'Come and work here!' a qualitative exploration of local community-led initiatives to recruit and retain health care staff in remote and rural areas of the UK.

Objectives: The recruitment and retention of health care staff to remote and rural communities is a major challenge. This study explored the experiences of remote and rural communities in trying to attract and retain health care staff and their families in the UK.

Methods: Qualitative case studies in five remote and rural communities, two in England and three in Scotland. We conducted interviews with 22 participants across the five sites, including community members actively involved in recruitment and retention, health care professionals, and their family members. Fieldwork combined remote and in-person data collection. We used thematic analysis across cases drawing on asset-based community development as our theoretical framework.

Results: Communities undertook various activities such as making promotional videos, social media campaigns, getting involved on interview panels, and informal social integration efforts. They drew on a range of local assets to encourage health care staff to come to the area, including showcasing local landscapes, outdoor activities, a safe, welcoming community for children and families, and good quality of life. They also drew on the skills of local people with backgrounds in marketing, design, communications and photography or film-making. The absence of some key assets posed challenges, particularly lack of housing, schooling provision, employment opportunities for other family members, and cultural activities. Community-led initiatives were often prompted by local dissatisfaction with health organisations' efforts to recruit health care staff, and a wish to exercise some control over recruitment initiatives. Activities were commonly driven by a small number of individuals. While this worked well in some communities, the burden of responsibility could be substantial. This also sometimes led to tension within communities. Retention efforts commonly relied on informal networks of key individuals who intentionally forged social links for incoming families.

Conclusions: There is a key role for communities to play in recruitment and retention in remote and rural regions. There is an opportunity to actively engage community members in collaboratively crafting a campaign that highlights the area's key attractions while being mindful of limitations on reliance on an asset-based approach. Retention is a neglected topic, relying on key individuals going out of their way to help newcomers integrate. The formation of a community stakeholder group could help formalise this and reduce reliance on the goodwill and energy of individuals.