‘Get away from it all’ or ‘Too good to be true?’: a qualitative exploration of job advertisements for remote and rural posts

Recruitment and retention of the healthcare workforce are crucial to maintaining access to services and provision of care, but these are ongoing challenges for health services both in the UK National Health Service (NHS) and globally. We know from systematic reviews of the international literature that many recruitment and retention strategies are based on little definitive evidence. As part of a wider study of place-based community-led initiatives to attract healthcare staff to remote and rural areas, we decided to examine how NHS job advertisements represent the community to which they are recruiting, drawing on the concept of asset-based community development (ABCD) to focus on which social and professional community assets are given prominence and how. In total, 270 job advertisements for posts in remote and rural areas of the UK were collected between July and December 2022, from a monthly search of three sources: the British Medical Journal job advertisement site; the NHS Scotland GP job site, and the NHS Scotland jobs site. We then contacted named recruitment contacts from all the advertisements collected where possible, to ask how many applications were received and whether an appointment had been made. Informed by the ABCD lens, job advertisements were analysed using a thematic framework analysis approach to identify the different assets that advertisements highlighted. Responses from advertisers contacted were added to the framework, including free text about their experiences of trying to recruit. Advertisements ranged from a couple of short paragraphs of text describing the post, with perhaps (although not always) a few details about the location, to lengthy and elaborate descriptions of both the post and the local community, sometimes with photographs, links to further information and videos about the community. We found that while many advertisements included plenty of detailed information about the community and the lifestyle, other places may not be realising the full potential of local assets. One simple change would be to provide more visual information, either in the advertisement itself or - if that is too costly - in a linked website or document. Emails were sent to 189 advertisers, and we received 45 responses. Of the 45 responses received, only 18 stated that an appointment had been made as a direct result of the advert. Feedback from advertisers has also suggested that those recruiting to rural and remote posts may need to proactively seek connections with potential applicants rather than hoping that the advertisement alone will be enough to find them. There is evidence from our results that local place-based assets are not always featured as strongly or as visually as they could be in advertisements for remote and rural healthcare jobs. To our knowledge, there has not been a cost-effectiveness analysis of different styles of advertisement and different advertising outlets, and how these impact on outcomes. When so much is spent on repeated and sometimes fruitless advertising, this could be a valuable piece of health economics research to take forward.