Key points
Employers are asked to apply consistent, transparent and non‑discriminatory approaches.
Employers should ensure overseas experience is not treated less favourably than UK non‑NHS experience.
Employers should review and update local policies accordingly and in partnership.
It does not replace recruitment processes, competency assessments or professional registration requirements.
This guidance supports employers in England in applying discretion under Section 12 and Annex 23 of the NHS Terms and Conditions of Service Handbook (NHS TCS) in a fair and consistent way, recognising experience gained outside the NHS, including internationally.
Introduction
Fair pay for all staff remains a core principle of the NHS terms and conditions of service agreement and reflects the legal requirement under the Equality Act (2010), to provide equal pay for work of equal value.
It is therefore essential that recognition of previous experience gained outside of the NHS is applied fairly, transparently, and without discrimination, particularly when assessing experience gained outside the UK.
The NHS has always recognised the significant contribution that international workers make to health and care service delivery across the UK and remains committed to ensuring that all international recruitment is conducted ethically and responsibly. Recruited staff bring valuable skills and experience with them. However, as international recruitment has expanded, a growing number of staff have joined the NHS without their previous overseas employment being recognised which impacts contractual entitlements specified in section 12 and annex 23.
While each organisation should have a local policy for recognising previous experience, the NHS Staff Council encourages greater consistency and fairness in how relevant experience gained outside the NHS is recognised.
Employers are asked to review their existing policies in partnership to ensure they align with the principles and aims set out in this guidance.
Purpose of this guidance
This guidance has been developed by the NHS Staff Council to address concerns regarding the unfair or discriminatory treatment of staff, particularly internationally recruited staff, in the recognition of experience gained outside the NHS. The development of this guidance has been informed by two key areas of work:
- the NHS Staff Council’s Equality, Diversity, and Inclusion Group (EDIG), which recommended updating Section 12 of the NHS Terms and Conditions of Service Handbook to support employers in recognising any periods of employment undertaken outside the NHS, including service gained within or outside the United Kingdom
- the nursing career progression group, established as part of the 2023 non‑pay deal commitments workstream, which recommended the development of further guidance to support employers in applying the terms and conditions relating to recognition of overseas experience within the NHS. This recommendation was accepted by the Secretary of State in April 2025.
The below covers the relevant sections and annexes from the NHS TCS Handbook and should be used in conjunction with this guidance.
Section 12 NHS TCS Handbook wording
Section 12: Contractual continuity of service
12. 1 An employee’s continuous previous service with any NHS employer counts as reckonable service in respect of NHS agreements on redundancy, maternity, sick pay, and annual leave.
12. 2 Employers have discretion to take into account any period or periods of employment with employers outside the NHS, (including service both within or outside of the United Kingdom) where these are judged to be relevant to NHS employment.
12.3 When employees who have been transferred out of NHS employment to a non-NHS provider return to NHS employment, their continuous service with a new non-NHS employer providing NHS funded services, will be counted as reckonable in respect of NHS agreements on sick pay, annual leave and pay step progression or incremental credit.
Employers must ensure that any discretionary recognition of reckonable service is fair, transparent, and non-discriminatory, including for staff with experience gained outside the United Kingdom.
Annex 23 NHS TCS Handbook wording
Annex 23 on pay progression provides detail of where previous service counts towards pay step progression.
16. Continuous previous service with any NHS employer counts in respect of reckonable service for pay step eligibility (See section 12: Contractual continuity of service).
17. Employers will continue to have discretion to take into account service with employers outside the NHS for this purpose, where this is judged to be relevant (See section 12.2: Contractual continuity of service).
This means there is a discretion to recognise prior service in non-NHS employment including that gained outside the UK in determining which pay point in a band staff will start on.
The consistent application of principles set out in this guidance will promote fairness, support workforce mobility, and ensure equitable implementation across NHS organisations. The NHS Staff Council encourages employers to adopt this guidance within their local policies and procedures and ensure that staff and decision makers understand how experience is recognised.
Principles to determine non-NHS experience
The process to determine whether discretion will be exercised to include non-NHS experience should be guided by the principles of fairness, transparency, and consistency. When looking at experience gained outside of the UK, consideration of previous roles and experience should be done in a non-discriminatory manner regardless of the country in which it was gained.
For example, where relevant experience within the UK is counted on a month for month basis, this should also be applied to experience gained internationally. Any monthly adjustment for orientation/transition should be able to be objectively justified for previous experience gained within the UK or internationally.
Action - Employers should review their existing policies to make sure these principles are reflected. In particular any policies that give more weight to non-NHS experience gained within the UK than internationally should be reviewed on the grounds that this could be discriminatory.
How to determine if experience is relevant
The relevance of a member of staff’s previous experience should include an assessment of its similarity to the role they are now employed in. At its simplest level this requires a comparison of the current job with the previous job. Job descriptions will be helpful for this if they are available.
If the previous job description is not available, employers should look at other evidence to understand the previous role requirements. This could be from a reference, a job summary statement or from a professional body. It will be important to talk to the staff member themselves.
Employers need to assess experience across a range of different settings, such as a nurse with experience on an elderly ward wanting to move to an intensive care unit, so should consider broad measures of comparability not just specific tasks, for instance: line management, decision making, accountability.
By considering the broad statements included in the job descriptions, employers will more easily be able to assess experience across a range of different settings, for example a nurse with experience on an elderly ward wanting to move to an intensive care unit. However, this should not become an assessment of the individual’s competency for each factor. It should be an assessment of their length of experience. Competency for the role should have been assessed in the job application and interview process.
Recognising experience gained outside the UK and the NHS is essential to ensuring fairness, valuing staff contributions, and supporting effective recruitment and retention.
Applying the principles set out in this guidance consistently will help organisations make equitable decisions and strengthen the NHS as an inclusive employer.
Additional resources
The following resources may also support with the recognition of experience gained internationally outside of the NHS.
Contact us
If you are an employer and have any queries on this guidance, please email us.
