Retaining Internationally Trained Talent in the NHS and Beyond
Updated: Sep 1
Dr. Omosefe Christina is a Medical Doctor, Entrepreneur, and Founder of Elite Exams. She blends frontline clinical practice with medical education and community programmes to help International Medical Graduates (IMG) and African families flourish in their careers and communities in the UK.
The National Health Service (NHS) is not struggling to recruit internationally trained professionals. It is struggling to keep them. Overseas-trained clinicians now make up a significant and growing proportion of the healthcare workforce. Yet organisations continue to lose this talent at rates that undermine service continuity, increase operational costs, and weaken patient care.
The question is no longer whether the NHS depends on globally trained professionals. The more urgent question is whether employers are building systems that allow them to stay.
Evidence suggests that, in too many cases, they are not. Findings from the General Medical Council's workforce research show that international medical graduates (IMGs) consistently report poorer workplace experiences than UK-trained peers, citing lack of support, isolation, and limited progression opportunities as primary concerns. These are not isolated complaints. They are structural signals. Retention is not a workforce problem. It is a design problem, and most organisations are still designing for loss.
Start with induction, and design it properly
Many internationally trained professionals arrive with high levels of clinical expertise, only to enter systems that assume familiarity with local norms. Research published in BMJ Open demonstrates that performance gaps are often linked not to clinical knowledge, but to differences in communication styles, workplace expectations, and organisational culture. A structured induction, covering clinical systems, escalation pathways, communication norms, and local context, can significantly reduce early attrition. The most effective organisations go further, pairing new clinicians with mentors who understand the migration experience and can support both professional and cultural transition. This is not about lowering standards. It is about removing barriers that should never have existed.
Stop mentoring, start sponsoring
Mentorship is widely promoted across healthcare systems. Sponsorship is far less common, and far more impactful. Sponsorship means senior leaders actively advocate for internationally trained professionals, recommend them for opportunities, champion their progression, and use institutional influence on their behalf. Evidence from the King's Fund highlights the persistent underrepresentation of ethnic minority professionals in senior NHS leadership roles, despite comparable qualifications and ambition. Organisations serious about retention must move beyond passive support structures. That means creating transparent pathways into leadership, ensuring equitable access to development programmes, and holding decision-makers accountable for progression outcomes, not just recruitment numbers.
"Culture, in this context, is not an abstract concept. It is infrastructure."
Culture is not soft, it determines who stays
For many internationally trained professionals, clinical performance is only one dimension of the working experience. They often navigate additional pressures, adapting to unfamiliar environments while carrying the social and professional weight of being perceived as outsiders. Research from the British Medical Association (BMA) shows that a significant proportion of IMG doctors report experiences of discrimination and microaggressions in the workplace, contributing directly to burnout and intentions to leave. Practical responses include psychological safety audits at team level, staff networks for globally trained professionals, zero tolerance policies for discriminatory behaviour enforced consistently from the top, and leadership development that centres inclusive and culturally aware management. These are not optional initiatives. They are core retention strategies, and they require the same rigour and resource as any operational programme.
Address structural barriers: Flexibility and immigration support
Internationally trained professionals often operate within constraints their UK-trained peers do not face. Visa requirements, financial obligations such as immigration health surcharges, and restrictions on employment mobility create layers of uncertainty that compound over time. Employers who provide proactive immigration support, through informed HR teams and clear, timely communication, reduce that uncertainty and demonstrate institutional commitment to people with temporary or settled status. Flexible working arrangements matter equally. For professionals managing transnational family responsibilities or reduced support networks, flexibility is not a benefit. It is a practical necessity. Organisations that recognise this reality report stronger engagement and longer tenure among internationally qualified staff.
Measure what you intend to retain
Retention is measurable and should be treated as a core organisational metric. Employers can track progression rates by training background, time-to-promotion data, staff experience scores segmented by workforce group, and attrition rates within the first two to five years. NHS workforce equality initiatives have made meaningful progress in data collection, but gaps remain between measurement and action at the trust level. Organisations that use workforce data to set targets, drive accountability, and report transparently are the ones that retain internationally trained professionals, not because they got lucky, but because they made it a deliberate priority.
The business case is already clear
Recruiting internationally trained clinicians requires significant financial, operational, and administrative investment. Losing them within a short timeframe multiplies those costs while eroding team stability and disrupting patient continuity. Retention is not a diversity initiative separate from operational priorities. It is central to workforce sustainability, and the numbers make that case without needing to be dressed up.
Globally trained professionals bring clinical expertise, diverse perspectives, and direct insight from other health systems that strengthen care delivery. Organisations that fail to retain them are not simply losing individuals. They are losing institutional capability, accumulated knowledge, and the kind of clinical breadth that no domestic pipeline can fully replace.
The challenge has never been attracting this talent. It has always been creating the conditions for it to remain, grow, and lead. That requires deliberate organisational design, structures that recognise contribution, enable progression, and build trust over time. Until employers shift from expecting individuals to adapt to systems designed without them in mind, internationally trained professionals will continue to leave, not from a lack of commitment, but because commitment alone is not enough to hold someone in a place that was never properly built to keep them.
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Dr. Omosefe Christina, Medical Doctor, CEO and Founder
Dr. Omosefe Christina creates digital learning platforms that turn frontline experience into practical support for international doctors in the UK. She is the CEO of Elite Exams, which supports the medical education of internationally trained doctors aspiring to become independent GPs. She builds digital systems, courses, platforms, and automated learning pathways to support doctors who migrate to the UK.
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