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

AbstractThe 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 SUMMARYO_ST_ABSWhat is a Rapid Review?C_ST_ABSOur 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 FindingsO_ST_ABSExtent of the evidence baseC_ST_ABSO_LI8 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. C_LIO_LIThe 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). C_LIO_LIMost reviews (n=8) looked for evidence of interventions within rural, remote or underserved areas. C_LIO_LIThe interventions were mapped across categories described by the WHO (2010). C_LI Recency of the evidence baseMost of the primary studies (n=275) were conducted within the last 20 years. Evidence of effectivenessO_ST_ABSEducational interventions (8 reviews)C_ST_ABSO_LISelecting students based on rural background: positive association with recruitment and retention (moderate-low quality evidence from 5 reviews). C_LIO_LILocating education institutions in rural areas / providing training within rural oriented medical schools: positive association with recruitment and retention (low quality evidence from 3 reviews). C_LIO_LIExposure 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). C_LIO_LIRural 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). C_LIO_LIFacilitating continuing education for rural and remote healthcare professionals: positive association with rural recruitment and retention (low quality evidence from 2 reviews). C_LIO_LI Rural-based training programmes: positive association for doctors and healthcare professionals (Moderate quality evidence from 2 reviews) with rural recruitment and retention. C_LI Regulatory interventions requiring return to service in rural areas (6 reviews)O_LIBonded schemes, scholarships or bursaries: positive association with recruitment but not retention (Low quality evidence from 2 reviews) C_LIO_LIVisa Waivers: mixed evidence on recruitment and retention (4 reviews) C_LIO_LIFinancial incentives: mixed evidence (1 review) C_LIO_LILoan repayments: associated with high retention (low quality evidence from 1 review) C_LIO_LIAccess to professional licences and/or provider number for international medical graduates: associated with low retention (low quality evidence from 1 review) C_LIO_LIAccelerated clinical training: positive association with retention (low quality evidence from 1 review) C_LIO_LIEnhance scope of practice: positive association with retention (low quality evidence from 1 review) C_LIO_LICompulsory service: effective/positive association with retention (low quality evidence from 2 reviews) C_LIO_LINational Health Insurance scheme: effective in terms of recruitment and retention (low certainty review evidence from 1 review; only one small study identified) C_LI Financial incentives without return to service requirement (3 reviews)O_LIBenefits 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. C_LIO_LILoan re-payment programmes: positive association with retention (low quality evidence from 1 review) C_LI Personal and professional support - factors that improve living and working conditions in rural areas (3 reviews)O_LIPositive association with retention (low level evidence from 3 reviews) C_LI Bundled strategies (4 reviews)O_LIThere was consensus that multi-component interventions positively impacted on recruitment, and retention of rural workforce C_LI Policy ImplicationsO_LIThe 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. C_LIO_LIThe findings highlight the importance of providing and locating undergraduate and post graduate training in rural locations. C_LIO_LIThe findings corroborate the use of bursary schemes for training, such as those already available for Nursing in Wales. C_LIO_LIFurther, 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. C_LI 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.