NHS Recruitment Processes Are a Major Contributor to Staff Shortages and Retention Challenges

Nurses and Doctors walking away
Imagine a world where NHS recruitment teams have too many candidates.


What if this world was actually the reality, with many NHS recruitment teams across the UK being overwhelmed on a regular basis?


The media are broadcasting record vacancy levels (latest stats record 46,000 nurse vacancies) and temporary agency spend has reached over £3 billion a year. So, why is it that great candidates are waiting to hear back from NHS Trusts nationwide?

What if attracting candidates to vacancies within the NHS is less of a problem than we are led to believe? What if it is the apathetic way the NHS recruitment process treats and alienates our incredible healthcare workers? It’s a profound suggestion, one which I am sure will anger some people, but I’m sure will also exert a rallying cry from others.

During my 7 years as Founder and CEO of Just R, we have developed solutions that, in all but exceptionally challenging circumstances, attract high volumes of quality candidates.

All problems solved, right?

Unfortunately not. In our experience, attracting candidates is rarely the challenge – just one of the reasons why we retained over 80% of our NHS clients last year. We are experts with 7 years committed to developing experience, defining and refining our approach, building a specialised team with in-depth systems and processes capable of providing solutions to even the most challenged NHS teams.

We know how to reach and attract candidates to the NHS; how to provide a simpler journey for candidates; and what it takes to retain values-aligned staff. But we also know that the real challenge is in supporting NHS teams to convert screened candidates into appointments.

“When the system deals with life and death and things aren’t working, we must begin to question: who, if anyone, these processes serve?”

Through my experience working with over 60 healthcare organisations I have witnessed a tremendous disconnect between the mindset of the clinical leaders (whose teams are worn down, burned out and in need of help), and the support teams tasked with getting them that help.

It is understandable that the NHS has established methods that can’t be deviated from. Some methods may be necessary in many instances, but even the most proven methods should be challenged.

When the system deals with life and death and things aren’t working, we must begin to question: who, if anyone, these processes serve?

My team at Just R have grown used to hearing about the way things “must be done”, and for years, I believed it as gospel. Then, we learned how these processes had been adapted for overseas candidates. It was then that I began to question why our largely domestic NHS-trained workforce should have a difficult and less supportive recruitment process than overseas-trained and based candidates.

A simpler and a more positive experience for all can and should be implemented. Candidates should feel wanted and be kept informed as they often have more than one option to choose from – many of which are non healthcare-related alternatives.

Consider the following scenario.

Jane, a qualified nurse, applies for a position at two different organisations. Let’s call them first choice and second choice. ‘First choice’ was the organisation that, on paper, best matched Jane’s career requirements and was where her gut was telling her to go. The second choice was, well, her second choice.

What if, through the application process, ‘second choice’ made Jane feel wanted and informed every step of the way, building a strong psychological contract, and ‘first choice’ barely communicated? There was no connection with ‘first choice’, effectively making the psychological contract between Jane and the employer completely one-sided.

Which employer do you think Jane would choose?

This is a scenario that constantly plays out with newly qualified nurses, and how many employers are quick to suggest the nurse was fickle rather than question their part in the decision?

This is what makes the recruitment period so important. The candidate could be lost to the second choice employer; an agency, private provider or not even healthcare related at all?

For the past 7 years, Just R has been working alongside the NHS with a mission to provide sustainable workforce solutions. We enable the appointment of high-quality, clinical (and at times medical and non-clinical) candidates into substantive NHS positions and we support NHS teams to do this as effectively as we can.

We set out to be the antidote to short-term, expensive solutions like temp agencies that only exacerbate the problem. Our focus has always been to help save NHS budgets, reduce agency spending and improve the working conditions for healthcare workers.

With our solutions, Trusts can define and communicate their employer brand using digital and social media marketing to reach targeted mass audiences, drive them to a simple application process, and then hold them in a talent pool for the Trust to utilise. Our campaigns not only reach and attract candidates for positions which need to be filled today, but also reach and deliver inspirational messages to the potential workforce of tomorrow.

The challenge lies in the conversion of application to appointment. There are different levels of this challenge across organisations, with many owning these issues and working in collaboration with us to perfect solutions; but across the health sector ‘recruitment process apathy’ is rampant.

I believe the media has a big role to play in the situation; when teams are bombarded daily with messages that there is nobody out there, they begin to believe it. But in the majority of cases, the people are there, they just expect to be treated better.

Rachael Bagshaw, CEO and Founder of Just R

Here is an example of a scenario which plays out regularly within projects we are delivering on behalf of NHS clients.

An NHS Trust comes to our team in the midst of a major recruitment challenge, there is an acute shortage of nurses and they are overly reliant on agency nurses. They need to recruit permanent staff to fill these vacancies. With a national shortage of 46,000, we are all aware this is not an easy task. We are assigned to work directly with recruitment teams, with no direct contact with the clinical areas (which is never ideal).

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Following in-depth work with the organisation to establish the employer value proposition and create an employer brand, the following will begin:

  • High-impact recruitment advertising campaign to attract Nurses 
  • Nurses and Student Nurses complete short online enquiry forms and candidates are added an online talent pool
  • Just R contact candidates, screen them and send an online short-form application (which we have developed to navigate around but work in conjunction with Trac)
  • Qualified Nurses complete the online application forms
  • Nurses should now be ready to be shortlisted and invited to interview

This is where we often begin to experience the barriers in the process. Instead of welcoming the candidates to interview, recruiting teams often take weeks (or months) to contact these excellent candidates, only to send them a generic email; an email asking them to start the application process again, whether via Trac or a physical application form (to download, print and complete).

This approach only tells the candidate that they are yet another commodity, reduced to information which isn’t at all relevant to whether they are good enough for the job.

The NHS must think again about recruitment practices and treat candidates as if they are customers, with its mission to provide the very best customer service. If you have always done something in a certain way, ask why? If your boss can’t provide you with an answer, have them ask their boss – or ask them yourself.

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