Summary: Code of Practice for the International Recruitment of Health and Social Care Personnel

health and care worker visa


The revised code of practice for international recruitment of healthcare personnel in England sets out in detail the provisions that must be followed when hiring overseas staff to fill essential skills gaps in the UK.

In this guide for care sector employers, we explain the key provisions of the Code of Practice to support effective and compliant overseas recruitment.


What is the code of practice for international recruitment?

The code of practice for international recruitment of healthcare personnel is specifically aimed at healthcare organisations based in England when recruiting overseas nationals.

In recognition of the important role that migrant workers play in the delivery of health and care services in the UK, the UK Government is committed to ensuring that employers only recruit from overseas in an ethically responsible manner.

As the government department responsible for implementing the code of practice, the UK’s Department of Health & Social Care (DHSC) is committed to regularly updating the code, where the most recent amendments to respond to emerging issues of concern include:

  • strengthening best practice benchmarks to ensure fairness and consistency in employment contracts, and setting out principles on the use of contractual repayment clauses
  • setting out the routes of escalation around any concerns about exploitative recruitment or employment practices, as well as breaches of the code
  • providing clarity on the code’s application to different international recruitment models
  • introducing a new knowledge test for recruiting organisations applying to be registered on the ethical recruiters list, and
  • expanding the illustrative scenario examples to help the code be correctly applied.


Who does the code of practice apply to?

One of the primary aims of the code is to promote high standards of practice in the ethical recruitment and employment of all overseas healthcare staff, and to ensure that all international recruitment is conducted according to internationally agreed principles of transparency and fairness. As such, all UK-based employers should adhere to this code when undertaking international recruitment activity to appoint personnel. This includes:

  • all UK employers, including local authority and integrated care systems, both public and independent. Importantly, NHS and social care commissioners should ensure compliance when setting up local contracts with independent providers. Additionally, where national contracts are signed with the independent sector to help increase capacity within the NHS or social care sector, complying with the code will be a contractual obligation;
  • any recruitment organisation, agency or collaboration supplying healthcare personnel to either the NHS, local authorities, social care organisations, or other UK health and social care providers. These organisations should appear on the ethical recruiters list;
  • any organisation employing or supplying overseas personnel, on either a temporary or permanent basis, to be deployed for the provision of a healthcare service.

When it comes to the definition of “health and social care personnel”, the code of practice applies to the appointment of all international healthcare personnel in the UK. This includes all permanent, temporary and locum staff within both clinical and non-clinical settings. This therefore covers doctors, dentists, medical staff, midwives, nursing staff, other health professionals, healthcare scientists, care workers, social workers and support staff.

This list is not exhaustive, although the appointment of healthcare professionals onto postgraduate training programmes as listed at Annex C will fall outside the code’s remit.


Purpose of the code of practice

The code of practice has two primary aims and four overriding objectives.

In addition to promoting high standards of practice in the ethical recruitment and employment of overseas personnel, and being transparent and fair within that process, the code aims to protect and promote the sustainability of healthcare systems through international co-operation. This is by ensuring safeguards and support for countries who have the most pressing workforce challenges in the context of health and social care.

In helping to meet these aims, the four objectives of the code are as follows:

  • To set out principles and best practice benchmarks to be applied by all those responsible for recruiting overseas healthcare personnel in the UK, in this way ensuring that recruitment is only undertaken in an ethical, managed and mutually beneficial way, in accordance with advice from the World Health Organisation (WHO);
  • To prevent any active recruitment to the UK from countries appearing on WHO’s Health Workforce Support and Safeguards List 2023 and which face pressing workforce challenges related to universal health coverage (as set out out under Annex A of the Code, where it is recommended that employers and recruiters check the red and amber country list for recent updates before embarking on any recruitment drive);
  • To set out the approach by the UK government to supporting international healthcare systems and workforces, and efforts to achieve universal health coverage and the UN’s sustainable development goals, alongside safeguards around active recruitment from countries experiencing the greatest health workforce vulnerability;
  • To provide reassurance to overseas personnel that employment within the UK’s National Health Service, local authorities and other healthcare organisations will offer high standards of induction and support if they choose to come to work in the UK.

It is worth noting that the red and amber country list does not prohibit individual healthcare personnel resident in list-countries from making a direct application to employers, but rather without being targeted by a recruitment organisation, agency or recruitment collaboration. The scenario examples as set out under the code illustrate how the definitions of “active recruitment” and “direct application” are applied in practice.


What does the code of practice say?

The code of practice comprises the DHSC’s key aims and objectives, together with guiding principles and best practice benchmarks when it comes to international recruitment for care workers. It also defines a number of key terms used within the code. By getting to grips with the contents of the code, and understanding what is meant by certain terms, this can help to ascertain the scope of the code and scenarios in which this applies. It can also help to implement training to those staff within an organisation responsible for any overseas recruitment. In this way, employers and recruiters can ensure compliance with code.

When it comes to training, the various illustrative scenarios set out under the code will be helpful. These scenarios do not provide employers and recruiters with an exhaustive list, but illustrate the types of conduct that would constitute breach or compliance with the code in the context of the international recruitment for care workers to the UK.

The annexes to the code of practice also provide employers and recruiters with important information relevant to the main provisions of the code. These include:

  • Annex A: red and amber list countries (where no active recruitment is permitted from red countries, and recruitment from amber countries is only permitted in compliance with the terms of government-to-government agreements between the UK and partner countries)
  • Annex B: green countries with a government-to-government agreement in place with the UK (green-graded countries are those which have signed a government-to-government agreement with the UK for international healthcare workforce recruitment)
  • Annex C: various postgraduate training programmes outside of scope of the code (where the appointment of healthcare professionals onto one of a number of listed postgraduate training programmes will not be subject to compliance with the code)
  • Annex D: the process for code of practice contraveners (providing an abridged version of the informal and formal escalation stages of investigation where NHS employers become aware of any recruitment or associated activity contravening the code)
  • Annex E: for reporting concerns about the welfare and employment rights of healthcare personnel (where a list is provided of the appropriate authorities to whom any concerns relating to the rights and wellbeing of overseas staff must be reported)
  • Annex F: the professional regulator contact details and links to further guidance (where a list is provided of the applicable regulators for the different healthcare sectors in the UK).


Key principles of the code

The code of practice is underpinned by the following five guiding principles:

  • If recruitment is managed properly, international migration of healthcare personnel can contribute to the development and strengthening of healthcare systems in both the country of origin and destination country
  • Opportunities exist for both individuals and organisations, as well as the health and care systems, to train, educate and enhance their clinical practice
  • Unless a government-to-government agreement exists to support managed recruitment activities undertaken strictly in compliance with the terms of that agreement, there must be no active international recruitment from red list countries
  • Recruitment of international personnel is monitored and reported on to the WHO, as well as the Cross-Whitehall International Recruitment Steering Group
  • In all terms of employment and conditions of work, international personnel will have the same legal rights and responsibilities as domestically trained staff, as well as the same access to further education training and continuous professional development.

These principles illustrate the importance for those falling within the scope of the code to adhere to its provisions. While international recruitment of healthcare personnel remains key to ensuring that the NHS has the human resources it needs, the code is there to ensure that any harm to the health and care systems of countries of origin is minimised, and that the rights of health and social care personnel coming to the UK are adequately safeguarded.


Best practice benchmarks under the code

It is expected that all employing and recruitment organisations or agencies within the health and social care sector in the UK will comply with the code of practice for international recruitment of healthcare personnel. It is also expected that employers and recruiters will apply the various best practice benchmarks set out under the code.

Additionally, reference is also made to the NHS Employers’ international recruitment toolkit, where that toolkit is designed to both encourage and enable supportive practices and processes for the recruitment of overseas personnel across a wide range of professions. As such, where applicable, the best practice benchmarks set out under the code should be read in conjunction with that toolkit. This can be found on the NHS Employers website.

The best practice benchmarks of the code comprise the following:

  • There should be no active recruitment of healthcare personnel from red list countries
  • All international recruitment by healthcare employers and recruiters will follow good recruitment practice and demonstrate a sound ethical approach
  • International healthcare personnel will not be charged fees for recruitment services in relation to gaining UK employment
  • All international healthcare personnel should have the appropriate level of English to enable them to undertake their role effectively and to meet the registration requirements of the appropriate regulatory body
  • All appointed international healthcare personnel must be registered with the appropriate UK regulatory body
  • All international healthcare personnel required to undertake supervised practice by a regulatory body should be fully supported within this process
  • All international healthcare personnel will undergo the normal occupational health assessment prior to commencing employment
  • All international healthcare personnel will have appropriate pre-employment checks, including those for criminal convictions or cautions as required by UK legislation
  • All international healthcare personnel offered a post in the UK should have a valid visa prior to entry
  • Appropriate information about vacancies will be made readily available, so that international personnel can make an informed decision as to whether to accept a job offer
  • Employers and recruiters must observe fair and just contractual practices when employing international healthcare personnel
  • Any repayment clause included within a contract of employment must abide by the four principles of transparency, proportionate costs, timing and flexibility
  • All newly-appointed international personnel will be offered appropriate support and induction, and employers and contracting bodies should also undertake pre-employment and placement preparation activity to ensure respectful working environments
  • Employers and recruiters should respond appropriately to applications from international healthcare personnel making direct applications
  • Employers and recruiters should record international recruitment activities to support the monitoring and measurement of international workforce flows and their impact.


Additional points for care providers in England

The remaining provisions set out within the code include the way in which the WHO Health Workforce Support and Safeguards List works, together with the red, amber and green grading of countries, plus case studies of government-to-government agreements.

The code also includes an explanation of the “Ethical recruiters list”. This is a list of recruitment organisations, agencies and collaborations in the UK, maintained and monitored by NHS Employers, that operate in accordance with the code. Accordingly, local employers and contracting bodies are advised only to use those who appear on this list.

There is a detailed explanation of how recruitment organisations, agencies or collaborations can apply to be included on the Ethical recruiters list, including taking a knowledge test, and how those who make the list will be monitored moving forward. Even though the Ethical recruiters list is maintained by NHS employers, this should be used by all public and independent healthcare organisations engaged in international recruitment.

Importantly, a recruitment organisation, agency or collaboration can be removed from the Ethical recruiters list if, following a formal investigation and appeals process, it is found to be in breach of the principles of the code of practice. An abridged version of the process for code of practice contraveners can be found under Annex D of the code.

Need assistance?

DavidsonMorris are experienced legal advisers to employers in the health & care sector. For specialist guidance and services that support cost-effective and legally-compliant overseas recruitment, contact us.

Last updated: 7 January 2024


Founder and Managing Director Anne Morris is a fully qualified solicitor and trusted adviser to large corporates through to SMEs, providing strategic immigration and global mobility advice to support employers with UK operations to meet their workforce needs through corporate immigration.

She is a recognised by Legal 500 and Chambers as a legal expert and delivers Board-level advice on business migration and compliance risk management as well as overseeing the firm’s development of new client propositions and delivery of cost and time efficient processing of applications.

Anne is an active public speaker, immigration commentator, and immigration policy contributor and regularly hosts training sessions for employers and HR professionals

About DavidsonMorris

As employer solutions lawyers, DavidsonMorris offers a complete and cost-effective capability to meet employers’ needs across UK immigration and employment law, HR and global mobility.

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