A time-to-practice metric for refugee clinician integration in receiving health systems: England as a worked example
File(s)
Published version
Author(s)
Kierkegaard, Patrick
Type
Journal Article
Abstract
Receiving health systems cannot improve refugee clinician integration pathways if no actor is responsible for the denominator, milestones, or stage-specific delays. England is a useful worked example. Published UK initiatives show that already-resident refugee and asylum-seeking doctors can reach NHS employment, supervised placements and professional registration, but they use different denominators, endpoints and follow-up conventions. They demonstrate feasibility without yielding a pathway metric that system-level purchasers, funders or regulators can compare, fund or improve. A minimum time-to-practice (TTP) specification would separate two clocks. A population or pre-pathway clock would record earlier dates, such as arrival, asylum-claim lodgement, first contact or first documentation of professional background, to show upstream delay and attrition. The pathway TTP clock would begin at pathway registration, when a minimum dataset is complete, a named pathway owner can act, and the case enters the reporting denominator. Two auditable milestones would then be measured from registration: TTP-1, the verified start of the first qualifying paid supervised placement; and TTP-2, practice-enabling, profession-equivalent registration. Work-eligibility status, documentation completeness, years out of practice and route complexity should be recorded to interpret variation rather than to exclude people from the denominator. TTP is not a measure of competence, programme effectiveness or speed alone. Its purpose is workforce governance: to define the denominator, milestones, safeguards and funding conditions needed to compare and improve a poorly observed route back into practice, while remaining distinct from active overseas recruitment.
Date Issued
2026-06-17
Date Acceptance
2026-05-26
Citation
Human Resources for Health, 2026, 24
ISSN
1478-4491
Publisher
BMC
Journal / Book Title
Human Resources for Health
Volume
24
Copyright Statement
© The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Publication Status
Published
Article Number
29
Date Publish Online
2026-06-17