'Come and work here!' Qualitative research exploring community-led initiatives to improve healthcare recruitment and retention in remote and rural areas.

Background: 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.

Objectives: 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.

Design and setting: 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.

Participants: 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.

Results: 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.

Limitations: 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.

Conclusions: 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.

Study registration: This study is registered as researchregistry7518.

Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR133888) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 34. See the NIHR Funding and Awards website for further award information.