Recruitment of Overseas Nurses and Midwives To UK

Nurses and midwives who wish to work in the UK but trained overseas 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 test (CBT) 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), held in the UK in one of the three test centres which will increase to five in March 2022.

The objective structured clinical examination (OSCE)

The OSCE is based on UK pre-registration standards. Candidates are required to act out scenarios that nurses or midwives are likely to encounter when assessing, planning, delivering and evaluating care. An individual entering the UK to take a nursing role has up to three months (12 weeks) from the employment start date noted on the certificate of sponsorship to sit the OSCE exam. During this period they can be legally employed as a pre-registration candidate. Applicants must complete the OSCE in the UK at an approved test centre.

What is involved in the OSCE?

The legacy OSCE (as part of the new ToC) is made up of six separate stations using simulated patients in a clinical setting. Four stations are designed to test the candidate’s knowledge and understanding of assessment, planning, implementation and evaluation of care (APIE), and the remaining two stations test clinical skills. The new OSCE has ten stations separated into four skills-based, APIE, and two silent skills. The NHS constitutional values and the 6Cs of nursing are assessed throughout the OSCE at all stations.  

Candidates who have begun their application, but have not yet taken either the CBT or the OSCE before August 2021, will also take the new test. Candidates who have attempted to take the CBT or the OSCE before August 2021 will have a 12-month transition window to complete the current ToC. After 12 months, they will need to take the new test.

Approved OSCE test centres

There are three universities that are approved OSCE test centres, providing a choice of four locations to sit the OSCE. Please visit the links below for more information:

• University of Northampton
• Oxford Brookes University (Oxford campus and Swindon campus)
• Ulster University (Northern Ireland).

The three test centres above will continue as providers and Leeds Teaching University Hospitals NHS Trust and Northumbria University have also been awarded contracts as OSCE test centres. Bookings can now be made at the Northumbria University test centre, but please note that only the new test of competence can be taken at this site. 

OSCE preparation

To ensure candidates have adequate time to prepare for the OSCE, they are given up to 12 weeks from the start date on their certificate of sponsorship (CoS) to complete the exam. In the run-up to the exam, candidates should be given support and the opportunity to practice and prepare for the OSCE. 

The experience a candidate has in the first few weeks is vital to their success in the OSCE. The NMC’s registration process no longer requires applicants to complete a period of supervised practice, therefore the importance of establishing a quality and well-structured induction and socialisation period is critical. Many trusts also provide specific OSCE preparation support for their international recruits. 

In preparation for the OSCE, it is important that candidates are familiar with the NMC nursing blueprints. The exam blueprints set out the scope and content of the OSCE in terms of the topics, skills and procedures that a newly registered nurse would need to know and be able to demonstrate. Find out more and access a copy of the blueprints on the NMC website.

Top tips for preparing candidates for the OSCE

The following top tips were provided by Cambridge University Hospitals NHS Foundation Trust and Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust – both trusts have support programmes in place. 

• Empower candidates with practice and experience, and stress the importance of being able to verbalise and demonstrate their knowledge.
• Build up their resilience and confidence to speak up in front of others, as this can be something which overseas nurses are not always comfortable with. 
• Set up practice rooms in the same way as the OSCE, with simulated patients in a clinical setting, so that the setting is familiar to them.
• Create a dedicated support group – for example, a Facebook group.
• Consider sending a representative to complete a train-the-trainer course. This is run by both the University of Northampton and Ulster University, and allows information to be cascaded within the trust.
• Make sure candidates have plenty of time to practise their skills prior to taking the OSCE.
• Plan a mock, timed practice at least three weeks before the OSCE date to help identify if the candidate is ready (any later than this may then cause a delay in getting a new test date within the 12 week limit).
• If your candidates are not ready for their test, make sure you give them the choice to change the date.
• Although there is always time pressure linked to a candidate sitting the OSCE and to move staff through this process quickly, low pass rates suggest speed initially may cause more difficulties in the long term.

Rules for employers and overseas nurse applicants

• All overseas applicants need to pass their 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 normally has up to 12 weeks 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.
• Individuals are responsible to decide which OSCE route they should be placed on. There are specific OSCE’s for adult nursing, paediatric nursing, mental health nursing, learning and disability nursing, midwifery, and nursing associates.
• Employers must ensure that before a certificate of sponsorship is applied for:
  • the individual has passed part one of the NMC test of competence (CBT) 
  • 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:
  • a copy of the employment offer letter
  • a copy of the email confirmation from the NMC to show the individual has passed the CBT.
• The skilled worker minimum salary requirement of £20,480 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.
• Applicants must pass their OSCE (candidates must pass all stations at 100 per cent) 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.
• Applicants only have to re-sit the parts of the exam they previously failed. There is a reduced re-sit fee of £397 to all applicants who have failed seven or fewer stations.
• 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. 
• It may take up to 35 calendar days for the NMC to process applications for PINs. If there are any issues with receiving PINs, then email TOC@nmc-uk.org and copy in NHSI.Workforce@nhs.net. The NMC is expediating this processing time and currently, it takes on average two to three weeks for a PIN to be received.
• 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.

New Test of Competence (ToC) Hub

The NMC launched its new test of competence with new scenarios in June 2021. 

Anyone who applies to the NMC after the new ToC goes live in August 2021, will take the new test.

The new OSCE will consist of four assessments followed by an APIE (assessment, planning, implantation, evaluation) and two silent skills stations.

In the latest update from the NMC, all legacy tests, whether the CBT or OSCE, must be taken by 31 July 2022. From 1 August 2022 only resits for the legacy test will be available. Also from 1 August 2022, all candidates taking their ToC for the first time will sit the new test.

Applicants should refer to page four of the CBT information booklet for nurses and midwives which includes detailed booking instructions and course/module information. If an incorrect CBT has been sat, applicants will be required to resit and pass the correct CBT.

The NMC have launched a website hub that contains all the information candidates, recruiters and employers prepare for the new ToC.

The hub includes:

• candidate handbooks
• test specifications
• blueprints
• practice tests for the new CBTs, and
• an OSCE prep resource pack.

For more details on changes to the new ToC and to view the support resources, visit the ToC hub.

Nursing on the shortage occupation list

Nurses remain on the shortage occupation list, as occupation code 2231.

The continuation of nursing on the shortage occupation list means the requirement to earn at least £20,480 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.

The Home Office is clear that employers must only apply for certificates when required and when it is certain when it will be used. The individual being sponsored must have a job offer and either:

• have obtained full registration with the NMC
• have passed the NMC’s CBT of competence (part one)
• be sponsored to undertake a supervised practice placement as part of the programme, which has been approved by the NMC.

Employers 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.