Immigration rules and the points-based system


Recruiting and retaining individuals from outside the European Economic Area (EEA) is an important part of ensuring the NHS has the right number of appropriately skilled healthcare professionals to meet local patient needs. The current points-based system was phased in between 2008 and 2010.

The Home Office has shared details of the future immigration system which will be implemented from 1 January 2021. The new system will apply to all overseas candidates, including those from the EEA. You can find more detail about this on the website including an introduction for employers and UK points-based immigration system: further details statement. You may also find it useful to read our summary to understand what the changes mean for NHS organisations.

Until then, the following guidance on the current system applies. For guidance on restarting your international recruitment after COVID-19, please visit our dedicated section

How does the current system work?

Under the points-based system, migrants must pass a points assessment before they are given permission to enter or remain in the UK. Each of the system's four tiers has different points requirements and the number of points needed by the migrant and the way the points are awarded will depend on the tier. Points are awarded to reflect ability, experience, age and where appropriate, the level of need in the migrant's chosen occupation.

Prospective applicants should assess their circumstances against criteria specified on the GOV.UK website.


The points-based system replaces all the previous work permits and entry schemes and is run by the Home Office (UK Visas and Immigration - UKVI). The system has four tiers, which are different routes to employment, training or studying in the UK.

  • Tier 1 (General) This applies to highly skilled individuals (previously the Highly Skilled Migrant Programme). This route is now closed to all new applicants and extension applications.
  • Tier 1 (Post-study work). Previously granted to individuals, who had graduated from a UK university under Tier 4, two years of leave to remain with the ability to work without a sponsor. This route is now closed to all new applicants.
  • Tier 2 This applies to skilled workers who are offered a sponsorship to fill gaps in the UK labour force (previously the work permit route).
  • Tier 4 This applies to students who wish to come to the UK to study. Individuals must be sponsored by the educational establishment to undertake their studies. From Summer 2021, newly graduated students will be able to transition from a Tier 4 visa to the Graduate Immigration Route to stay and work, or look for work at any skill level for two years.
  • Tier 5 This applies to individuals on a youth mobility scheme and temporary workers who are allowed to work in the UK for a limited period of time to satisfy primarily non-economic objectives, such as exchange schemes.

Due to COVID-19, a number of changes have been made for visa applicants. More detail is available in our up to date section on overseas skilled supply during COVID-19, as well as on the GOV.UK website.

Avoiding discrimination

Recruitment processes must not unlawfully discriminate on the grounds of nationality or race. It is important that employers keep all colleagues involved in the recruitment and selection process up-to-date on developments in legislation. You are encouraged to review your recruitment processes to ensure compliance with employment legislation and you should consider the following:

  • All applications should be shortlisted or rejected on merit.
  • Only when shortlisted candidates have been selected for appointment should you identify if they are non-EEA applicants and check their immigration status and right to work documents.
  • If the preferred candidate(s) require a Certificate of Sponsorship (CoS) in order to take up the role, you must assess the prospects of the organisation obtaining this against the requirements for issuing a certificate under the terms of your licence, including applying the Resident Labour Market test (RLMT).
  • Applicants invited to interview need to be informed about the process and that expenses, if applicable, will only be reimbursed from point of entry into the UK and that even if selected for appointment, appointment to the post is subject to the RLMT.
  • You might also consider including information in relevant vacancy advertisements indicating that overseas candidates wishing to apply, who would require immigration sponsorship, can self-assess the likelihood of obtaining a CoS for the post on the GOV.UK website. 

For further information, please see the Home Office guidance on avoiding discrimination while preventing illegal working: code of practice.

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