Retaining NHS staff from ethnic minority and migrant groups
| ISRCTN | ISRCTN62821969 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN62821969 |
| IRAS number | 351368 |
| Secondary identifying numbers | CPMS 66339; Grant Code: NIHR157268 |
- Submission date
- 17/04/2025
- Registration date
- 20/06/2025
- Last edited
- 20/06/2025
- Recruitment status
- Recruiting
- Overall study status
- Ongoing
- Condition category
- Other
Plain English summary of protocol
Background and study aims
The aim of this study is to improve understanding of how and why NHS staff from ethnic minority groups and/or staff who have migrated to the UK (“minoritised groups”) stay or leave the NHS. Ethnic minority staff comprise 24% of all NHS staff, including 42% of doctors and over 90% of nurses in the lowest pay grade. Staff from minoritised groups are at greater risk of harassment, low pay and poor career progression and they have been disproportionately negatively affected by the pandemic. The aim of this study is to explore how these (and other non-work related) experiences and factors influence HCWs, particularly those from minoritised groups, decisions to leave or stay in their jobs.
Who can participate?
Health care workers aged 18 years and over who have are leaving or thinking of leaving their job, or have recently left their job, and their managers within the health care workforce
What does the study involve?
We will ask you to:
1. Register your details (including contact details) on our secure web page.
2. Confirm you have read this Information sheet and provide consent to participate in the study using our secure web page, if you are happy to do so.
3. Complete a short demographic questionnaire, which will take approximately 5 minutes. We will ask some basic information about you, including your age, ethnicity, job role and also if you plan to leave or have already left your job.
4. On the basis of the information you provide, we will screen your eligibility against our sampling criteria, and if you meet the criteria, you will be invited to take part in an interview.
5. Your decision to participate will be confidential, and anything you say will also be confidential, and the information you give will be anonymised (so no personal data about you is shared).
6. Interviews will be at a time that is convenient to you and most will likely take place on Microsoft Teams, which is a safe online platform approved by the University of Leicester. If there is a preference for face-to-face/telephone interviews, this will be taken into consideration where feasible.
7. In the interview, you will be asked several open-ended questions regarding your perceptions about different aspects of your job, intention to leave, the impact this has/will have on your personal and professional life and finally your views about improving staff retention.
8. We will record your responses using the Teams feature or use an encrypted voice recorder if doing it face-to-face or telephonically (and will require your consent for this).
9. The interviews will take around 45 minutes – 1 hour to complete.
10. The interviews will primarily be conducted in English; however, if you feel that language will be a significant barrier for you in expressing yourself during the interview, we might be able to arrange for an interpreter.
11. After the interview, we will offer you a £25 shopping voucher as a token of our appreciation, on signing a contributor disclaimer form which reiterates the voluntary nature of your participation
12. If you consent to be re-contacted, we may contact you again to invite you to participate in further aspects of the study such as focus groups or to record your experiences as a ‘story’
What are the possible benefits and risks of participating?
This research is part of the UK-REACH I-CARE study and could help to improve our understanding of why healthcare staff leave or stay in the NHS, particularly those from minoritised groups. The findings could inform policy interventions to help NHS organisations retain staff. However, there may be no direct benefit to you personally.
There are no known disadvantages or health risks associated with this research. However, there are some questions about sensitive topics that some people may find upsetting – you can choose not to answer any question(s) that you do not feel comfortable answering, and you may stop at any time. The study team has experience of working on/hearing about difficult/sensitive topics and will follow a distress protocol if they identify any signs that you are becoming distressed during the interview and will support you. In addition, on the UK-REACH website (www.uk-reach.org), we provide contact details for organisations that provide support for mental health and wellbeing, including some particularly relevant to healthcare workers. You can also contact the study team by telephone or email. Contact details are provided at the start and end of this document.
Where is the study run from?
The study is co-led by the University of Leicester and University College London (UK)
When is the study starting and how long is it expected to run for?
March 2024 to February 2027
Who is funding the study?
NIHR Health and Social Care Delivery Research (HSDR) Programme (UK)
Who is the main contact?
1. Holly Reilly, hlr21@leicester.ac.uk
2. Manish Pareek, mp426@le.ac.uk
3. Kath Woolf, k.woolf@ucl.ac.uk
Contact information
Scientific
University of Leicester
University Road
Leicester
LE1 7RH
United Kingdom
 ORCID ID |
0000-0001-8984-3802 |
|---|---|
| Phone | +44 (0)7425611865 |
| hlr21@leicester.ac.uk |
Principal Investigator
Development Centre for Population Health
Department of Respiratory Sciences
University of Leicester
University Road
Leicester
LE1 7RH
United Kingdom
| ORCID ID |
0000-0003-1521-9964 |
|---|---|
| Phone | +44 (0)116 2585506 |
| mp426@le.ac.uk |
Principal Investigator
UCL Medical School
London
WC1E 6DE
United Kingdom
| ORCID ID |
0000-0003-4915-0715 |
|---|---|
| Phone | +44 (0)20 3108 9216 |
| k.woolf@ucl.ac.uk |
Study information
| Study design | Observational; Design type: Qualitative |
|---|---|
| Primary study design | Observational |
| Secondary study design | Qualitative study |
| Study setting(s) | Other |
| Study type | Other |
| Participant information sheet | Not available in web format, please use the contact details to request a patient information sheet |
| Scientific title | United Kingdom research study into ethnicity and COVID-19 outcomes in healthcare workers: increasing retention of healthcare staff from ethnic minority groups, Work Packages 4 and 5 (qualitative and co-design study) |
| Study acronym | UK-REACH I-CARE WP4&5 |
| Study objectives | This is a qualitative study and does not have a hypothesis. The main research question is: In which contexts, and why, are staff from minoritised groups more likely to leave or stay within the NHS workforce post-pandemic compared to white British groups? |
| Ethics approval(s) | Approved 10/04/2025, University of Leicester Health, Biological and Psychology Sciences, Research Ethics Committee (University of Leicester, University Road, Leicester, LE1 7RH, UK; Tel: not available; ethics@le.ac.uk), ref: 25/PR/0361 |
| Health condition(s) or problem(s) studied | Retention of healthcare staff from ethnic minority groups |
| Intervention | WP4 will adopt a qualitative research design, using interviews with staff and managers at selected NHS trusts. A multi-factorial approach will be applied to purposively sample trusts from all categories (e.g. acute, mental health and community, ambulance etc), locations (e.g NHS regions), across the staff stability spectrum and percentage of ethnic minority staff. Within the sampled Trusts, we will purposively recruit staff (including those who have left/intending to leave) from across ethnic and migration backgrounds and roles (including those in allied health professional roles), and staff responsible for retention (e.g. HR and clinical managers) to capture diverse and intersectional experiences. Various recruitment strategies will be employed to recruit staff from different ethnicities, migration statuses and job roles take part in the study. Interviews will primarily be conducted online, but a face-to-face option would be available if participants prefer this mode and it is logistically feasible. WP5 is a co-design collaborative work package that involves the interaction of the research team with individuals with lived experience of working and experiencing care within the NHS during the current retention crisis, and representatives of organisations with responsibility for representing HCWs and/or protecting patients. Involvement is primarily via the PPEP and STAG through a series of workshops. Workshop materials will be used to create a set of policy interventions. ~20 WP4 participants, with permission to recontact, will be approached to take part in focus groups to seek feedback and refine the suite of policy interventions developed in WP5. Participants will be reconsented to take part in the focus groups WP5 will also involve co-designing of narrative stories together with selected participants from WP4 (based on their interview data) and a team of professional storytellers. We will conduct qualitative interviews with 50 HCWs who have left or are planning to leave their NHS jobs and 25 managers at hospital trusts to understand the reasons for leaving. Interviews will primarily be conducted online and transcripts will be generated, which will be analysed thematically. We will also co-develop a set of policy interventions that can be adopted by the NHS to help staff stay in their jobs. For this, we will conduct workshops with stakeholders (staff, patients, regulators and policy makers) and use the materials gathered in the workshops to develop a set of policy intervention scenarios. A few participants who take part in the interviews and consent to be recontacted will be invited to take part in further focus groups to test and refine these policy intervention scenarios. Alongside this, short narrative audio stories about true-life experiences of HCWs leading to their leaving or staying in their jobs will be co-created with a set of interview participants. These audio narratives will be disseminated through the study website as part of sharing the findings of the study in an impactful way. |
| Intervention type | Other |
| Primary outcome measure | Work Package 4: Understanding NHS staff perceptions on how, why and in which contexts staff from minoritised groups leave or stay working within the NHS, using qualitative interviews with staff who are thinking of leaving, are in the process of leaving, or have left NHS employment, and with NHS managers. (Single interview per individual). Data will be analysed using the framework approach to thematic analysis to allow for both inductive and deductive contributions. Work Package 5: Synthesis of data from the other work packages, via narrative and a map of the systems involved in the theories that underlie the study overall. Synthesis continues through the study but the final synthesis and workshops will be undertaken once the basic analyses of all other work packages are completed. The final programme/system theory will be co-designed with the Study Stakeholder Group and Patient and Professional Expert Panel in workshops and presented visually as a map to help policy-makers and practitioners understand which interventions to choose and to start to develop evaluation measures. Other resources (training resources/policy interventions) will also be designed in these workshops to support NHS leaders and managers to improve retention, the acceptability of which will be explored via focus groups with NHS staff who took part in Work Package 4. These resources will include audio narratives in the form of 'stories' of individual people from WP4 as well as other formats (e.g. toolkit, report) informed by the STAG. Workshops and focus groups are primarily to co-design resources and the discussions from these will be reported as simple narratives or summaries to aid in co-design work. |
| Secondary outcome measures | There are no secondary outcome measures |
| Overall study start date | 01/03/2024 |
| Completion date | 28/02/2027 |
Eligibility
| Participant type(s) | Health professional |
|---|---|
| Age group | Adult |
| Lower age limit | 18 Years |
| Sex | Both |
| Target number of participants | Planned Sample Size: 75; UK Sample Size: 75 |
| Key inclusion criteria | All participants in WP4 will be aged 18 years and over, willing and able to give consent. Participants will be staff working in/who have left/who are intending to leave an NHS Trust identified from our work in other work packages. Purposive sampling will recruit across locations, rurality/urbanity, retention rates and participants will come from a range of ethnic and migration backgrounds and roles (including those in allied health professional roles), and staff responsible for retention (e.g. HR and clinical managers) to capture diverse experiences and any identified gaps from previous WP findings. If necessary, to ensure diversity of experiences, we will additionally invite consenting UK-REACH questionnaire participants from diverse ethnic/migration groups with high or low attrition intentions from across job roles (including allied health professionals) and geographic locations. The WP4 research team will identify participants consenting to recontact and invite up to 14 of these HCWs from groups working within contexts identified in WP2 as putting them at particularly high risk of leaving, and up to 7 managers in organisations with low retention. If needed, the WP4 research team will invite more participants until at least 10 HCWs and 5 managers have agreed. These will take part in focus groups in addition to interviews. 10 interview participants who are identified by the research team as having compelling true-life experiences will be invited to take part in audio recording their stories. They will be reconsented for taking part in this activity. Collaborators in WP5 will come from two groups: 1. We will build on the UK-REACH infrastructure to develop an I-CARE PPEP group from an existing group which draws membership of HCWs (including allied health professionals) and patients to create an equal and diverse group. We will meet this group biannually. 2. Stakeholder Group (STAG): Through the UK-REACH programme, a national stakeholder group (STAG) was created in 2020 and meets periodically. It includes representation from the NHS (including NHS Workforce Education and Training Directorate, NHS Confederation, NHS Race and Health Observatory), major regulators, HCW unions (BMA, RCM), ethnic minority HCW organisations (BAPIO, Filipino Nurses Association). The STAG will meet quarterly during I-CARE. We will specifically reach out to organisations representing allied health professionals through the Allied Health Professions Federation so that these are included, since the current STAG does not include them. |
| Key exclusion criteria | Anyone not fitting the inclusion criteria or, for WP4, who has not consented |
| Date of first enrolment | 01/05/2025 |
| Date of final enrolment | 28/02/2026 |
Locations
Countries of recruitment
- England
- United Kingdom
Study participating centres
Infirmary Square
Leicester
LE1 5WW
United Kingdom
Kingsway Hospital
Kingsway
Derby
DE22 3LZ
United Kingdom
Beaconsfield Close
Hatfield
AL10 8YE
United Kingdom
Pinewood PLACE
Dartford
DA2 7WG
United Kingdom
Poplar Grove
Stockport
SK2 7JE
United Kingdom
Randalls Road
Leatherhead
KT22 7AD
United Kingdom
Elm Grove
Brighton
BN2 3EW
United Kingdom
61 Glenburnie Road
London
SW17 7DJ
United Kingdom
14 Tewin Road
Welwyn Garden City
AL7 1BW
United Kingdom
Birchwood
Warrington
WA3 7PG
United Kingdom
Coreys Mill Lane
Stevenage
SG1 4AB
United Kingdom
St. Pancras Hospital
4 St. Pancras Way
London
NW1 0PE
United Kingdom
London
E9 6SR
United Kingdom
47-49 King Street
Dudley
DY2 8PS
United Kingdom
Leicester
LE1 7RH
United Kingdom
74 Huntley Street
London
WC1E 6DE
United Kingdom
Big Data Institute
Old Road Campus
Headington
Oxford
OX3 7LF
United Kingdom
Sponsor information
University/education
University Road
Leicester
LE1 7RH
England
United Kingdom
| Phone | +44 (0)116 373 6039 |
|---|---|
| yg27@le.ac.uk | |
| Website | https://le.ac.uk |
"ROR" |
https://ror.org/04h699437 |
Funders
Funder type
Government
Government organisation / National government
- Alternative name(s)
- National Institute for Health Research, NIHR Research, NIHRresearch, NIHR - National Institute for Health Research, NIHR (The National Institute for Health and Care Research), NIHR
- Location
- United Kingdom
Results and Publications
| Intention to publish date | |
|---|---|
| Individual participant data (IPD) Intention to share | Yes |
| IPD sharing plan summary | Available on request |
| Publication and dissemination plan | Findings from all work packages will be collated into a final report, delivered to the NIHR. All written outputs including protocols will be published in line with the University of Leicester's publication policy. All publications will be Open Access and will be available via the University’s Library database. NIHR funding must be acknowledged in all written outputs. Participants will be notified of progress and outcomes of the study via an annual newsletter. All reports and publications will also be uploaded to or linked from the study website. Study progress and findings will also be presented at appropriate conferences. Authorship of the final reports/publications will be attributed to the research team outlined in the protocol, whom combined, hold the responsibility for the conception and design of the study, the acquisition, analysis and interpretation of data, and the final approval of the reports/publications to be disseminated. Individual attributions will be indicated within any final reports. Acknowledgements to include in the final reports/publications will include the funders, sponsors and stakeholders/sites and participants who have facilitated the research. Project outputs submitted for publication will follow the International Committee of Medical Journal Editors’ defined authorship criteria for manuscripts submitted for publication. |
| IPD sharing plan | Approved researchers will be able to apply for access to the anonymised transcripts generated during this study via uk-reach@leicester.ac.uk (see data access policy on the UK-REACH website: https://www.uk-reach.org/main/data_sharing. Transcripts will be made available to once analysis and publication have been completed for the main study. Transcripts will be retained by the study for 6 years from the study end date, until 28/02/2032, and will be available for access by other approved researchers until this time. Data sharing mechanisms will be agreed upon within the data sharing agreement for each study requesting access. Participant consent for use in further studies has been obtained but additional ethical approvals may be required for new analyses- this will be addressed on a case-by-case basis within the data sharing agreement. |
Editorial Notes
27/05/2025: Study's existence confirmed by the NIHR.
