This chapter highlights considerations for leaders and managers of multinational healthcare teams. A number of theoretical frameworks are applied to understanding these multinational teams. For the manager, additional competencies may be required to ensure effective work towards shared goals as high levels of cultural heterogeneity influence team functioning and healthcare delivery. As multinational teams will all have their own unique characteristics, the manager should recognise and adapt to this.

While the National Health Service (NHS) is the primary health provider in the UK, health services more generally have a diverse and global workforce. The multinational and multidisciplinary workforce interacts daily with patients and carers of cultural, ethnic and social diversity. Clinical teams, on the other hand, experience an interplay of variables such as professional status, age, gender, years of experience and complexity of roles carried out. Interspersed with this are individual staff cultures, language competencies, countries of origin, values and beliefs.

The workforce

Table 14.1 gives a breakdown of NHS staff (2015 figures) by professional category. About 11% of this healthcare workforce, 14% of the professionally qualified clinical staff and 26% of doctors were born outside the UK.

Doctors

As of April 2016, doctors from 1 52 different countries are registered with the UK medical regulatory body, the General Medical Council (GMC), with the largest numbers from India, Pakistan and South Africa (GMC, 2016) (Fig. 14.1). Medical workforce demography and migration trends are continuously changing (full details available on GMC website). The number of graduates from the European Union (EU) joining the UK medical register is greater than the number of international medical graduates (IMGs), exceeding the numbers from South Asia. European graduates were about a tenth of all doctors in 2013, whereas IMGs represented a quarter. The number of UK graduates leaving to work abroad is also increasing. Regarding ethnicity, 47.7% of doctors on the register describe themselves as White, 18.7% Asian and 2.6% Black, 3.6% as belonging to other ethnic groups and 1.4% as being of mixed origin.

In psychiatry, 59% of doctors on the specialist register are UK graduates, 32% IMGs and 13% European graduates. More than a third of psychiatrists in training are non-UK graduates.