Overview

• The UK-REACH study of over 5,700 NHS staff under the Agenda for Change pay scale found overseas-born ethnic minority workers are significantly less likely to be appointed to higher bands than UK-born peers, even after adjusting for education, role and experience.
• Asian and Black healthcare professionals born outside the UK experienced the largest disparities in reaching senior pay grades, highlighting intersecting effects of ethnicity and migration status.
• Ethnic minority staff make up nearly 25% of the NHS workforce but occupy just 10% of senior roles, revealing a sharp drop in representation at higher pay bands.
• Prolonged validation of overseas qualifications, limited access to professional networks and fewer tailored leadership training opportunities contribute to delayed career advancement for migrant workers.
• Authors recommend that NHS HR systems routinely capture migration status alongside ethnicity to enable targeted interventions and monitor equity in promotions and pay.