Recruitment of overseas nurses and midwives

immigration passport stamp

Nurses and midwives who have trained outside the European Economic Area (EEA) and want to work in the UK as a nurse or midwife must gain professional registration with the Nursing and Midwifery Council (NMC). Applicants are tested for competence through a two-part process to gain registration. 

  • Part one - computer-based multiple choice examination which is accessible around the world for applicants to access in their home countries.
  • Part two - practical objective structured clinical examination (OSCE) which will always be held in the UK.

The immigration rules changed in March 2015 to allow for an individual nurse to come to the UK to prepare for the OSCE.   

Rules for employers and overseas nurse applicants

  • All overseas applicants need to pass a computer-based test (CBT) and comply with all other initial requirements of the NMC overseas nursing process (including achieving language capability requirements) to be eligible to sit the OSCE and complete their registration. NMC guidance is available on how an overseas applicant can meet the required level of English language capability.  
  • An individual entering the UK to take a nursing role has up to three months from the employment start date noted on the certificate of sponsorship (CoS) to sit the OSCE exam. During this period they can be legally employed as a pre-registration candidate. 
  • Employers must ensure that before a certificate of sponsorship is applied for:
    • the individual has passed part one of the NMC test of competence 
    • the individual has been issued with an offer of employment, and
    • the individual has achieved the required level of language capability. 
  • In any applications for certificates of sponsorship, you are required to send the following evidence to Tier2Limits@homeoffice.gsi.gov.uk in support of the application:
    • a copy of the employment offer letter
    • a copy of the email confirmation from the NMC to show the individual has passed the CBT, and 
    • evidence that a Resident Labour Market Test (RLMT) has been carried out.
  • The general Tier 2 minimum salary requirement of £20,800 is temporarily removed in these circumstances, though employers are still advised to place nurses in an interim position with a salary at least equivalent to that of a band 3 role.
  • Applicants may sit the OSCE up to three times as part of one application (applies to applications started after 06 April 2017). 
  • Applicants must pass their OSCE within eight months from the start of their visa.
  • If an applicant is unsuccessful at their first or second OSCE attempt, they must wait a minimum of 10 working days before they can take the examination again. Previously, applicants had to wait three months before they could take the OSCE for the third time.   
  • As of July 2018, applicants now only have to re-sit the parts of the exam they previously failed. There is now a reduced re-sit fee of £496 to all applicants who have failed four or fewer stations, regardless of which part of the exam they failed.
  • If the applicant is unsuccessful after their permitted attempts, the employer must stop sponsoring them and as a result their leave to remain period will be shortened.
  • Upon successful completion of the OSCE and awarding of NMC registration, employers need to commit to ongoing employment of the individual as a registered nurse on a salary of at least £20,800.
  • Employers must be able to provide evidence of the above arrangement if requested.  

Employers or individuals with queries about individual NMC registrations are advised to contact the NMC directly

Nursing on shortage occupation list

Nurses remain on the shortage occupation list, but employers have been required to still carry out a RLMT before recruiting a non-EEA nurse. Find out more information in our Tier 2 policy changes section.

The continuation of nursing on the shortage occupation list means the requirement to earn £35,000 or more to qualify for permanent settlement in the UK (indefinite leave to remain) will not apply to individuals for whom nursing has appeared on the shortage occupation list at any time during their employment in a nursing role - they will still need to meet all the other settlement criteria

Applying for a certificate of sponsorship - need to know

  • From 6 July 2018, applications for certificates of sponsorship for nurses fall under the unrestricted category. This is a temporary change until further notice. Applications will still be subject to the resident labour market test and all other requirements of Tier 2.  Employers may need to increase the number of unrestricted certificates of sponsorship they require for the year due to this change and can do so via their SMS account. 
  • The Home Office has been clear that employers must only apply for certificates when you need them and when you are certain they will be used. The individual being sponsored must have a job offer from you and either:
    • have obtained full registration with the NMC
    • have passed the NMC's CBT of competence (part one)
    • have obtained the NMC's permission before 30 April 2015 to undertake the overseas nursing programme, and be sponsored to undertake a supervised practice placement as part of the programme, which has been approved by the NMC.
  • You are required to provide evidence of the above in any applications for certificates of sponsorship. You must send a copy of the employment offer letter and a copy of the email confirmation from the NMC to show the individual has passed the CBT. This evidence should be sent to Tier2limits@homeoffice.gsi.gov.uk to support your application.
You can sign up for our weekly workforce e-bulletin to ensure you receive any updates on changes implemented for overseas nurse applicants.

Latest Tweets

Latest Blog Post

Integration on the front line - NHS reservists working together

06 / 9 / 2019 2pm

Gemma Wright, programme lead for the Armed Forces programme, blogs about her experience on a military reservists hospital training exercise.

Why Register?

Great reasons to register with NHS Employers

  • A personalised website
    Manage your profile and select topics of interest to you
  • Access your dashboard
    Bookmark useful content to help you quickly find what you're looking for
  • Get involved
    Contribute to our Talking Points discussions, comment on and rate our webpages
  • Keep up to date
    Receive the latest newsletters and media summaries

Log In