A surge in the number of medics coming to work for the NHS from overseas poses a risk to the health service, unions have claimed.
An analysis of workforce figures found the health service may be becoming over-reliant on recruits from abroad. Figures from NHS Digital showing the share of healthcare staff recruited from overseas almost doubled between 2014 and 2021.
Several organisations responded on Friday with fresh calls for the Government to tackle the NHS staffing crisis.
According to an analysis by the BBC, 34 per cent of doctors joining the health service in 2021 came from overseas – a rise of 18 per cent in 2014.
The broadcaster also found the share of UK doctors joining the health service had fallen from 69 per cent in 2015 to 58 per cent last year while the share of new UK nurses fell from 74 per cent to 61 per cent in the same period.
Unfilled positions 'unsustainable'
Meanwhile, the share of doctors recruited from outside the UK and the EU rose from 18 per cent to 34 per cent and the share of nurses rose from seven per cent to 34 per cent.
Patricia Marquis, Royal College of Nursing director for England, said the number of unfilled nursing positions in the NHS was "unsustainable".
"Every vacant role makes safe patient care harder to maintain," she said. "We are seeing a sharp increase in people leaving nursing, with 25,000 leaving the UK register in the last year.
"After a decade of real terms pay cuts, a growing over-reliance on international recruitment and limits on education funding, our members are saying enough is enough."
She added that while internationally recruited nurses are invaluable to the NHS "ministers must do more to boost the domestic recruitment of nursing staff.
"One of the simplest ways to retain staff is to pay them fairly," she said.
Doctors cutting hours
Dr Kitty Mohan, chair of the international committee at the British Medical Society, a trade union for doctors, said the analysis showed that the NHS has "grown heavily reliant" on doctors from overseas.
She said: "This was evidenced during the pandemic as international doctors were front and centre of the battle on the NHS front line – with a disproportionate number sadly losing their lives to the virus.
"The simple fact is that we do not have enough doctors, nurses and other healthcare staff to meet the growing and increasingly complex healthcare needs of our population."
Dr Mohan also cited reasons why doctors are cutting their hours or planning to leave the NHS, including years of pay erosion, punishing workloads, restrictive immigration rules, and verbal and physical abuse.
"We are calling for the Government and NHS England to publish a long-term workforce strategy as soon as possible," she said.
"It must be transparent, made publicly available and include details of current workforce numbers and future workforce requirements based on patient need."
'Urgent action' needed on shortages
Danny Mortimer, chief executive of NHS Employers, also called for "urgent action" from the Government to tackle "chronic staff shortages in the longer term".
He said: "International recruits have always been an important component of the NHS workforce. We recognise and highly value the contribution our overseas staff make to our teams and the care we provide to our patients.
"International recruitment should be seen as one part of a multistrand approach to workforce planning and the Government's Code of Practice for international recruitment helps employers ensure they are adhering to ethical recruitment practices.
"While there is also a focus on growing and retaining the domestic workforce, we can't escape the fact that there are 105,000 vacancies in the NHS and 165,000 vacancies in social care. We are in need of urgent action and the new prime minister must commit to publishing a fully costed and funded workforce plan to tackle chronic staff shortages in the longer term."
Mr Mortimer added that the Government needs to deliver a "realism reset" on the NHS as "a dose of political honesty and levelling with the public about what the NHS is facing and what it needs from the future prime minister to address it".
A Department of Health spokesman said: "We continue to grow the NHS workforce who deliver the quantity and quality of healthcare the Government has promised. There are over 4,300 more doctors and 10,200 more nurses working in the NHS compared to last year, and we are on track to deliver 50,000 more nurses by 2024.
"We're boosting our homegrown recruitment – including by opening five new medical schools and providing a 25 per cent increase in funding for medical school places over three years to 2020, with the first graduates from this cohort entering foundation training this year."
"Internationally trained staff have been part of the NHS ever since its inception and they continue to play a vital role in helping us tackle the Covid backlogs. We have recently signed bilateral agreements with countries like India, Philippines, Kenya, Malaysia and Sri Lanka to support the recruitment and training of nurses."