Authors' objectives: Recruitment and retention of healthcare staff in rural and remote areas is a significant problem for the National Health Service. Some communities have experimented with initiatives to support recruitment and retention, but these actions are often ad hoc and undocumented. To explore the experiences of remote and rural community members and organisations of trying to attract healthcare staff and their families. To map local context and describe initiatives they have undertaken to improve recruitment. To understand how community initiatives have been received by those staff and families who have been attracted to work and live in a rural area as a result. To assess which initiatives seem to have been more or less successful and why. To provide resources for other communities and the National Health Service based on this learning. Recruitment and retention of healthcare staff in rural and remote areas is a significant and growing problem for the NHS and a persistent policy issue. Much research in this area has focused on the motivations and background of practitioners themselves and the organisation of work. There has been less focus on the experiences of people living in remote and rural communities and what they themselves have done to help to attract staff. Some communities have experimented with initiatives to promote their area; to get involved in the recruitment and selection process; and to welcome and integrate new health professionals and their family members into local life. These community-led initiatives are often ad hoc and undocumented, particularly around retention. This project was prompted by the public research partners on another study on rural medical workforce led by the principal investigator (PI) Locock [Chief Scientist Office, Scotland Health Improvement, Protection and Services Research (HIPS) 19/37]. They talked to us about both formal recruitment initiatives, but also small informal acts designed to make new doctors and their families feel welcome and integrated. This new research was, therefore, designed with our public partners, aiming to capture this learning and share it with other communities as a basis for potentially developing recruitment and retention strategies of their own. To explore the experiences of remote and rural community members and organisations of trying to attract healthcare staff and their families to their area. To map local context and describe initiatives they have undertaken to improve recruitment and retention. To understand how community initiatives have been received by those staff and families who have been attracted to work and live in a rural area as a result. To assess which initiatives seem to have been more or less successful and why. To provide resources for other communities and the NHS based on this learning.

Authors' results and conclusions: Case studies: communities engaged in a range of activities, such as making promotional videos, social media campaigns, help finding accommodation and informal social integration efforts. They drew on multiple local ‘assets’ to encourage healthcare staff to move to the area, including showcasing beautiful local landscapes; outdoor activities; a safe, cohesive community for children; and high quality of life. Often a small number of people drove these efforts. While this worked well in some communities, the burden of responsibility could be unsustainable, and not all communities have people with the necessary skills and time. There was less focus on retention than recruitment. Where this worked well, it relied on informal networks of key individuals who created social links for incoming families. Communities struggle with the absence of some key assets, including housing; schools; employment opportunities for family members; cultural activities. Job adverts: different emphases on job details, place and wider area. Only 18/49 advertisers (of 189 approached) reported positive outcome in terms of appointments. We suggest greater use of photographs and place descriptions in future advertisements. Successful recruitment and retention need to focus on the whole person and family, not just the job. There is an important role for communities to play, but communities cannot be expected to solve all recruitment and retention problems. Central and regional government and the National Health Service could work in supportive partnership with communities at an earlier stage, benefiting from their local contextual knowledge and energy. We recommend further longitudinal ethnographic research into retention and a health economics study of the cost-effectiveness of National Health Service job adverts. Our findings demonstrate that there is an important role for communities to play in both recruitment and retention. In remote and rural areas where the NHS is struggling to recruit, they could more proactively invite community members to the table to devise jointly a campaign which showcases the things which that community knows to be its main attractions. Addressing the lack of available and affordable housing for key workers in remote and rural areas is a fundamental issue for the governments of the four nations of the UK. The Scottish Government has recently responded to the issue of rural housing by committing to publish a Remote, Rural and Islands Housing Action Plan by 2026 and establishing an Affordable Housing Initiative for key workers in rural areas. Retention is a neglected issue. Socially, it is supported by an actively welcoming community, with key individuals who go out of their way to help someone forge links and take part in local social activities. The formation of a community stakeholder group could help formalise this and reduce reliance on the goodwill and energy of individuals. Professionally, there could be benefits in a ‘buddying’ system, perhaps with someone from a different rural community, to whom they can talk about the challenges of remote and rural practice and life and gain tips for navigating their new context.

Authors' recommendations: There is scope for further research with new campaigns to test our findings. We would particularly recommend further research into retention. We would suggest conducting longitudinal ethnography within a range of remote and rural communities which have recently recruited new staff and observing over time how these staff fare and how the relationship with the wider community unfolds. In terms of NHS job advertising, there is scope for a health economics study of the cost-effectiveness of adverts of different styles and platforms. We also recommend a qualitative evidence synthesis of published articles on community involvement in recruitment and retention.

Authors' methods: Qualitative case studies, three in Scotland and two in England. A case description of each site was developed, and interviews were analysed thematically. Documentary framework analysis of published job adverts for remote and rural healthcare posts. Case studies: 22 individuals, including community members, healthcare practitioners and family members, took part in interviews and focus groups. Job adverts: 270 from British Medical Journal, and National Health Service Scotland websites for general practitioner and general National Health Service vacancies. This is a small exploratory study. Sampling was constrained by the small number of eligible communities and people involved. Planned ethnographic fieldwork was impacted by the COVID pandemic. This was a qualitative study, based on five case studies, three in Scotland and two in England. In addition, we collected and analysed a sample of job adverts for remote and rural NHS posts across the UK. Ethical approval for the study was granted by the University of Aberdeen School of Medicine Ethics Review Board. Given our focus on what communities in different parts of the country can do to attract and retain healthcare staff, a case study approach offered the most appropriate way to gain a rounded understanding of local action in context.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/NIHR133888

Year Published: 2025

URL for published report: https://www.journalslibrary.nihr.ac.uk/hsdr/DJGR6622

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/DJGR6622

Organisation Name: NIHR Health Services and Delivery Research programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk