NHS doctors are being offered cash bonuses of up to £5,000 to recruit colleagues for jobs at private hospitals, as commercial healthcare providers compete for staff with an overstretched public health service. US-owned HCA Healthcare, which runs more than 30 facilities in London and Manchester, and claims to be the largest private provider in the world, is spending tens of thousands of pounds recruiting NHS-trained doctors, the Guardian can reveal. Referral fees vary, depending on skills and seniority. According to marketing material seen by the Guardian and doctors working for HCA who asked not to be named, the company is offering bonuses of £5,000 for intensive care doctors – one of the most in-demand specialisms – £2,500 for general resident doctors, and £1,000 for more junior roles. The money is offered for staff who go on to work for HCA part- or full-time, meaning they either leave the NHS or reduce the hours they work in the public health service. At the height of the pandemic, as state-funded hospitals were in danger of becoming overwhelmed, the company emailed recruitment messages to NHS doctors offering golden hellos equivalent to 10% of annual salary. Other perks for those who want to join the US health company include critical illness cover of up to £10,000 after a year of service, 50% off gym membership and dining out, life insurance and access to private GPs as often as needed. The company, which is opening a £100m private hospital in Birmingham later this year, is also offering generous sums to those who join. In marketing material from February 2023, circulated on LinkedIn to people looking for work, HCA offered £10,000 welcome bonuses to paediatric nurses joining its Portland hospital in London, where royals including the Duchess of Sussex, and celebrities such as the chef Jamie Oliver’s wife Jools, have given birth. A spokesperson for HCA UK said: “Along with many others both in the private and public sector, we offer all employees, not just clinical staff, a number of benefits and incentives as standard practice such as bonus schemes, critical illness cover, private healthcare, pension contributions and life insurance as well as provide all our employees with a one-off payment if they help recruit a new member of staff, whether clinical or non-clinical.” In contracts seen by the Guardian, HCA also has strict rules on where else employed doctors can work in the sector after leaving, stating that a year after quitting they cannot work for a rival. They specifically say “for the avoidance of doubt” this includes Cleveland Clinic – another American-owned health firm – and the London Clinic. The perks on offer will add to concerns about the creep of privatisation in Britain’s healthcare provision and a drain of talent away from state-funded hospitals. The NHS is in the midst of a jobs crisis, and needs to find 62,000 medical professionals to fill vacancies across the UK, according to a report by MPs. One senior doctor, speaking anonymously, said: “Generally speaking there is a raid on not just doctors but lots of layers of healthcare workers. There is a poaching of good, talented, NHS resource because the NHS has ceilings where there is no flexibility to incentivise staff. There is a drain by the independent sector of NHS talent at all levels.” David Rowland, the director of the Centre for Health and the Public Interest, an independent thinktank, said: “There is only one finite pool of medical professionals in the UK, the vast majority of whom are employed directly by the NHS. Recruitment referral fees of this kind are likely to form part of an overall strategy employed by private hospital companies to pull medical professionals away from working in the NHS and towards the private sector.” He added: “As the for-profit healthcare sector grows, particularly in large cities like London, Manchester and Birmingham, where new facilities are opening we would expect to see more strategies of this kind designed to pull more medical professionals away from the NHS and towards the private sector.” Private hospitals have increasingly moved into offering intensive care services, when previously they tended to deal with elective procedures – treatment that is scheduled in advance because it does not involve a medical emergency. HCA has high dependency and critical care units in their main hospitals. “No matter how ill you become, when you’re one of our patients, you won’t have to be transferred to another hospital,” the HCA website says. In a brochure sent to anyone who takes a job, employees are told: “If you know of a dedicated, skilled professional who measures up to the high standards we set for ourselves at HCA, point them in our direction. For every one of your referrals who makes the grade, you’ll receive a bonus of £1,000.” In an email from 2020, at the height of the pandemic, a HCA recruiter circulated the following email to NHS doctors: “We have competitive salary offers. We are recruiting in the range £60-75k (for full-time 1.0FTE), and at the moment we have a Golden Hello Scheme where you would be eligible for a 10% salary bonus after one-year service for critical care only. As an employee of HCA you would also be able to access our employee benefits package with includes things like free private healthcare, private GP package, private dental package, pension, disability benefit, cycle to work scheme, meals/entertainment card, travel card, technology benefit, subsidised gym memberships etc (there’s quite a lot included).” The manager says they have flexibility on hours worked but “most prefer to do the full shift”. They added: “There is also a career pathway structure for medical leadership within the company if you considering this career direction.” At the end of November, a record 7.2 million patients in England were waiting for elective care, non-urgent medical treatment ranging from hip replacements to heart operations on the NHS. More than half of those on the list had been waiting up to 18 weeks and about 400,000 patients had been waiting more than a year, according to data from NHS England.