Code of Practice for International Recruitment - March 2023

The latest version of the Code of Practice was updated on 23 March 2023. These updates include: 

• Comoros, Laos, Rwanda, Samoa, Timor-Leste, Tuvalu, Zambia, and Zimbabwe have been added the Code of Practice red list. 
• This means all active international recruitment from these countries will need to stop with immediate effect.
• Making it a condition of the benchmark on information provision that the guidance on applying for a health or social care job in the UK from abroad is provided to international candidates at the earliest opportunity.
• Clarifying that the appointment of healthcare professionals onto postgraduate training programmes is outside the scope of the Code.
• Making it mandatory for organisations on the ethical recruiters list to respond to the NHS Employers biannual survey on recruitment activity.
• Updates to improve and streamline the process for Code contraveners.

NHS Employers continues to manage the Ethical Recruiters List of recruitment organisations, agencies, and collaborations recruiting internationally that adhere to the Code of Practice for the International Recruitment of Health and Social Care Personnel. These organisations can find information about the application process and apply online via our application process page.

Although NHS Employers maintain 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 Code of Practice implements the WHO Global Code of Practice in the UK. The WHO Global Code of Practice promotes voluntary principles and practices in the ethical recruitment of international health and social care personnel within member states. For further information about the WHO Global Code, please visit the WHO website.

Who does the Code apply to?

All organisations employing health or social care personnel, contracting bodies and recruitment organisations, agencies, or collaborations recruiting internationally are strongly advised to adhere to the Code of Practice. This includes (but is not limited to) the NHS, private health care providers, social care providers, local authorities and any recruitment organisation, agency, or collaboration contracted to fill vacancies.

The Code applies to the appointment of all health and social care personnel, clinical and non-clinical, supplied internationally to the UK. This includes (but is not limited to) medical staff, nursing staff, midwives, doctors, dentists, healthcare scientists, allied health professionals care workers, social workers, residential and domiciliary care workers, and support staff within both the public and private sectors.  

Joining the Ethical Recruiters List does not mean that the recruitment organisation, agency, or collaboration concerned is a preferred supplier, nor that employing organisations do not need to consider their obligations to recruit ethically when contracting them. Signing up means that a recruitment organisation, agency or collaboration has agreed to adhere to the Code’s guiding principles and best practice benchmarks.

NHS Employers will conduct checks (annually and randomly) to ensure compliance. We also encourage employers to share any concerns about any recruitment organisation, agency, or collaboration with us if they believe the guiding principles and/or best practice benchmarks of the Code are being contravened by emailing Internationalrecruitment@nhsconfed.org. Annex D of the Code sets out how to report concerns about the welfare and employment rights of health and social care personnel.

Guiding principles

There are five guiding principles that underpin the Code of Practice.

1. 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.
2. Opportunities exist for individuals, organisations and the health and care systems to train and educate and enhance their clinical practice.
3. 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.
4. 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. 
5. 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

It is expected that all organisations that comply with the Code will apply these best practice benchmarks and will enter contracts solely with recruitment organisations, agencies, or collaborations that have also agreed to abide by these.

• 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, recruitment organisations, agencies, or 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 making a direct application.
• Health and social care employers, recruitment organisations, agencies, collaborations and contracting bodies should record international recruitment activities. This will support the UK to monitor and measure the impact of international recruitment flows on the health and social care sector in both the country of origin and the UK.

Devolved administrations

Each of UK's four nations' devolved administrations adhere to the aims, objectives, guiding principles and best practice benchmarks of the Code of Practice, but holds its own Code of Practice to reflect the different organisational structures in each nation.