International recruitment and the NHS post-Brexit

Vilija Vėlyvytė looks at the use of overseas recruitment in the NHS since Brexit and argues that it should be a key part of any plan to solve workforce shortages. 

The need to reduce the NHS’s reliance on international recruitment has become a recurring theme in the government’s response to NHS workforce shortages. It is echoed in Labour’s 10 Year Health Plan for England and is also expected to inform the next iteration of the NHS workforce strategy, anticipated in the coming months.

This post traces the evolution of international recruitment into the NHS since Brexit. It argues that international recruitment is a vital component of any credible solution to workforce shortages, and should be acknowledged as such.

The NHS has long used overseas recruitment to meet staffing needs. The UK’s membership of the EU facilitated this by allowing EU and EEA-trained health professionals to take up NHS employment on unusually low-friction terms offered by the EU’s framework for free movement of persons.

Brexit brought free movement to an end. Unless protected by settled or pre-settled status, EU nationals seeking to work for the NHS post-Brexit are subject to the same immigration rules as other non-UK nationals.

They must apply for the Health and Care Worker (HCW) visa that did not exist under EU law (introduced in 2020). It makes working in the UK conditional on meeting criteria relating to occupation, salary and sponsorship. Permission to stay is also time-limited: leave is granted for up to five years, after which the visa must be extended.

Notably, the UK maintains a ‘standstill’ regime for the recognition of healthcare qualifications obtained in the EU and EEA. This means that EU/EEA applicants can register and practice in the UK without additional competence assessments. A unilateral policy measure, the ‘standstill’ is not guaranteed to last indefinitely. It is due for review in 2028; if revoked, EU applicants would be subject to the procedures applicable to other internationally trained candidates, including individual evaluation of qualifications and – where required – standardised testing.

The post-Brexit legal and policy landscape has inevitably dulled the UK’s appeal to EU nationals. Nuffield Trust analysis shows that the share of EU/EEA-trained healthcare professionals registering to practise in the UK fell markedly after Brexit, with nursing most affected.

That decline has, however, been counterbalanced by a steep increase in recruitment from outside the EU/EEA. For those who never had the benefit of the free movement, the HCW visa – offering lower fees and expedited processing – became a gateway to NHS employment. The impact was dramatic. Nearly one in five NHS staff in England now report a non-British nationality, up from roughly one in eight before Brexit. Medicine and nursing show the starkest shift: in recent years, over half of newly-registered doctors and nearly half of newly-registered nurses trained outside the UK and EEA. Internationally recruited staff have at this point become indispensable to the NHS’s day-to-day service delivery.

Despite rapid growth in international workforce, shortfalls persist. The NHS vacancy rate was 6.7% in 2025 and is expected to rise over the next decade. The situation is worse in social care, where vacancies remain around 7% – down from 11% in 2022 (before the HCW visa was extended to social care roles).

The causes are multiple and complex: insufficient training capacity, chronic underfunding across health and social care, and persistent retention problems linked to pay and working conditions. The effects, moreover, cut across both sectors: shortages in social care delay hospital discharge and lengthen waiting times, while NHS gaps draw staff away from already fragile care providers. This dynamic leaves both systems more exposed.

The initial post-Brexit policy response was to lean heavily on international recruitment. The emphasis has since shifted towards domestic supply.

The 2023 NHS Longterm Workforce Plan ties large training expansion explicitly to becoming less reliant on international recruitment; the 2025 Immigration White Paper uses immigration policy to steer employers towards investment in domestic skills to ‘grow our domestic workforce’ and ‘end reliance on overseas labour’; and the 10-Year Health Plan for England, released in the same year, likewise signals a move away from ‘dependency on international recruitment’, aiming to reduce it to below 10% by 2035.

This rhetoric portrays international recruitment as something of an uncomfortable necessity – tolerated to plug current gaps, but politically undesirable and expected to recede as domestic capacity builds.

What, then, is the alternative plan? The current NHS workforce strategy, presented in the Conservative government’s 2023 Long Term Workforce Plan, focuses on expanding domestic training. It promises to double medical school places and nearly double nursing training places by 2031/32, projecting an overall workforce increase of around 60% by 2036/37. The Plan also pledges to improve retention through measures including enhancements to the physical working environment, support for flexible working, and pension-related reforms intended to keep staff in post for longer.

The Plan is ambitious but offers little clarity on implementation. How will education and training capacity be expanded? What will finance that expansion once the dedicated five-year funding ends? Can retention realistically improve without confronting issues of pay? These are some key questions that remain unanswered.

The Labour government has criticised the Plan as implausible and has committed to publishing a ‘refreshed’ workforce plan expected this spring.

Unlike the NHS, social care has no statutory long-term workforce plan. That omission is ever more striking in the current political climate: last year, the Home Office closed the HCW visa route to new care worker applications, as part of the wider effort to reduce lower-skilled migration. The government has also commissioned an independent review of social care, but its terms of reference require recommendations to remain ‘affordable’. This casts doubt on the prospect for meaningful change.

It is clear that there is no quick fix to the UK’s health and care workforce crisis. What should be resisted is the tendency to frame international recruitment as problematic in itself. Doing so undervalues the contribution of internationally recruited staff to the day-to-day functioning of the NHS and care services, and risks diverting attention from the real drivers of shortages, which are long-standing and largely domestic in origin.

By Dr Vilija Vėlyvytė, Lecturer in EU Law, The Dickson Poon School of Law, King’s College London and co-editor of forthcoming book The UK Regulatory Framework Post-Brexit: ‘Law Unbound.