which have partnered together to pool resources into a central system to recruit candidates for vacant positions within that collaboration, whether or not it is on a commercial basis.
All of the definitions about come under the statutory definition set out in the Employment Agencies Act 1973 section 13(3).
Health and social care employers and contracting bodies also need to ensure they are compliant with the CoP
- An employer is the person or organisation by whom an employee or worker is (or, where the employment has ceased, was) employed.
- Contracting bodies are health or social care providers which contract with health and social care personnel to provide a service, rather than employing them directly. For example, general practitioners who are not salaried may be contracted by NHS England and Improvement, rather than employed.
Example of active recruitment
An employment agency is approached by an individual resident in Bangladesh - a country on the red list - who has been referred to the agency by their friend who is working as a social care nurse in the UK. The agency supports the individual with their application and makes a bonus payment to their friend for the referral. This is in breach of the code of practice. An agency should not facilitate the recruitment process unless the candidate has already been appointed by the employer through a direct application, at which point the employer may seek support from an agency with the remaining part of the recruitment process. In addition, referral fee schemes are deemed to be active recruitment and are not permitted in countries on the red list.
Example of acceptable recruitment
A nurse resident in Sudan – a country on the red list– makes a direct application to a job advert in the NHS unassisted. He is interviewed by the trust and deemed successful for the post, subsequently travelling to the UK on receipt of his visa. This activity did not include any active recruitment therefore does not contravene the code of practice.
Red List Countries
The map below displays the countries that appear on the red and amber lists and should not be considered for active recruitment to health and social care roles in the UK.
Amber List Countries
As of 11 November 2021, the Department of Health and Social Care (DHSC) announced that Kenya has been added to the amber list of countries in the Code of Practice for the International Recruitment of Health and Social Care Personnel in England.
This means employers and recruitment agencies, including NHS trusts, must stop all active recruitment of health and social care personnel from Kenya to the UK with immediate effect. Please read this news article for more information.
As of 22 August 2022, DHSC has announced that the governments of Nepal and of the United Kingdom have signed a Memorandum of Understanding (MOU) on the managed and ethical recruitment of Nepalese healthcare workers to the UK as part of a trail.
However, the MOU does not allow organisations to actively recruit from Nepal. By virtue of this MOU, Nepal is now on the amber list. Please read this news article for more information.
- International migration of health and social care personnel can make a contribution to the development and strengthening of health and social care systems to both countries of origin and destination countries if recruitment is managed properly.
- Opportunities exist for individuals, organisations and the health and care systems to train and educate and enhance their clinical practice.
- There must be no active international recruitment from countries on the red list, unless there is an explicit government-to-government agreement to support managed recruitment activities that are undertaken strictly in compliance with the terms of that agreement.
- Recruitment of international health and social care personnel is closely monitored and reported on to the Cross Whitehall International Recruitment Steering Group and the WHO.
- International health and social care personnel will have the same legal rights and responsibilities as domestically trained staff in all terms of employment and conditions of work. They will have the same access to further education and training and continuous professional development.
Best practice benchmarks
- There is no active recruitment of health and social care personnel from countries on the red country list.
- All international recruitment by health and social care employers, agencies, recruitment organisations, recruitment collaborations and contracting bodies will follow good recruitment practice and demonstrate a sound ethical approach.
- International health and social care personnel will not be charged fees for recruitment services in relation to gaining employment in the UK.
- All 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.
- All appointed international health and social care personnel must be registered with the appropriate UK regulatory body.
- All international health and social care personnel required to undertake supervised practice, by a regulatory body, should be fully supported in this process.
- All international health and social care personnel will undergo the normal occupational health assessment prior to commencing employment.
- All 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.
- All international health and social care personnel offered a post will have a valid visa before entry to the UK.
- Appropriate information about the post being applied for will be made available to a candidate at an early stage so international health and social care personnel can make an informed decision on whether to accept a job offer.
- Recruiters, contracting bodies and employers must observe fair and just contractual practices in the employment of international health and care personnel.
- Any repayment clause included in an employment contract must abide by the 4 principles of transparency, proportionate costs, timing and flexibility.
- All newly appointed international health and social care personnel will be offered appropriate support and induction. As part of this employers and contracting bodies should undertake pre-employment/placement preparation activity to ensure a respectful working environment for all.
- Health and social care employers and contracting bodies should respond appropriately to applications from international health and social care personnel who are a direct application.
- Health and social care employers, recruitment organisations, agencies, collaborations and contracting bodies should record international recruitment activities. This will support the monitoring and measurement of international workforce flows and their impact.