A rapid review of the effectiveness of interventions and innovations relevant to the Welsh NHS context to support recruitment and retention of clinical staff

Abstract

The National Health Service (NHS) is experiencing an acute workforce shortage in every discipline, at a time when waiting times are at a record high and there is a growing backlog resulting from the COVID-19 pandemic. This Rapid Review aimed to explore the effectiveness of interventions or innovations relevant to the Welsh NHS context to support recruitment and retention of clinical staff. The review is based on the findings of existing reviews supplemented by a more in-depth evaluation of included primary studies conducted in the UK or Europe. The review identifies a range of interventions that can be used for enhancing recruitment and retention in Wales, particular in rural areas, and supports multiple- component interventions. The findings highlight the importance of providing and locating undergraduate and post graduate training in rural locations. The findings also corroborate the use of bursary schemes for training, such as those already available for Nursing in Wales. Further, more robust evaluations, based on comparative studies, are required to assess the effectiveness of interventions to support recruitment and retention of clinical staff. There was limited evidence on interventions aimed at allied health professionals. Most of the primary studies included in the reviews used cohort (pre-post test) or cross-sectional designs. Most studies lacked a comparison group and did not use statistical analysis.TOPLINE SUMMARYWhat is a Rapid Review?Our rapid reviews use a variation of the systematic review approach, abbreviating or omitting some components to generate the evidence to inform stakeholders promptly whilst maintaining attention to bias. They follow the methodological recommendations and minimum standards for conducting and reporting rapid reviews, including a structured protocol, systematic search, screening, data extraction, critical appraisal, and evidence synthesis to answer a specific question and identify key research gaps. They take 1-2 months, depending on the breadth and complexity of the research topic/ question(s), extent of the evidence base, and type of analysis required for synthesis.This report is linked to a prior rapid evidence map published as: What innovations (including return to practice) would help attract, recruit, or retain NHS clinical staff? A rapid evidence map, report number – REM00028 (May 2022)Background / Aim of Rapid ReviewThe National Health Service (NHS) is experiencing an acute workforce shortage in every discipline, at a time when waiting times are at a record high and there is a growing backlog resulting from the COVID-19 pandemic. This Rapid Review aimed to explore the effectiveness of interventions or innovations relevant to the Welsh NHS context to support recruitment and retention of clinical staff. The review is based on the findings of existing reviews supplemented by a more in-depth evaluation of included primary studies conducted in the UK or Europe.Key FindingsExtent of the evidence base8 systematic reviews and 1 scoping review (with an evaluation component) were included. The reviews included 292 primary studies (218 unique studies), 9 of which were conducted in Europe and UK.The reviews focused on dentists (n=1), general practitioners (n=1), physicians (n=1); the medical workforce including undergraduates (n=1), medical undergraduates (n=1), and a variety of different health professionals (n=3) including those in training (n=1).Most reviews (n=8) looked for evidence of interventions within rural, remote or underserved areas.The interventions were mapped across categories described by the WHO (2010).Recency of the evidence baseMost of the primary studies (n=275) were conducted within the last 20 years.Evidence of effectivenessEducational interventions (8 reviews):Selecting students based on rural background: positive association with recruitment and retention (moderate-low quality evidence from 5 reviews).Locating education institutions in rural areas / providing training within rural oriented medical schools: positive association with recruitment and retention (low quality evidence from 3 reviews).Exposure to rural health topics as part of the taught curricula for undergraduates and postgraduates: positive association with recruitment (moderate-low quality evidence from 2 reviews).Rural clinical placements, fellowships or internships in undergraduate or post-graduate education: mixed evidence associated with rural intentions or actual employment (recruitment and retention; low quality review evidence from 7 reviews).Facilitating continuing education for rural and remote healthcare professionals: positive association with rural recruitment and retention (low quality evidence from 2 reviews).‘Rural-based training programmes’: positive association for doctors and healthcare professionals (Moderate quality evidence from 2 reviews) with rural recruitment and retention.Regulatory interventions requiring return to service in rural areas (6 reviews):Bonded schemes, scholarships or bursaries: positive association with recruitment but not retention (Low quality evidence from 2 reviews)Visa Waivers: mixed evidence on recruitment and retention (4 reviews)Financial incentives: mixed evidence (1 review)Loan repayments: associated with high retention (low quality evidence from 1 review)Access to professional licences and/or provider number for international medical graduates: associated with low retention (low quality evidence from 1 review)Accelerated clinical training: positive association with retention (low quality evidence from 1 review)Enhance scope of practice: positive association with retention (low quality evidence from 1 review)Compulsory service: effective/positive association with retention (low quality evidence from 2 reviews)National Health Insurance scheme: effective in terms of recruitment and retention (low certainty review evidence from 1 review; only one small study identified)Financial incentives without return to service requirement (3 reviews):Benefits that make working in rural areas more attractive and offset other costs/losses (e.g. higher salaries) or in-kind benefits (e.g. subsidised or free housing or vehicles): inconclusive evidence for high income countries, but positive association in middle income countries for improving recruitment and retention (low quality evidence from 3 review). A very low-quality UK study reported a positive association.Loan re-payment programmes: positive association with retention (low quality evidence from 1 review)Personal and professional support – factors that improve living and working conditions in rural areas (3 reviews):Positive association with retention (low level evidence from 3 reviews)Bundled strategies (4 reviews):There was consensus that multi-component interventions positively impacted on recruitment, and retention of rural workforcePolicy ImplicationsThe review identifies a range of interventions that can be used for enhancing recruitment and retention in Wales, particular in rural areas, and supports multiple-component interventions.The findings highlight the importance of providing and locating undergraduate and post graduate training in rural locations.The findings corroborate the use of bursary schemes for training, such as those already available for Nursing in Wales.Further, more robust evaluations, based on comparative studies, are required to assess the effectiveness of interventions to support recruitment and retention of clinical staff. There was limited evidence on interventions aimed at allied health professionals.Strength of EvidenceMost of the primary studies included in the reviews used cohort (pre-post test) or cross-sectional designs. Most studies lacked a comparison group and did not use statistical analysis.

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