Why the NHS Has a Problem, Dissertation Example

Abstract

The National Health Service is the basic healthcare provider in the United Kingdom. The body offers basic healthcare services to the UK residents and foreigners as well. Moreover, they are mandated with staffing of their healthcare facilities with the required medical personnel. The organization has however been battling with staff shortages and it is projected to last in foreseeable future. The NHS has employed some stopgap measures to curb this problem. One of the measures is hiring of skilled medical practitioners from foreign countries. This has greatly aided to boost the already failing sector. However, a recent trend has emerged that of foreign medical practitioners quitting the service after a short stint. This therefore raised the research question to investigate the causes for the high rates of turnover. The study is qualitative in nature in that I had to ask the selected research participants questions on the current situation at hand. The research also took an antagonistic approach in that I pitched the views of the affected medical practitioners against the views of the NHS board mandated with managing their affairs. Moreover, secondary sources of data were used. Analysis of data took a thematic approach using qualitative analysis. From the analysis I was able to come up with five themes that I have discussed in the document. These themes were categorized depending on the factors that surfaced in many of the response in questionnaires and interviews I conducted. The findings from the results of the research were of varying nature and most varied from one individual to another. The results I have hence discussed in the document. This proved that the recent trend of foreign medical practitioners quitting is justified. The government therefore should look into the matter and act accordingly in conjunction with the NHS. The NHS is a critical sector to the population of UK therefore issues that result to understaffing generally affects their aim to provide services. Foreign practitioners are as important as the home-grown practitioners hence they should have fair treatment.

Why the NHS has a problem retaining recently migrated overseas medical staff

Chapter 1: Introduction

The purpose of this chapter is to give a brief overview of the state of the National Health Service (NHS). The chapter introduces the reader to the current state of the NHS with regards to the quality of services offered. It will illustrate the current state of the general practitioners (GPs) and their plight to have the general doctor-patient ratio further improved.

Introduction

Since the turn of the century, the 21st century has witnessed unprecedented migrations in the various parts of the world. This large-scale migration processes can be attributed to the growth and technological advancements witnessed in the world. Faster, safer and secure means of transport have been developed thus making movement of people from one place to another easier.

People immigrate and emigrate from their countries to other countries due to various reasons. Some of the common reasons that influence migration of people include; search for better employment opportunities, escaping from scourges of political and ethno-religious wars, search for better education institutions among other things. All this or one may influence a person to emigrate to foreign lands. This has had both positive and negative effects to the immediate communities and some countries. More recently, there has been a surge in the number of immigrants looking for employment opportunities. This fact can be attributed to the volatile global economy. This kind of immigration motives is usually witnessed between developed and developed countries. People from the developing or rather poorer countries yearn to immigrate into developed countries in order to secure employment opportunities. This scenario has resulted in massive brain drain from the developing countries.

The United Kingdom (UK) has received a fair number of immigrants from other parts of the world looking forward to join the big work force. The UK job market is so wide that it has been able to sustain the influx of immigrant within its borders. The government policies on immigration therefore helps in filling the void of needed professions hence the economy continues to thrive. The health sector is a key sector of the economy in the United Kingdom. The government has managed to develop an extensive healthcare system in the country. This requires a lot of staff to handle the daily operations.

It is important on the other hand to note the values that drive the operations of the National Health Service. The values are namely; “working together for patients, respect and dignity, commitment to quality of care, compassion, improving lives and everyone counts” (The NHS constitutional values hub, 2017). According to World Health Organization (2018), the recommended doctor-population ratio is 1:1000. Currently, the doctor-patient ratio stands at 2.8 doctors for 1000 patients. This is a good ratio because it is above the recommended ratio by the World Health Organization (WHO) of 1:1000. However, this still falls short of the standard doctor to population ratio among the European Union (EU) countries.

The average doctor to population ratio among EU nations stands at 3.9 doctors for 1000 patients. According to Wickware (2018) this represents a figure of 28% lower than the EU average. This was arrived at after sampling data from the nations that make up the European Union. This can be attributed to factors ranging from socio-political issues to economic factors. On another lens, EU member countries such as Greece have an impressive doctor-patient ratio of 6:1000 patients. For a long time, it has been theorized that the reason to a smaller ratio in the UK is budgetary issues but that seems not to be the case. According to Wickware (2018), the UK government allocates an average share of the national budget to the health sector. Therefore, there is no direct correlation between budget allocation by the government and the number of medical personnel. To further illustrate this, Wickware (2018) says that “France spends a relatively high amount (11.0%) and has relatively few doctors (3.3) per 1000 people, whilst Germany spends 11.3% of national income and has an above-average number of doctors (4.1) per 1000 people”. Therefore, this gives rise to the question on what the UK is doing differently or what they are not doing altogether.

To further raise the alarm, the number of medical practitioners, particularly the general practitioners (GPs) has further continued to dwindle over the years. This has further been accelerated by the Brexit process that created a rift between UK and other EU member states. According to Wickware (2018), the UK government in “2015” through its Health Secretary made an official announcement that the government intended to increase the number of full time equivalent (FTE) GPs by 5000 by the year 2020. Since that official announcement, the number of FTE GP’s has dwindled as more practitioners are either leaving the profession or working on part time basis. The question that lingers now is as to why the NHS in partnership with the UK government has been unable to maintain the number of practitioners in the health sector.

Research questions

The purpose of this chapter is to outline the research questions that guide the research paradigm. The following are the research questions;

What are the reasons that propel foreign medical staff to leave the NHS?

What is the period that foreign medics work under the NHS before quitting?

What is the role of the government in the failure of NHS to retain recently migrated overseas staff?

Research Background

The purpose of this chapter is to provide a sufficient overview into the whole quagmire hovering over the National Health Service (NHS). The chapter shall provide an insight on the key players of the health sector, the make-up of health care staffing, how the demand and supply for health practitioners has been changing over the years.

The health care system is a complex sector that has many stakeholders in play in the running of affairs. A thriving healthcare system is important for the overall wellness of a country’s economy. Currently, the National Health System (NHS) has “1.5 million people” in its payroll. This makes the health service the biggest employer in England and one of the largest in the world. The biggest employer in the world is United States Department of Defence which employs close to 2.9 million people in the world. However, the demand for health services is higher than the supply provided. It is increasingly frustrating to see the numbers of health personnel dwindling instead.

The National Health Service comprises of qualified clinical staff who account for forty percent of the total healthcare staff. The clinical staff is made of general practitioners (GPs), nurses and midwives, and medical specialists. Other key staff members include support staff that work in integral functions that include managing properties and estates that belong to the NHS (Rolewicz & Palmer 2020). A majority of the staff, standing at 1.1 million are full time equivalents (FTE).

This staff works in hospitals and community services centres (HCHS) as direct employees of NHS trusts providing ambulance, mental health and community and hospital services”(Rolewicz & Palmer, 2020). This group further comprises 19,000 staff that work as local commissioners of health services (clinical commissioning groups). In addition, around 130,000 staff work in primary care otherwise known as general care (Rolewicz& Palmer, 2020).  NHS hospitals in the UK cut across community and general care domains.

In both set ups, the number of doctors is approximately 150,000 whereas nurses and midwives make up around 330,000. This is an enormous number of a workforce in any set up, however, it is important to note that this is just slightly over a third of the total NHS workforce. The rest of the workforce population is made up of “healthcare scientists, physiotherapists and occupational therapists.”(Rolewicz & Palmer, 2020). Therefore, the NHS is one big sector that has many sector players integrated together. Besides, the NHS has indirectly employed staff as well. Hospitals are allowed to outsource a company to perform duties that are out of NHS jurisdiction for example laundry, catering and cleaning. It is reported that are indirectly employed by NHS through non-NHS organizations total to slightly over 55, 000.

Deficit of staff in the NHS

In 2019 between October and December, there was a listed vacancy of 100,000 positions meant to be filled in the NHS hospitals. These figures on job vacancies announced give an introspective insight on the status quo of the NHS. This figure, indicates that there is one vacancy in every twelve job positions. This gives a deficit of 8.1% of the job quota. This deficit is unevenly spread in the country. Some places suffer more shortage than other places. For example, London has the highest number of full-time equivalent vacancies standing at (10.7%) whereas North East and Yorkshire experience the least full-time equivalent vacancies standing at 5.5%. On the other hand, according to Rolewicz & Palmer (2020), nursing and midwifery had the most vacant positions standing with figures slightly over 35,000. Moreover, administrative and clerical posts had over 17,000 vacant positions.

The primary care also been affected and has a big deficit. The positions of general practitioners further declined by 6% in 2019. Numerically this represents a loss of 1800 posts. This trend goes against the target that was set by the UK government in 2016 aiming to have 5000 general practitioners more by 2020. This is a target that the NHS has fallen short of. However, they have set new targets that aim to increase the number of general practitioners by 6000 by 2025 (Rolewicz & Palmer, 2020).

In 2019, the NHS started a drive to recruit doctors from all over the globe including the developing nations that are outside Europe. In estimates provided by the by the sector, the NHS intends to employ and give work permits to “5000 extra nurses” annually in order to supplement the deficit that exists. The UK health sector heavily depends on foreign practitioners to provide services in the NHS hospitals and centres. To put this into perspective, according to Reality Check (2019), the number of medical practitioners in the NHS is 12% of the total workforce. This means that 56 practitioners out of 1000 are non-British, therefore, their importance in the health sector cannot be understated. A big chunk of these health workers come from the EU zone.

However, in the recent past, the influx of general practitioners and nurses that come to work in the UK has continued to dwindle. This has been attributed to the Brexit issue that has constrained the relations between UK and the other EU member countries amongst other diplomatic constraints. There are several non-EU countries that also supply medical practitioners to the NHS. The largest outside source of medical practitioners are from India, however, there are also several countries that supply medical personnel to the NHS. The countries are namely; Nigeria, Pakistan and Egypt. These for countries mainly supply medical doctors. The main source of immigrant nurses to the NHS is from the Philippines, India, Ireland, Spain, Portugal and Zimbabwe. As of June 2018, the Philippines provided the highest number of nurses, “10, 719″ (Reality Check, 2019).

The regulatory authority for nurses, the Nursing and Midwifery Council (NMC) released a report regarding the issue. The report asserts that the number of nurses that were registered from non-EU nations rose drastically by 126 percent in a single year in 2018(Reality Check, 2019). The regulatory authority tasked with the recruitment drive has measures and guidelines that they have set up to enhance recruitment regulations. One of such measures is having a look into the economic conditions of a target country and the health infrastructure that is in the target country. It is important that this is strictly adhered to so that to avoid further impoverishment of such countries. Nevertheless, Reality Check (2019) states that some individuals from such countries seek work permit in the UK without any convincing or interference from the NHS.

This program of sourcing trained medical staff from other countries out of the UK has benefitted the listed countries. The immigrant staff are able to acquire new skills and medical procedures that they can use to help the health systems of their motherland countries. Moreover, they help boost their countries of origin revenue through their foreign remittances. In some countries, for example India and the Philippines, training skilled medical personnel is a valued business that in turn is improving their health systems. On a broader look, more countries in the world are building wealth and getting richer by day. This has an effect on the populations who in turn focus on acquiring best health services. This shall provide room for more skilled medical personnel. Currently, the number of trained medical staff is not enough yet globally according to the World Health Organization (WHO) recommendations. It is estimated by the WHO that by 2030, there will be a deficit of 18 million extra medical staff globally (Reality Check, 2019). The NHS should therefore work towards meeting its target.

The work environment in the UK has been volatile due to the high turnover, rate of the medical staff. This high turnover rate has alarmed the NHS and other government executives since it indicates that there is an underlying problem that has been ignored for long. There has been a longstanding issue about visas and work permits for non-British citizens. This issue was brought upon by the tricky question on Brexit whereby the UK opted to withdraw membership from the EU. This debacle had adverse effect on non-British residents who are now forced to remit thousands of pounds per year to renew their work permits.

Moreover, they are further subjected to pay £400 per annum for using NHS services. This also cuts across any member of the family household. This are heavy charges considering that the economic conditions are quite adverse (Campbell, 2019). This issue has elicited mixed reactions among medical personnel. In an interview with medical staff on the ground, one general practitioner expressed his views with so much pain. “Despite the NHS needing additional doctors these policies send the message that doctors on visas are second class employees, unwanted and completely disposable.” Such sentiments from the medical staff should be taken seriously and the issues at hand addressed promptly. Failure by the bodies tasked to address these issues has resulted in a shortage that is already felt in many health institutions under the NHS.

The main plight of these medical practitioners is poor working terms and conditions that they are subjected to. There is the pressure point that have so far faced the NHS in its mission to provide better services. The number of nurses for instance that are going through hardships is soaring high. This was evidenced in 2016 when nurses in NHS broke the record for grants applied. These are hardship grants that are used to help the affected nurses settle their bill. The annual salary increment for the nursing staff was reduced to one percent. According to Lay (2017), this phenomenon puts the nurses at a 14 percent disadvantage compared to the previous years. More than 700 nurses hence applied for grants to help them cope with the rising living standards in the UK.

The other attributed factor by the medical personnel that intend to leave the NHS is the issue of fatigue which eventually builds to burnout. This aspect has been greatly attributed to the relatively lower doctor-patient ratio in the UK as compared to other European countries. A lower patient-doctor ratio is harmful to medical staff working conditions due to lower resting hours. It is widely thought that health systems that exposes their staff to burnout conditions may have a negative effect on the patients due to the resulting low productivity.  Other countries in the EU such as Greece and Netherlands have higher ratios thus, they become lucrative to highly skilled medical practitioners (O’Connor et al., 2016).

NHS attempts to achieve a balance in services offered and the number of medical personnel, it is important that the NHS focuses on retention and attrition in the workforce. Improving retention of the workforce has been touted as a good method to fix the already dwindling staff numbers.

Problem Statement

The purpose of this chapter is to present the problem that shapes the course of research question. The NHS is currently facing a shortage of medical practitioners to satisfy the demand. The NHS employs trained medical staff from other countries. The foreign staff are then granted work permits to enable them operate within the jurisdictions of the NHS guidelines and the law. However, there has been a huge turnover rate among the foreign staff. They leave the NHS due to various reasons. The dissertation seeks to answer the questions.

Research aims and objectives

The purpose for this chapter is to give an overview of the aims and objectives of the research question.

Research aim

The aim of the research is to examine the reasons behind low medical staff retention in the NHS. The research subjects are immigrant medical personnel.

Research Objectives

To establish the factors that affect medical personnel thus driving them away from the NHS market.

To establish factors that attract the medical personnel in the UK market to leave for other markets.

To investigate whether there are cohorts within the immigrant doctors that are harder to retain than other groups. In this case, several variables shall be considered. It will be important to establish whether some skillsets experience more work turnover than other job skillsets. Another variable that is considered is the demographic composition in the jobs turn over. It is important to establish thus what makes retention of one demographic group harder than another group.

To establish other opportunities that can be used to fill this void.

Rationale of the Study

Many studies have been conducted in an aim to investigate the reasons behind high rate of turnover in the NHS especially among the foreign staff. The study aims to conduct further research to answer this question. This shall involve interviewing practitioners who left NHS so as to have a clear insight on the matter. Moreover, foreign staff under contract in the NHS are also used as a control of the research.

Chapter 2: Literature review

The purpose of this chapter is to give an insight into the research question at hand. The section seeks to provide precise information as to why the research topic is essential, providing essential theories in the process. This chapter will guide us to understand the driving force for the practitioners to join the UK market and the factors that also facilitate in pushing them away from the UK market.

Overview of immigrant medical personnel in the UK’s NHS

The UK, mainly the NHS has been an attractive destination for skilled medical personnel that wishes to enterprise their skills. The UK market is heavily dependent on skilled immigrant workers who come in to fill in the void.  These medical practitioners come from different countries in the world, mainly from EU member states, India, Egypt, Nigeria, the Philippines, amongst other nations. The NHS is a sophisticated sector that is well developed and networked throughout the country. The NHS provides a wide array jobs, and they include; “nursing and midwifery, medical and dental jobs, emergency services, allied health professions, health science services, support services, administrative services, and directorial jobs”(Civica, 2020). The medical personnel have a threshold that they have to meet to be granted visas and work permits to work in the UK.  Moreover, the work permit taxes, which amount to thousands in pounds per annum are imposed on immigrant workers, which make it hard for them to continue operations in the UK.

Introduction and background of the NHS

The National Health Service (NHS) was established in 1948. In the original organization blueprint, the intended workforce was around 144,000 staff members. Seventy years later, the NHS is the single largest employer. The current number of medical staff under NHS payroll stands at approximately 1.1 million staff. This number comprises full-time equivalents (FTE) medical staff working in NHS funded hospitals and in community services centres (Beech et al., 2018). Different types of professional staff make up the NHS service system. They include “doctors, nurses, scientists, porters, clerks and therapists” (Beech et al., 2018). The medical staff therefore regarded as its greatest asset since, without them, service providing would be a challenge.

There has been a looming staff shorted for quite some time now. This staff shortage presents a difficult challenge to the NHS in its bid to provide quality medical services to its clients. In its ten-year long-term plan, the NHS highlighted that they have put in measures in place to mitigate this problem. Putting this shortage issue into numerical perspective, the recent statistics that highlight this shortage indicate that NHS hospitals, mental health and community service providers are having a total of 100,000 full-time equivalents. This represents a shortage of one in every eleven job posts (Beech et al., 2018).

The adversity of this shortage problem is not spread evenly as some departments are worst hit. The nursing profession is the most affected. There are around 41 000 nurse vacant job posts. This means that there is one vacant nursing job in every eight positions. Moreover, shortage of staff issue in the NHS also cuts across the medicine department. Some sub-specialties in medicine such as psychiatry is facing a severe problem to the extent that it has been listed by UK’S Migration Advisory Committee as a key concern for staff shortage.

The scope of these shortages is also felt in general practice which is a core sub-sector of the medical profession. The adult, social care sector, is also under a severe threat of staff shortage just like the NHS. It is reported in 2018 that the adult care sector had 1.1 million full-time equivalent jobs, but the job turnover has been rising ever. The current vacant positions in the adult care sector stand at 11,000. This means that “one in ten social workers and one in eleven social care worker roles are vacant” (Beech at al., 2018). This acute shortage in key medical personnel is touted to worsen due to Brexit tension that hovers over. UK Brexit issue is predicted to cause an upset in staff numbers to the NHS and the health sector in general not only in the long run but also in the short term.

According to Beech et al. (2018), the total influx of medical workers, mainly from the European Union (EU) region is lower than the total outflow of medical practitioners. This represents a negative flow of skilled medical labour. The NHS executives reported that between July 2017 and July 2018, there were 1584 nurses under NHS who quit their jobs. The nurses were from EU member states who are the primary source of skilled medical labour to the NHS (Beech et al., 2018).

Several factors cause this high turnover of labour in the NHS. These underlying factors if not adequately addressed, will bring the NHS down to its knees. Foreign medical practitioners have a wide range of issues that they have wanted to be looked into for a while now. One of the problems is discrimination in the workplace. Immigrant medical workers have cried about the disparity that exists in wages. There has been grumbling about the existing wage disparity between men and women. The discrepancy as of 2017 was 8.6 per cent. Men, therefore, earn relatively more than their female counterparts. These disparities exist though the NHS has tried to bridge that gap. A survey was conducted on the NHS staff showed that 12.8 per cent of immigrant staff felt that their working institutions do not provide equal opportunities for career advancement or promotion opportunities (Beech et al., 2018).

The other reason that medical practitioners are leaving the NHS is due to monetary reasons. The UK government has been slapping immigrant workers with hefty taxes as they attempt to apply for work permits and visas. Moreover, immigrant practitioners are ordered to pay annual taxes that amount to thousands of pounds. The health sector market in the world is very competitive; thus, there is always an option for better pay. This, therefore, puts the UK in a situation of skill-drain from their market. Some medical practitioners seek to leave NHS jurisdiction in pursuit of a better “work-life balance” (Kutscher, 2019).

Pressure of working for long hours due to understaffing becomes too much to bear for most of the foreign medical workers. This presents them with frequent burnouts which duly affects work performance hence putting patients at risk. Other reasons cited by the foreign medics is the issue of violence from the patients; this puts their lives at risk in their workplaces and perhaps leave them with post-traumatic stress disorder (PTSD). It is, therefore, a culmination of many factors that drives foreign medical practitioners from the UK market.

Challenges facing the NHS

In a bid to understand the research question, it is vital to understand the challenges that face the NHS. These challenges give the underlying problems that build up and later become a factor in our research question. There has a high growth of population in the UK This has had a direct effect on the demand for better health services. The government, through the NHS, has not been able to provide adequate medical staff to cater for the population. A recent report by the NHS declared that there is a shortage of more than 100, 000 medical staff. This is a big gap compared to other nations in Europe, and it poses a significant challenge to the NHS in its quest to offer quality health services to the population.

Moreover, the Health Ministry estimates that the number of vacant medical staff positions will grow to “250, 000 by 2030.” This will hamper NHS quest to implement The NHS Long Term Plan and would see a surge in long waiting lists in the country. The NHS Long Term Plan is a ten-year plan that was set out by the Health Ministry to drive service delivery expansion and change (Buchan et al., 2019). The following are the concerns that face the NHS:

GP Shortages

This has been a significant issue affecting the NHS. The government had initial plans to employ 5,000 new GPs to fill the staff shortage; however, this has been going on at a slow pace hence making the target unattainable by the intended date. This will pile more pressure in the already fragile department of GPs. A recent research data by the NHS estimates that in every five current GPs, two intend to quit with the coming five years.

Moreover, in another survey, a data set of 2, 195 GPs, was used to test the intentions of foreign medical staff to leave NHS. The report indicated that 39 % of the GPs intended to leave direct patient care sector by 2022. This is compared against the same data set that was obtained in 2005.  Results at that time indicated that only 19.4% of GPs intended to leave the general practice. Moreover, there have been reports from researches showing that there has been a growing trend of GPs taking early retirement. The number has since doubled since 2010 (Buchan et al., 2019).

Nursing shortage

The rate of nursing vacancy is very high in the medical profession. The worrying aspect is that this number has been growing over the years. On October 2018, there were 41, 000 declared nursing vacancies in the UK This issue has become out of hand and had the motion moved in the House of Commons Social Care Select Committee regarding nursing shortage issues. In the report tabled, it is reported that “the nursing workforce is overstretched and struggling to cope with demand […] Major changes have been med to routes into nursing. However, too little attention has being given to retaining the existing nursing workforce, and more nurse are now leaving their professional register than joining it.”

Moreover, it was noted by the committee that revenue allocation to continue development of professions was reduced from £205 million in 2015 to around £ 83 in 2017. This has hindered the sector from continuing mass production of skilled occupations. In an official report from the Chief Executive of NHS Improvement said that they work towards achieving an equilibrium of inflow and outflow of staff withing five years from 2018 to 2023. However, the nurse’s shortage is predicted to last for a long while (Buchan et al., 2019).

New policy responses to nurses’ shortages

The policies that the government has taken to curb this shortage is by introducing new systems into nursing. This includes nursing “associates, nursing degree apprenticeships and the Nurse First scheme.” These were not the intended mitigation measures expected from the ministry. The effects of these measures are yet to be realized. The intended results will be witnessed later. However, according to the Chief Executive of Health Education, the immediate effect by this move has been the instant surge of staff from social care being recruited into nursing, thus affecting the social care sector. New reports suggest that the response has had an immediate impact on nurse retention. This has been particularly effective in areas mostly affected by high turnover (Buchan et al., 2019).

International Recruitment

The Brexit issue has had a significant impact on the UK’s international relations, especially European Union countries. Brexit has brought upon newer migration policies which have hindered more medics from being recruited into NHS. Furthermore, there have been new requirements for language testing, thus blocking more potential practitioners to access the UK market. This, therefore, forces the government to seek alternative sources, especially from non-EU countries such as Nigeria, India, Pakistan and the Philippines. Government figures indicate that the number of foreign nurses from the EU region is dwindling. For instance, the intake of nurses in 2017/2018 was one third less the intake that preceded in 2016/2016 (Buchan et al., 2019).

Uncharted territory for staff NHS pays

For a long time, there has been a standoff in salary matters. The government had imposed a “seven-year public sector pay freeze” which limited the review process for salary increment but, in the process, helped NHS to boost its total annual revenue. This move was made after the realization that the step would not solve all the organization’s problems; however, this leaves the NHS in cash-crunch (Buchan et al., 2019).

Lack of investment in ongoing training and development

There has been a lack of incentive drive in continuing professional development (CPD) for NHS medical staff. The revenue streams have been capped for a while now.  The total revenue that was allocated in current training and development for existing staff in 2018/2019 is equal to a third of the income that was allocated on the same initiative in 2014/2015. Therefore, the total revenue set aside was £84 million. This intentional shoving aside of development programs has brought the quality issue into question.

Issues that drive medical staff from the NHS

Many foreign medical practitioners are attracted to the NHS with the hope of smooth sailing of affairs. Many factors pull medical staff among them include better facilities, better wages and the promise to further professional career development. However, they later come to the reality of affairs and decide to leave in pursuit of better markets—one of the most popular destinations being New Zealand and the Netherlands. Foreign medical staff are, however, used as a short-term fix to the underlying problems. The following are some of the issues;

Diplomatic issues between the UK and EU

A majority of the foreign workforce in the NHS originate from member countries of the EU. However, there has been an ongoing embargo due to Brexit issue. This has brought much diplomatic tension between those countries and the UK. This has made the acquisition of Visas and works permits hard for them. Moreover, those who have acquired valid work permits which are most expensive are further subjected to more taxes annually. The government has been trying to solve this issue, but the process has taken much time. Foreign staff form non-EU regions also have a relatively cumbersome process (Lin, Ding and Li, 2018).

Cultural differences

Many if not all, overseas medical staff experience culture shock on arrival into the UK landscape. This is quite obvious since they come from a different part of the world with different cultures. Culture shock has many cons than pros; many people are not able to get through it, thus affecting their gradual integration into the NHS. From past interviews on subjects from overseas countries, they expressed their views on how culture difference affects them. One medical staff narrated their first experience on having to adjust to different British patient care methods due to differences from countries of origin. A medic may be conversant with tool operations from their country of origin but have a hard time to operate tools in the UK.

For instance, medical staff from the United States are used to the standard approval process, but in the NHS, they are made to unlearn this and consequently learn conventional UK approbation methods which include formal documentation. The UK medical system involves a lot of “paperwork” as compared to other foreign countries of their origin. These practices often result in foreign nurses to spend much time doing paperwork, time that would otherwise be used in patient care-giving. The NHS system core principle has family-centred care. Family-centred care is thus regarded as an essential principle, and all nurses then ought to give services in line with this principle. In addition to this, the UK levels of autonomy decision making are different. The medical staff thus have to get master the NHS health care values keenly (Lin, Ding and Li, 2018).

Communication barrier

Communication is a critical aspect that facilitates efficient service delivery. There exists a high contrast difference in language due to accent and pronunciation factors. This affects how the foreign medical staff understands and expresses themselves in a conversation. In a research immigrant foreign nurses, they revealed how the communication barrier isolates them from native UK medics. Moreover, this hinders their communication with patients. This, therefore, makes it harder to enhance ward integration between foreign and native physicians. It is further reported that other foreign medics have a hard time as well to understand other foreign practitioners due to their accents (Lin, Ding, and Li, 2018).

Communication barrier is such extensive that it may affect career development. Some individuals find themselves in career-stagnation due to communication issues. For example, in a study conducted, the reports indicated that nurses of African origin experienced more career stagnation as opposed to their counterparts trained in UK due poor communication skills which can be alluded to new language shock. However, this problem can be used by the nurses instead to their advantage in rendering services to ethnic minorities in multi-ethnic areas such as London (Lin, Ding, and Li, 2018).

Unequal treatment

For quite some time, the issue of unequal treatment in the workplaces has affected foreign medics. Nurses from foreign countries have reported discrimination in workplaces in the form of separation. Besides this, foreign nurses expressed their dissatisfaction for under-appreciation. This comes in the light that foreign medics put in extra shifts at a job compared to their native counterparts. Moreover, some foreign nurses complained that there is discrimination in job assignment. They claim that foreign black and ethnic minority population are assigned harder jobs.

On the other hand, foreign medics have a hard time to pursue career development since they have limited exposure to opportunities, unlike their counterparts. This includes management exposure and enhanced career training. For some of the medics, it has become so worse that their ethnic identity could give or deny them lucrative job opportunities. There has also been racial discrimination for foreign practitioners which makes it challenging to create the required harmonious multicultural working environment (Lin, Ding and Li, 2018).

De-skilling

This is a problem that also aims to discriminate foreign medical practitioners. Foreign medics often find themselves on the ridicule end when their hard-acquired skills are not regarded highly. They are more often than not treated as juniors compared to their native counterparts on the same skill level. This behaviour goes a long way to affect an individual’s confidence and self-esteem. This is a wrong perspective from the native medics and the NHS who could instead integrate the different skillset and culture that foreigners have in the bag. However, their importance is only viewed as a stopgap measure. This hence denies the foreign medics chance to better their skills and have career development (Lin, Ding and Li, 2018).

Formal support

New staff should be provided with the essential support system so as to create a harmonious working environment. Moreover, a good support system enables a group of staff to have easy time in settling down. Majority of foreign medical practitioners feel that they are deprived of the necessary formal support. Foreign medical staff often face formal challenges during interviewing processes, production of curriculum vitae. This problem can be solved either through formal training of the new, foreign medics as they settle in or either via conducting mentoring sessions.

Formal support would come in handy during checking in and settling in period. Foreign staff have openly expressed that this would help them become familiar with UK health-care system. A proposed change to improve this is to have incoming medical staff acquire crucial documents such as a work permit from their respective countries British Embassy. In NHS institutions, induction culture is vital for familiarization. However, the reality is that foreign medical staff are offered little support unlike their UK-trained counterparts (Lin, Ding and Li, 2018).

Informal support

There has been little informal support to foreign medical staff. The support at the base is minimal or non-existent. This creates a toxic working environment. For instance, a foreign nurse prefers to seek help from fellow nurse of the same colour instead of turning for help from the relevant seniors. Lack of clear-cut support system has led to thriving of other vices such as racism. In such scenarios, people find safety and comfort by converging in groups along ethnic and racial lines (Lin, Ding and Li, 2018).

?hapter 3: Research Methodology

The purpose of this chapter is to provide a well detailed presentation of the research methods and methodology used in the discourse of this research study. This chapter will first provide a justification to the choice of research approach. Subsequently it will be followed by research design as well as the advantages and disadvantages of the tools used to conduct this research. This will then be followed by a discussion on the viability of the tools used in research design to produce credible results. The tools ought to meet the aims and objectives that govern the research principles. The chapter then discusses the sample size of the research and the sampling strategies employed during the research process. Moreover, data analysis methods are discussed. Concluding the chapter is discussion on the ethical considerations, challenges and limitations that face the research paradigm.

Research Philosophy and Methodology

Research Philosophy

Research Philosophy is a general researcher’s belief on the guidelines that should be used to collect, analyse, interpret and use data in a research. According to Dudovsky (2011), there are there are several assumptions and guidelines that are taken in a research process. In this case the research involves study into the issues that result in poor foreign staff retention in the NHS. This research is guided by ontology philosophical approach. This approach is the fit for this research study because of the nature of the study which involves current happenings. Moreover, this research has used constructivism theory because it best suits the qualitative data approach of the study.

Rationale for Choice of Approach

There must be a rationale that is followed to arrive at a choice of philosophical approach. The research is presented with two philosophical assumptions. However, for the purpose of this study, ontology was taken into assumption. The following is the rationale followed:

General reality of the world. There are many prejudices against people from certain places in many parts of the world. Thus, it is not an isolated case only happening in the UK.

What the general standard overview of organizations in the world are. This rationale helps in rating the performance index of the research organization, the NHS.

The perspective of being part of the NHS. This is simply putting oneself in the shoes of foreign NHS staff.

The general perspective of being in authority or being under authority. This simply involves looking at both those in power and the ones being governed.

Methodology

The research into the causes of high turnover rates among foreign medical staff is done under ontology philosophical approach. This is due to the realistic nature of our research problem. The data that is used in this research is qualitative data. Qualitative data is the most suitable in this research because the research entailed speaking to participants. Primary and secondary data collection methods are used in the research. Primary data was collected by use of questionnaires and interviews. The questions were designed specifically for each target group of participants.  Secondary data was obtained from the internet and other agencies. The questions were designed specifically for each target group of participants.

Case Study Research Design

A case study is a research approach method which is used to provide a detailed analysis into a real-life subject issue for easier understanding. This research uses qualitative research method. Also, online qualitative research is used to simplify the research process. Qualitative methods are used because the research does not involve collection and use of numerical data. Qualitative method instead focusses on use of words which bring about people’s opinions, thoughts, and feelings about a given topic (Tiley, 2017). Moreover, it is preferred because the research study requires interpretation in order to decipher the information. In this case it shall involve use of NHS medical staff and the relevant boards and committee to get information on the issue at hand in an exploratory manner.

Moreover, this research makes use of triangulation to since it involves view of research objectives on a broader perspective. Triangulation as a result helps in drawing a connection between the various variables under research (Tiley, 2017). This shall help find the connection between the factors that cause high turnover of foreign medics the general effect to NHS service delivery in the country. The desire for this outcome demanded that use of questionnaires and interviews be imposed. This help in maintaining the integrity of information. Besides that, the research design for study on the NHS has many formulated hypotheses on the cause matter issue. These hypotheses have been developed mainly through observation of events that happen.

Research Methods

This chapter shall discuss in detail the various methods used to collect for analysis. Research methods are the tactics, processes and techniques that are used in the process of data collection and analysis. This is done so as to provide a clear understanding into the research topic at hand. Data used in research is put into four primary groups depending on the data collection method namely; “observational, experimental, simulation and derived” (Tiley, 2017). This research primarily uses observational data and derived data.

In this research, the main data collection techniques used are questionnaires and interviews. These wore done randomly and selectively cutting across different staff population groups so as to have a non-biased representation of the data.

Questionnaires

Questionnaires were the most preferred method due to the qualitative nature of the data used in the research process. Questionnaires were administered to the respondents via emails and filed back via the same platform.

Interviews

Interviews were the most preferred methods of data collection due to the qualitative nature of the research process. Interviews were administered to the selected respondents via telephone calls and other video conferencing tools such as zoom.

Other methods used

Other data collection methods were also used in the study of the reasons that leads to high turnover rate among the foreign medical practitioners brought to serve under the NHS. The research employs use of observation and focus groups.

Sampling

The purpose of this chapter is to illustrate the sampling techniques that have been used in the course of this research study. Sampling is the process of selecting a small group from a target research population to be a representation of the whole population. This therefore means that by looking at the general characteristics of the sample group gives us an outlook of the whole target research population. In this research study, sampling was very useful due to its lower cost compared to other research methods. Moreover, it was time saving and it was deemed to produce an accurate result.

There are five types of sampling used in research: random sampling, systematic sampling, convenience sampling, cluster sampling and stratified sampling (Mccombes, 2020). For the purpose of this research study, two sampling strategies were selected, namely random and stratified sampling. This is further generalized into stratified random sampling. This sampling method was most suitable for the research due to the diverse nature of our target population. Our target population involves a look into two groups; the foreign medical staff and the governing bodies mandated with solving understaffing issues in the National Health Service. Moreover, the sampling methods were the most suitable due to the existing relationship between the two sub-groups.

Participants of the research study were selected on the basis that they fit the defined criteria. The fist defined criteria is whether the medical practitioner is an immigrant or a homegrown. The next set criteria are their countries of origin. This is further divided to whether the participant comes from the European Union (EU) region or if they are come from other non-EU overseas countries. It is important to define the scope of the criteria used in the sampling process. This is due to the realization that both target research participants are not subjected to similar treatment hence the need. The sample size is made up of equal numbers of medical staff that originate from the EU region and those that come from the rest of the world. Moreover, this was also important following the philosophy of the study that is ontology

In an attempt to avoid gender bias, the research sample was made of men and women form majority of medical professions in equal proportions. There were representatives from general practitioners, nurses and midwives, medical physicist among many others.

The second group of participants consisted of persons representing the NHS and are tasked with looking into the affairs of foreign medical staff. The population sample size for this group was eight participants. The defined criteria in selecting these participants is the position that they hold in the NHS board mandated with the task. Therefore, senior officials were the most suitable for this sample size. Moreover, in an attempt to have equality in the sample distribution, the population sample comprised of four men and four women. In order to obtain data from the research participants, two methods were used; use of questionnaire and interviews. I questionnaires used among the medical practitioners’ group; however, some were willing to be interviewed. Use of interviews was the most preferred method to collect data from officials in the NHS board tasked with foreign medical staff affairs. However, questionnaires were also used to complement interviews. Questionnaires were sent via emails and interviews were conducted through telephone calls.

Table to support sampling

Table 1: Details outlining the interviewees nationality, profession, and gender and length of service.

Table 2: Details outlining the NHS interviewees gender, length of service and board position.

Developing the data collection instrument

The purpose of this chapter is to highlight the methods that were used in data collection and why they were the most suitable.

Questionnaires

For this research purposes, I formulated two set of questionnaires and interview scripts for the two strata of the sample population.

The questionnaire that I formulated purposefully for the foreign medical staff in this research had set of ten open-ended questions and closed questions. The questions were related to their outlook of state of affairs in the NHS and issues that we though they would like looked into. I arrived at the set of questions after using some primary and secondary sources of data regarding the issue. The main secondary sources of data used were materials such as journals that are available freely online. This provided a solid base towards finding solutions for the research. The first section of the questionnaire were demographic questions such as age, gender, country of origin and the current medical profession.

Next were questions regarding the profession such as a person’s length of service in the profession, the responsibilities that they have been given and the general qualifications in the profession. The main questions of the questionnaires were divided into sections to enhance clarity and ensure that the questions are within the confines of the research study. Moreover, the questions are designed through the lens of the foreign medical staff so as to make it easily understandable to the researcher and the respondents.

The questionnaire that was set for the NHS officials in charge of foreign medical staff affairs had a set of fifteen questions. The questions are of open ended or closed nature. The questions are structurally set like the other set of medical staff. The only difference is that this questionnaire was set from a perspective of the NHS officials.

Interviews

For this research purpose, I formulated two interview scripts with each intended for a particular stratum. In both population sample sets; the interview scripts have ten questions for both parties with at least eight of the questions are open-ended but just two are closed questions.

The interview script questions intended for foreign staff medics were designed in perspective of the practitioners. The questions were set to enable a reflection into the experiences of the medical staff in the NHS, the general feeling towards the status of affairs in the NHS. Moreover, respondents were also given chance to give recommendations to improve the state of affairs.

The interview script questions intended for NHS board officials were designed to suit the respondents general view on the state of affairs. The questions were designed to seek answers to why they have failed to live up to the targets. Besides, the questions also tested the official’s leadership aptitude and general willingness to look into the matter.

Data analysis

The analysis of data provided by questionnaire respondents was done using thematic analysis technique. This method is most suitable with qualitative data as is the case in this research study (Crinson, Leontowitsch and Morgan, 2017). Data collected via interviews and questionnaires has a wide range of answer sets and nominal ranges hence there was no need to use quantitative methods of data analysis and software tools such as MATLAB and SPSS.

Moreover, the interview responses were analysed manually by listening. Here I was keen to look out for thematic cues in the conversation. This was done in an attempt to identify some occurring patterns which would help in the discourse of the research. The results from the questionnaires were presented via graphic timelines and table charts. In some responses, the results were presented as an icon beside brief description of the medical practitioner’s grievances.

Ethical Considerations

This chapter shall explain the ethical parameters that guided the flow of this research study. There are many ethical considerations that one ought to consider before conducting a research study. The first and perhaps the most important ethical consideration is the regard for a participant’s consent. In this research, the participants were given a notice some time before for consideration. Some participants agreed to the requests whilst others kindly declined the requests. It is against the law and one could get into serious trouble if they used data without consent from the participants. Research participants have different personalities, there are some who did not want their identities revealed whereas there are some who are okay with that.

The confidentiality of an organization or company where the respondents work should be maintained in a research unless granted permission. Therefore, in compliance with these guidelines, the researcher has to get consent from the company or organization to interview the respondents who have given consent. Another ethical consideration is that the information collected during the research process ought to be used for reasons only related to the scope of the study and it should be stored confidential.

Challenges and limitations of research

There were several problems and challenges that the researchers encountered in the course of the research study for this dissertation.

The first block was the challenge of accessing a pool of willing participants. There are many blocks in the path as some participants reject participation with the fear of retribution from parent organizations. Moreover, some companies blatantly decline any form of interview on whosoever.

Another challenge is limited time frame and financial estrangement. Low finances also partially contributed to the choice of the data collection methods.

The methodology chosen for this research study has been gripped by some limitations.

The first limitation of the study is small sample size which in turn limits generalization of the data.

The other limitation of the study is the philosophical approach taken. This limits the researcher to widen the scope of the study. This may deem the results as biased.

Time constraints limited the research process. This is couple up with the current global COVID pandemic thus making it harder to access some of the research participants due the regulations set.

Chapter 4: Findings

The purpose of this chapter is to analyse the data collected from the research study. I did research in an attempt to study the reasons why doctors in the NHS who recently migrated there are experiencing a high turnover rate.

Case Study background

Over the years, there has been a grappling shortage of skilled medical practitioners to work in the NHS. This necessitated the move by the UK government to advertise medical jobs for overseas medical practitioners to come and work in the UK. The NHS is a huge sector of the country and holds a key position in staffing of medical practitioners in all its hospitals. It has thus been deemed by many as the bloodline of the UK population.

Thematically organized subsections

The findings during the course of the research were varying due to the depth of the research study. Therefore, in order to put the findings in clear perspective, a thematic approach was taken. In our case study, there were several re-occurring themes on the challenges that prompt foreign staff in the NHS to leave. I have outlined below.

Compromised work balance

Many foreign medical practitioners cited a compromised work balance as one of the reasons for NHS exit.  Most practitioners are working under high pressure due to the underlying problem in staff shortage. This in the long run often lead to burnout. Most of the research participant felt that they had better chance to have a healthy work balance in other countries.

Lack of Clear-set career progression paths

There was a general feel among the participants, especially nurses and other sub-professions regarded to be under GPs in terms of skillset. In one interview, the official outlined that “They don’t have adequate career progression as opposed to our medical counterparts who actually have a pathway” (Kutscher, 2019). To put emphasis on this, one of the participants, a nurse had this to say “It’s very much a situation of dead man’s shoes. You are put in a job and you’re not actually given the training you need to get the next role. So, people get stuck in a rut. Because of the way the NHS works, your skills become very specialized.” That summarizes the general feel.

Staff Under-appreciation

This is a common theme that appeared from the research data. Many of the respondents felt that they are not given ample support by the management in their work.

High Costs of Living

This is a theme that occurred in most of research data especially professions lower than general practitioners such as nurses. This can be underpinned to lower wages to some groups then coupled up with the tariffs imposed on them. In an interview, a director noted that “The real issue for us here is the high cost of living and working in London. Not only for us but all public sector workers…the evidence we have submitted to the London Health Board and indeed to the national pay review body is asking them to seriously consider what more can be done to support all public sector workers with the true cost of living in our capital cities.”

Diplomatic rows

The UK has experienced estranged diplomatic ties with some countries since the Brexit question was tabled. This duly affects international relations and has been dragged into issuance of visas.

Summary of Findings

The research question study is investigation of the causes that result to newly immigrated staff to the NHS to leave after a short stint. It is important to know the underlying causes since it poses a greater challenge to the general service delivery of the NHS.

In the research, the following were the key findings behind the high turnover rate among immigrant medical practitioners. The medical practitioners cited lack of balance between social life and work, high cost of operation and charges, Brexit question, stress and burnout, staff underappreciation, and lack of career development measures as the reason for quitting the NHS.

Chapter 5: Discussion

The primary aim for this research study has been to investigate the root causes for high turnover rate among medical staff that migrated into the UK to work in the NHS. Qualitative approach was the most preferred approach due to the nature of the study that involves asking research participants questions via interviews and use of questionnaires. The research involved taking into account the feelings of the participants who freely expressed themselves through the set questionnaires or interviews. This chapter includes a discussion into the key findings that I made at the end of this research study. The findings discussed are related to the provided literature on the reason why foreign NHS staffs are quitting after a short stint in the service. Moreover, the discourse shall include the findings that I made after interviewing officials mandated with affairs of this group. Also included in the chapter is a discussion on how this study connects with the literature available.

Moreover, the chapter includes a discussion of the aims and objectives of the study and whether they have met the criteria to address the challenges at hand. Also included is a discussion of the study limitations, areas for future research and a brief summary.

The purpose of discussion and areas of future research is to aid in answering the following research questions:

• What reasons propel recently migrated foreign medical staff to leave the NHS?
• How long does the foreign medical staff work in the NHS before quitting?
• What role does the government play in all this?

The factors that influence foreign medical staff to leave the NHS have a multi-dimensional and broad scope. The factors have been narrowed down using thematic approach of data analysis. The themes are: (a) A compromised work balance among the foreign medical practitioners, (b) Lack of clear-set career progression paths (c) Foreign staff under-appreciation (d) high costs of living (e) diplomatic rows. These factors that result to high turnover rate among the foreign medical staff vary from one individual to another. Moreover, some of them are relatable to the hosting organization. On the other hand, some themes have been as a result of the integration of both factors. The issue under research has been a culmination of all these factors thus giving rise to the problem.

Research aims and objectives

Research aims

The aim of the research is to investigate the reasons that result to low staff retention in the NHS.

The research has been successful in unearthing the reasons that are behind the ongoing exodus of skilled medical personnel from the NHS after a short stint. I managed to highlight the factors behind the research problem. Moreover, the period that the medical quit after enrolling was unearthed. The research suggests that the period that it took before quitting varied from one individual to another. As result it helped debunk various misconceptions that are embedded to public opinion thus increase awareness of the issue. Therefore, in as much these factors require a mass intervention, a more personal approach should be considered.

Research objectives

I set out the research study with an aim to meet the following study objectives. The following are the research objectives:

Factors that affect medical personnel

There are various factors that affect foreign medical staff resulting in high turnover rates among them. The range of factors that result to this phenomenon include: (a) high living costs, (b) lack of a balance in work-life aspect, (c) biased treatment against foreign staff, (d) inadequate career progression paths.

Factors that attract foreign medics to other healthcare market destination

There are various factors that have been attributed to be pull factors for foreign medical practitioners to other countries. These factors have been as result of deficiencies in the NHS. These factors include: (a) Promise of better working terms in other countries, (b) friendly working environment in other countries, (c) low cost of living, (d) availability of equal career progression paths, (d) relatively better working conditions in the destination countries.

Cohorts among the study group that are harder to retain than others

The research embarked on studies to investigate which cohort among foreign medical practitioners is experiencing highest turnover rates. The cohorts for this research were established based on the nationalities. Thus, the cohorts are research participants from EU nations and those that hail from regions out of EU. Turnover are not uniform as some cohorts are comfortable while some cohorts find it difficult to persevere. The other cohort was established on the basis of professions. Some medical professions such as nurses experience high turnover rates.

Measures that should be put in place to tackle this problem

During the research process, the participants were able to give their opinions on the measures that would help improve their situation. Interviews with NHS board officials resulted in gainful insights on how the issues can be tackled, on a long term and short-term scope.

Reasons that propel recently migrated foreign medical staff to leave the NHS

The NHS has been grappling with serious shortage of skilled medical staff over the years and it is a problem touted to last for a while if not adequately addressed by the relevant bodies given the mandate. Many medical personnel apply in droves to fill the vacancies left by the preceding medical staff that have since quit service. These medical practitioners act as a stop-gap to the problem hence they are critical to the service. The vacancies announced by the board have a wide range of specialties to cover all the sectors of the medical profession. However, a common pattern where recently recruited foreign staffs are quitting the service after some short time spent in the profession.

I used a thematic approach in the analysis of data from the respondents. From that I managed to narrow down to five themes which commonly appeared in the responses given by the research participants. These themes have a dynamic nature because the reasons are independent from one participant to another. The themes are discussed in depth in the section that follows.

A Compromised Work-life Balance

A balanced work and social life are major considerations for many people in the job industry. Medical practitioners are not an exception to this. According to Osaro and Chima (2014), work-life balance is the ‘state of equilibrium in which demands of personal life, professional life, and family life are equal”. Moreover, aspects of life rather than work include “personal interests, family and social or leisure activities.” It is a general feeling among the participants I interviewed that their work balance has been compromised. This means that they have to spend more time working thus eating into time meant for other life aspects.

This problem is one that has resulted from NHS board’s failure to curb the problem at its infancy. The current understaffing being witnessed in NHS hospitals has led to an overload of work (Osaro and Chima, 2014). According to Campbell (2019), a good number of NHS staff, more so foreign staff are leaving because they are tired of spending most of their time sparing very little quality time that they can spend with their respective families and loved-ones. He goes on to say that the number of medical staff that have quit the NHS has tripled over the period of the last eight years. This factor was spread out across all medical specialties in the responses from our research participants.

The research participants cited working beyond the recommended working hours has taken a toll in their life routines. The current condition of the NHS according to the participants is the workload assigned to the practitioners is enormous, long working hours and staff shortage. This has greatly hindered quality service delivery by the medical staff. The compounding effect of this is that it may have negative impacts to the mental well-being of the affected parties. Proper management of man-power will result to less working-days being lost due to stress related to work.

Lack of career progression path

Career progression paths should be provided and outlined in a job contract. According to Crinson, Leontowiwitsch and Morgan, 2017). Career progression is critical for further development of skills and competence. During the research, many foreign medical practitioners felt that they were not provided clear paths for career development compared to their British counterparts. The respondents attributed this to the managers of the various institutions. They claimed that the managers gave preferential treatment to locally honed medical counterparts. In an interview with a board director in the NHS, he reiterates that it is a process that requires support from all quarters to work in unison. Moreover, career progression topic should be planned carefully by the managers lest they risk upsetting their staff due to the poor conversation. Besides, it is a sensitive topic due to the nature of information that is passed.

The research found out that the career progression infrastructure that is laid has a lot of shortcomings. First concern is that the conversations that are shared on career progression are not being implemented. This has created a hostile environment in the working places. This definitely causes disgruntle among the foreign staff hence affecting productivity. It is every employee’s ambition to further their career skills hence a higher pay grade group. The government in conjunction with the NHS should track the career development of each employee and engage them in conversations so as to gauge their level of involvement.

Diplomatic Rows

In the recent past, the UK has found itself amidst diplomatic relations row with countries from the EU. This is where most of its immigrant doctors are sourced from. This situation has escalated after the divisive Brexit poll. This has been followed with tighter restrictions being imposed on the aspiring medical practitioners wishing to join the UK job market. The charges for working visas and work permits are at an all-time high for immigrant medical staff.

In the research study, the participants expressed feeling of being alienated from the rest of population after the Brexit poll.  In an interview with NHS executive official, they reiterated that it is true that referendum question definitely had a huge impact on how they currently view the society at large. This situation has further been worsened by the mere fact that most of the foreign staff working hail from the EU region. The medical bodies in General Medical Council and the British Medical Association reveal that the number of medical practitioners who are willing to leave the NHS has been on the rise (Exworthy and Chick, 2017). Moreover, some of the participants felt that this is a deliberate measure put in place so as to frustrate the medics and others who are willing to join the NHS.

One of the differences in my studies compared to the available literature on this matter and the implications that it has in the long run. My research assumption has been that Brexit question affects the whole foreign staff working in the NHS. Therefore, the general assumption was that the decisions shall made collectively. However, my research studies prove otherwise. It was my realization that decisions regarding this matter are made independently by an individual. The research unearthed that the reason for this raged from levels of attachment to the country by the amount of time spent giving service in the NHS. Thus, it was finding that medical practitioners who had recently migrated to the UK had higher probabilities of leaving compared to their foreign counterparts who had spent more time there. Doctors who had stayed in the country for let’s say a span of twenty years and have families feel more British they say than their countries of origin. This can be explained by naturalization theory.

However, some of the seasoned foreign staff in the NHS say that it is only a matter of time before they decide to leave as well. This is because, given more time to work there, they will perhaps reach their elastic level limit, as they allude in literature, it will be the final straw that breaks a camel back.

High Costs of living

Most medical practitioners live in major cities and other urban centres. This is due to the knowledge that a majority of the population in the UK reside in urban centres due to varied reasons known to them. Therefore, it only makes sense for foreign medical practitioners to reside in cities. However, the medical practitioners have had to grapple with hard-biting teeth of tough economic times that result to high cost of living. Moreover, this has not been helped by the fact that they are still subjected to higher tariffs. The general belief and assumption by the general public is that medical professions are given big salaries which should act as a cushion to the tough economic times. This research was able to debunk more than it meets the eye. The underlying truth is that their salaries have not been reviewed upwards for quite some time now. According to NHS (2020), the monthly salaries for doctors working in the NHS range from £ 2,200 to £ 3,400 after tax. On the other hand, registered nurses in the UK earn an average of £23,000 per annum.

In the research study, more nurses reported feeling strained by the living costs in the cities, for example London. In the available literature, according to Ross (2020), housing in London is averagely £ 2,500 per month for a two-bedroom apartment in the business district. However, the cost of housing in London is high and medics can barely afford. During the research, some of the participants, especially nurses said that rent money could take up to half of their monthly salaries. This gives them much worry as they attempt to gain financial freedom. Besides, this trend has been observed within a period of five years.

There is a link between shortage of staff and the cost of living in the city. The related literature debunks my misconception on this matter. According to Mitchell (2020) the link between staff shortage and cities costs of living cannot be further ignored. This is because it results to low staff retention thus piling more pressure on the already overwhelmed sector. Staff retention is crucial for having a stable health system. It is common knowledge that the state of a staff has direct impact on the quality of services offered. From my research, I observed that, staff from the nursing profession was the most affected. This affected more than half of my research participants. The government should come up with sustainable housing projects for its staff. Moreover, housing should be offered near their work places so as to cushion them against transport problems.

Foreign staff under appreciation

Appreciation of staff is important for motivation purposes. Moreover, it eliminates any chances of having toxic environment in the work places. Under-appreciation of staff has been going on for quite some time now. During the research, the medical practitioners felt that homegrown counterparts were receiving preferential treatment in some aspects. This narrowed down to aspects like allocation of duties, staff promotion among others. This hence makes the demoralized to perform such tasks willingly, subsequently it affects the quality of service deliveries since they may have planned go-slows in work to have their issues addressed.  In my research, the group of professions that felt duly undone is nurses.

According to Mcllory (2020), the lowest paid healthcare profession is nursing. This has elicited mixed reactions with nurses feeling agitated for their regard as merely helpers of doctors thus lower pay. Moreover, the rate of salary increment for nurses is slow over the course of their professional career. This has thus resulted to high rates of turnover in the nursing profession who quit for other health care markets. This literature goes relates with research responses. The participants asserted that it was easier for a male nurse to occupy a top position compared to a female nurse. Besides, female nurses comprise 90% of the total nurse population but they manage to fill only a third of senior positions. My research participants suggested that the structure to oversee inequality between the foreign staff and homegrown one is systematic in nature hence they feel powerless to affect any revolutions for changes thus the only viable option remains quitting the service.

?ontributions to the Literature

The research set out to investigate the factors that cause high medical staff turnover especially amongst the recently immigrated medical staff. There has been a grappling shortage of medical staff in the NHS which is set to worsen if not curbed at its infancy stage. Foreign medical staff offer good short-term to long-term solutions to the research problem. Currently, even as the foreign medical practitioners meditate on whether to leave or not, the shortage is still growing. The importance of foreign medical personnel cannot be understated and their overall importance has been witnessed during the global COVID-19 pandemic where their efforts to save lives have not gone unnoticed. It is otherwise obvious that the country could not handle the weight of the pandemic without their involvement.

The research has highlighted the plight of medical foreign practitioners who are majorly voiceless since they among the minority. Therefore, in the process I have debunked the various popular public myths and misconceptions. This research study aims to highlight the various measures that can be affected so as to improve their living and working conditions especially junior nurses who are not well paid. The research seeks to create public awareness on the state of affairs in the NHS. For a long time now, the public has been in the dark about the matter.

Direction for Future research

With staff shortage projected to rise over the coming years, adequate investment should be deliberately aimed at conducting research on the problem question. This is a critical sector that directly affects millions of residents in the UK alone. Moreover, there are millions more who depend on NHS healthcare as a form of medical tourism. My research was limited by a number of factors therefore I could not be able to exhaust all themes. The research was done during COVID pandemic period thus physical meets for interviews were limited because there are standard guidelines in place to emphasize on social distancing. Moreover, some respondents did not want a meet due to fear of infection. Therefore, future researches should create adequate measures to navigate through this. Future researches should further delve into bringing the government on board and task them to provide answers on the issue at hand. The research was conducted primarily on willing participants located in London. It is therefore important that future researches are conducted in different parts of the county so as to assess if the factors cut across all parts of the country evenly.

Chapter 6: Conclusion

There is a looming shortage of medical practitioners in the NHS. This has made it harder for the NHS to provide services efficiently. This shortage has prompted the NHS to look for other alternatives to fill the void. The most viable option is enrolment of skilled medical staff from foreign countries. Their importance cannot be understated as they have effectively acted as a stopgap. However, the recently witnessed trend where they quit after a short stint in the industry has raised eyebrows across many sectors. This thus prompted the research question which I extensively covered. Their concerns as medical professions should not be ignored as they could snow-ball to something bigger and catastrophic to the country at large.

Chapter 7: Recommendations

I undertook a research study to investigate the causes behind the witnessed high turnover rates among foreign medical staff. I was able to unearth the underlying problems behind the problem. From the data collected and analysed, I was able to come up with several recommendations to the problem question. The recommendations are as follows.

How to improve work-life balance

This was a key reason among the research participants. The NHS board should strive to improve staffing of the hospitals and medical centres under their jurisdiction. This will result to a reduced work-balance as recommended by workers unions. Therefore, the medical personnel will be able to carry out their tasks effectively and consequently have enough time to concentrate on other life aspects.

How to motivate medical staff

The opinions from the research participants reflected the underlying bug that is staff under-appreciation. This is a major issue that cuts across all medical professions. Incentives should be introduced to award the medics.

How to subsidize cost of living

A good number of participants alluded high costs of living as the reason that propels them out of the NHS. In order to help the situation, the NNS board should work in tandem with other relevant bodies to reduce the cost of housing and transport amenities. This was cited by many as to what resulted in high living costs.

How to solve diplomatic related squabbles

Many medical practitioners have found themselves in a limbo over their respective government’s rows with the UK. This was mainly brought by the emotive Brexit question. The UK government should therefore review its tariffs to suit the needs of the practitioners. Renewal of visas process should be made less hectic and work permit charges be reviewed.

References

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