Evaluating a social prescribing initiative to support international medical graduates

Problem

Across England, there is a GP workforce crisis. Training schemes increasingly rely on international medical graduates (IMGs) to fill places. Within Yorkshire and Humber (Y&H), most GP trainees are IMGs. We know IMGs have distinct educational and professional developmental needs. However, less is understood about the challenges IMGs face outside of work that may act as barriers to them settling and remaining in the region.

This project seeks to answer two questions regarding GP trainees within Y&H. What are the reported non-work related challenges and barriers to settlement that IMGs experience when moving to the Y&H region? Does a local social prescribing scheme (SPS) set up start to address these challenges?

Approach

This project is a retrospective evaluation and analysis of interventions put in place by Health Education England (HEE) to identify and address the non-workplace needs of GP trainee IMGs. HEE Y&H introduced two initiatives to support IMGs: a survey of trainees’ current needs, and a local SPS to help IMGs settle.

HEE designed a survey ‘Hello my story’ which was distributed to three cohorts of new GP trainees in 2021/2022. The survey covered a broad range of topics both within and outside of work.

The SPS allowed trainees to self-refer and receive personalised support. They were informed of the SPS shortly after receiving training offers.

Data available for evaluation and analysis included: 403 questionnaires across cohorts, a data set describing referral reasons to the SPS.

A review of the survey dataset identified two questions which explicitly addressed the evaluation aims. The responses were analysed using thematic analysis (Braun and Clarke) to describe the perceived non-work challenges. We plan to compare with the SPS referrals to provide data triangulation and highlight any gaps.

As an evaluation of local interventions and not research, ethical approval was not required.

Findings

Data analysis is ongoing and will be concluded in March. Three main challenges have been described.

Firstly, the social isolation faced by IMGs: being separated from family/friends, loneliness, difficulty making friends, and home sickness. One trainee felt ‘living without family in the UK makes things stressful’.

Secondly, addressing basic needs and services: accommodation, finances, childcare/schooling, and visa issues. A trainee advised ‘I haven't been able to arrange permanent accommodation yet’.

Thirdly, poorly managed expectations: weather and culture adjustment.

Initial analysis shows the SPS referral data broadly supports the challenges described.

Consequences

This evaluation supports HEEs assumption that IMGs require additional support outside work. Early indications suggest SPS may address some of the challenges described.

The findings will inform the ongoing development and delivery of extra support within GP training programmes targeted towards IMGs allowing them to feel best supported and settled.