What innovations (including return to practice) would help attract, recruit, or retain NHS clinical staff? A rapid evidence map

National Health Service (NHS) waiting times have significantly increased over the past couple of years, particularly since the emergence of COVID-19. The NHS is currently experiencing an acute workforce shortage, which hampers the ability to deal with increasing waiting times and clearing the backlog resulting from the pandemic. Plans to increase the workforce, by recruiting new staff, retaining the existing NHS clinical workforce, and making return to clinical practice more attractive will require a number of approaches. This Rapid Evidence Map aimed to describe the extent and nature of the available evidence base for innovations (including return to practice) that could help attract, recruit, or retain NHS clinical staff, in order to identify the priorities and actions for a rapid review. Three options were proposed for a subsequent focused Rapid Review and discussed with stakeholders: (1) review of primary studies that have evaluated return to practice schemes; (2) review of reviews of factors that influence retention; (3) review of reviews of interventions for supporting recruitment and retention. A decision was made that option 3 would be useful to inform practice and a rapid review will be undertaken. Funding statementThe Wales Centre for Evidence Based Care was funded for this work by the Wales Covid-19 Evidence Centre, itself funded by Health & Care Research Wales on behalf of Welsh Government. TOPLINE SUMMARY What are Rapid Evidence Maps (REMs)?Our Rapid Evidence Maps (REMs) use abbreviated systematic mapping or scoping review methods to provide a description of the nature, characteristics and volume of the available evidence for a particular policy domain or research question. They are mainly based on the assessment of abstracts and incorporate an a-priori protocol, systematic search, screening, and minimal data extraction. They may sometimes include critical appraisal, but no evidence synthesis is conducted. Priority is given, where feasible, to studies representing robust evidence synthesis. They are designed and used primarily to identify a substantial focus for a rapid review, and key research gaps in the evidence-base. (N.B. scoping reviews are not suitable to support evidence-informed policy development, as they do not include a synthesis of the results.) This report is linked to a subsequent focused rapid review published as: RR00028. Wales COVID-19 Evidence Centre. A rapid review of the effectiveness of interventions/innovations relevant to the Welsh NHS context to support recruitment and retention of clinical staff. April 2022. The rapid review report is available in the WCEC library: https://healthandcareresearchwales.org/about-research-community/wales-covid-19-evidence-centre Background / Aim of the Rapid Evidence MapNational Health Service (NHS) waiting times have significantly increased over the past couple of years, particularly since the emergence of COVID-19. The NHS is currently experiencing an acute workforce shortage, which hampers the ability to deal with increasing waiting times and clearing the backlog resulting from the pandemic. Plans to increase the workforce, by recruiting new staff, retaining the existing NHS clinical workforce, and making return to clinical practice more attractive will require a number of approaches. This REM aimed to describe the extent and nature of the available evidence base for innovations (including return to practice) that could help attract, recruit, or retain NHS clinical staff, in order to identify the priorities and actions for a rapid review. Key Findings Extent of the evidence base {blacksquare}systematic or rapid reviews, 11 narrative reviews, 7 scoping reviews, 5 reviews of existing reviews (umbrella reviews), 18 primary studies, and 5 organisational reports or websites were included. {blacksquare}evidence was categorised by the phenomena of interest: return to practice; factors influencing recruitment and/or retention; and interventions or strategies for improving recruitment and retention {blacksquare}evidence was organised for each of the different clinical staff groups working within the NHS: nurses and midwives; doctors, including general practitioners (GPs); dentists; allied health professionals; and mixed groups of health professionals. Return to practice Extent of the available evidence There was limited secondary evidence available for return to practice, and further searches for primary studies were conducted.{blacksquare} For nurses and midwives, evidence was available from scoping (n=1) and systematic (n=1) reviews, primary studies (n=4), and an organisational report. {blacksquare}For doctors (including GPs), evidence was available from systematic (n=2) and narrative (n=1) reviews, organisational websites (n=2), and primary studies (n=7). {blacksquare}There was no available evidence on return to practice for dentists. {blacksquare}For allied health professionals, evidence was available from primary studies (n=5) and an organisational website. {blacksquare}For mixed groups of healthcare professionals, evidence was available from a systematic (n=1), a primary study, and an organisational report. Summary content Return to practice was investigated after leaving for a variety of reasons such as mental and physical health issues, disability, maternity leave, caring responsibilities, personal or professional development opportunities, career break, moving sectors, and retirement. The evidence highlights the challenges surrounding healthcare professionals wishing to return to practice particularly with regard to "skills fade". There are a number of routes for healthcare professionals to return to practice or training, which are well documented. However, data on their effectiveness are limited. Factors influencing attraction, recruitment and retention Extent of the available evidence {blacksquare}For nurses and midwives, evidence was available from systematic (n=11 nurses, n=1 midwives), narrative (n=2 nurses) and scoping (n=1 nurses) reviews. {blacksquare}For doctors (including GPs), evidence was available from scoping (n=2), systematic (n=5), rapid (n=1), narrative (n=1), and umbrella (n=1) reviews. {blacksquare}There was no available evidence on factors influencing attraction, recruitment, and retention of dentists. {blacksquare}For allied health professionals, evidence was available from systematic (n=3) and narrative (n=1) reviews. {blacksquare}For mixed groups of healthcare professionals, evidence was available from systematic (n=3), rapid (n=1), and umbrella (n=1) reviews. Summary content These reviews mainly focused on rural and remote areas. A broad range of factors was identified, and it has been suggested that strategies to improve attraction, recruitment and retention need to be multifaceted. Interventions for improving attraction, recruitment and retention Extent of the available evidence {blacksquare}For nurses, evidence was available from umbrella (n=2), narrative (n=2), and scoping (n=1) reviews; no reviews were identified for midwives. {blacksquare}For doctors (including GPs), evidence was available from scoping (n=3), systematic (n=4), and narrative (n=1) reviews. {blacksquare}For dentists, evidence was available from one systematic review. {blacksquare}For allied health professionals, evidence was available from a scoping (n=1) and narrative (n=1) review. {blacksquare}For mixed groups of healthcare professionals, evidence was available from scoping (n=1), systematic (n=1), rapid (n=1), narrative (n=3) and umbrella (n=1) reviews. Summary content Many of these reviews focused on rural and remote areas Implications for a Rapid ReviewThree options were proposed for a subsequent focused Rapid Review and discussed at a stakeholder meeting (held on 2nd February 2022): (1) review of primary studies that have evaluated return to practice schemes; (2) review of reviews of factors that influence retention; (3) review of reviews of interventions for supporting recruitment and retention. A decision was made that option 3 would be useful to inform practice.