Building a sustainable workforce

Before you recruit a single person, you need to know the size and shape of the hole you are filling.

Nearly every conversation I have starts with today’s vacancy: the rota that won’t cover, the service manager who hasn’t slept. That pressure is real, and I never dismiss it. But the organisations that escape the cycle are the ones that also look up: at what demand will do over ten years, at what the domestic pipeline will deliver, and at the honest size of the gap between the two.

International recruitment can’t carry a workforce strategy on its own. It earns its place alongside the slower work: training people at home, keeping the staff you already have, redesigning roles where the old shape no longer fits. Get that balance right and patients keep getting safe, timely care.

Understanding future demand

Before anything else, understand what your workforce will need to look like over the next five to ten years, not just what’s vacant today.

The scale is not abstract. Three numbers frame why planning for it, rather than reacting to it, matters.

Understanding domestic workforce supply

Look internationally only once you know what the domestic pipeline can deliver.

Identifying the workforce gap

Bring demand and supply together. The distance between them is what workforce planning addresses.

That gap (not this month’s vacancy list) is the real basis of workforce planning. Sizing it is what turns reactive hiring into strategy.

Taking a whole-system approach

When neighbouring organisations bid for the same handful of clinicians, everyone pays more and someone still goes without. Plan together where you can, so international recruitment flows to the places patients feel the shortage most.

Chapter 3 shows what that coordination looks like in practice, governance and supervision included: Planning & preparation.

Where international recruitment fits

This is the heart of the chapter. International recruitment works best as the last lever pulled, not the first. It belongs at the end of a longer chain of workforce investment, and it weakens whenever it is asked to stand in for that chain.

The strongest strategies combine several of these rather than leaning on one. Recruit internationally without investing in retention and you simply swap one staffing problem for another; focus on retention alone and you may still fall short if too few graduates are coming through.

And there’s a newer constraint worth naming early. Increasingly, the limiting factor is neither recruitment nor registration but whether organisations have the supervision capacity to safely support internationally trained professionals into practice. A workforce plan has to account for that capacity before recruitment begins, which is where Chapter 3 picks up.

Key principles

An Ethicare reflection

From our founder

One of the biggest things I’ve noticed working across Australia and New Zealand is that organisations often focus on today’s vacancy rather than tomorrow’s workforce. International recruitment is sometimes viewed as a response to immediate pressure, when in reality it works best as part of a much broader strategy.

I’ve seen exceptional results where organisations plan ahead, invest in their domestic workforce, and use international recruitment strategically to address genuine gaps. No single initiative builds a strong workforce. Combining the right approaches at the right time does.

Sophie CareemFounder, Ethicare Resourcing · former NHS change leader

Before you recruit internationally: a checklist